Introduction

Pleurisy, an inflammation of the tissue lining the chest and covering the lungs (pleura), is typically caused by a viral infection but can also be triggered by conditions like pneumonia or lupus. It manifests as sharp chest pain worsened by coughing or deep breaths in your child.¹

Further tests may be required to identify the cause of the pleurisy, with treatment tailored accordingly. Symptoms may fluctuate over a few days or persist if the underlying issue hasn't been managed. Home care measures can help ease the discomfort.¹

Anatomy of the pleura

The pleural tissue has two layers, one layer covers the outer surface of the lungs, while the other lines the inner chest wall. The space between these layers, known as the pleural space, typically contains minimal fluid. These layers function akin to smooth satin, facilitating the expansion and contraction of the lungs during breathing.²

In pleurisy, these tissues experience swelling and inflammation. Consequently, the two layers of the pleural lining rub against each other, resembling sandpaper friction. This friction induces pain upon inhalation and exhalation, which diminishes or ceases when holding one's breath. ²

What is pleurisy?

Pleurisy (“PLUR-uh-see”), or pleuritis, refers to the inflammation of the pleura, a delicate membrane encasing the lungs and lining the chest cavity. Pleurisy causes sharp chest pain (pleuritic pain) that worsens during breathing.³

Purpose

Although pleurisy is more common in adults, it can affect children and cause significant discomfort. This article aims to provide parents and caregivers with a comprehensive understanding of pleurisy in children. It will cover the causes, symptoms, and treatment options, aiming to assist them in effectively managing this condition in children.

Causes of pleurisy in children

Pleurisy in children can be caused by various factors, including:²

• Infections
• Viral infections like the flu or respiratory syncytial virus (RSV) are common causes
• Bacterial infections, such as pneumonia, can also lead to pleurisy
• Autoimmune diseases: conditions like juvenile rheumatoid arthritis or lupus can cause inflammation of the pleura
• Chest injuries: trauma from accidents or surgical procedures can result in pleurisy
• Other medical conditions: diseases such as tuberculosis, though rare in children, can also cause pleurisy
• Certain inherited diseases, such as sickle cell disease
• Certain medications and recreational drugs

Symptoms of pleurisy in children

The main symptom of pleurisy is sharp, stabbing chest pain that worsens with breathing, coughing, or sneezing. In children, other symptoms may include:^2,4

• Shortness of Breath: difficulty breathing due to pain or underlying lung issues
• Cough: persistent coughing that may worsen the chest pain
• Fever: often accompanies infections that cause pleurisy
• General Malaise: fatigue, weakness, and reduced appetite

Diagnosing pleurisy in children

To diagnose pleurisy, your healthcare provider may use a combination of medical history, physical examination, and diagnostic tests. Common tests include: ^3,4,5

• Blood tests: these can help determine if there's an infection present. Additionally, they may identify autoimmune disorders like rheumatoid arthritis or lupus, which can sometimes manifest with pleurisy as an initial symptom
• Arterial blood gas (ABG) tests: assess how effectively your child's lungs are absorbing oxygen and removing carbon dioxide from the bloodstream
• Chest X-ray: X-ray imaging can provide insight into whether your child's lungs are fully expanding and if there's any indication of air or fluid accumulation between the lungs and ribs
• Computerized Tomography (CT) scan: this imaging method offers detailed cross-sectional images of the chest, allowing healthcare providers to assess the condition of the pleura and identify other potential causes of pain, such as a blood clot in the lung
• Ultrasound: utilizing high-frequency sound waves, ultrasound imaging can produce precise images to help detect any pleural effusion (fluid build-up) in your child's pleural space
• Electrocardiogram (ECG): this heart-monitoring test may be recommended to rule out certain cardiac conditions as the underlying cause of your child's chest pain
• Thoracoscopy is a procedure where a small, illuminated tube equipped with a camera is inserted into the chest cavity to examine the lungs and surrounding tissues for any abnormalities or issues

Treatment options for pleurisy in children

Treating pleurisy in children involves addressing the underlying cause and relieving symptoms. Common treatments include:^4,5

Medications

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

The pain and inflammation associated with pleurisy are usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Occasionally, your healthcare provider may prescribe steroid medication.

Antibiotics

If bacterial pneumonia is the cause, an antibiotic can be prescribed to manage the infection. If the cause is a viral infection, pleurisy may go away on its own.

Corticosteroids

It is used for severe cases of autoimmune diseases.

Thoracentesis

In this procedure, a needle is inserted through the chest wall between the ribs to remove excess fluid in cases of significant pleural effusion, which can relieve symptoms and help with diagnosis. The needle insertion is usually done with the guidance of ultrasound.

Rest and supportive care

These steps might help relieve symptoms related to pleurisy:

• Ensuring the child gets plenty of rest and stays hydrated. Positioning the child to minimise pain and using a humidifier can also help
• Monitoring and follow-up: regular check-ups with a healthcare provider to monitor progress and adjust treatment as necessary

Complications

Pleurisy can lead to several complications:²

• Pleural effusion: Pleuritic pain relief can occur when fluid accumulates between the layers of tissue surrounding the lungs, known as pleural effusion. This separation prevents friction between the pleurae.
• Atelectasis: Excessive fluid in the pleural space can exert pressure, potentially causing the lung to partially or fully collapse (atelectasis). This can lead to breathing difficulties and coughing.
• Empyema: If the surplus fluid becomes infected, it can result in the formation of pus within the pleural space, a condition called empyema. Empyema is often accompanied by fever.

Seek medical advice

Call your healthcare provider right away if you think your child may need emergency care.

Watch closely for changes in your child's health, and be sure to contact your doctor If your child experiences a new or higher fever, severe trouble breathing, severe chest pain, or passes out (loses consciousness), seek immediate medical care.

Summary

Pleurisy in children, though less common than in adults, requires early diagnosis and appropriate treatment to prevent complications. Understanding the causes, recognising the symptoms, and knowing the treatment options can significantly improve the management of pleurisy in children. If your child shows signs of pleurisy, seek medical attention to ensure timely and effective care.

FAQs

Why should I avoid giving my child too many pain medications? 

Unless instructed by your child's doctor, do not give your child multiple pain medicines simultaneously. Many pain medications contain acetaminophen, known as Tylenol, and excessive intake of it can be harmful.

When is it appropriate to stop giving antibiotics to my child?

If your child's doctor has prescribed antibiotics, ensure you follow the instructions precisely. Avoid ceasing the medication too early simply because your child's symptoms improve. Your child needs to complete the entire course of antibiotics as prescribed.

Is it safe to give aspirin to my child?

It's important to avoid administering aspirin to individuals who are under 18 years old. This is due to its known association with Reye syndrome, a potentially serious and harmful illness that affects children and teenagers.

Is my child at risk for other lung problems?

While pediatric pleurisy itself doesn't directly increase the risk of other lung issues, underlying causes like infections or autoimmune diseases might. Watch for new symptoms and consult a doctor for guidance.

What can I do at home to ease my child's pleurisy pain?

Help your child rest comfortably, keep hydrated, and use a humidifier for breathing. Ask your child's doctor about appropriate over-the-counter pain relievers for children.

What signs indicate complications in my child with pleurisy?

Look out for worsening chest pain, breathing difficulty, persistent fever, increased coughing, or fluid buildup in the lungs. Promptly seek medical help if any of these occur.

Is pleurisy likely to recur in my child?

Recurrence depends on various factors. Follow-up with the doctor regularly and ensure your child receives vaccinations and practices good hygiene to minimize the risk.