Childhood Interstitial Lung Diseases (chILD) are a group of rare lung diseases that affect children and have some common symptoms like shortness of breath, rapid breathing, coughing. They affect the lung diffusely and lead to lungs inability to provide enough oxygen to the body. As a result, these children require special treatment and care.

There are many types of ILD that can affect children of different age groups. They can be genetic or acquired and may differ in severity.

Some examples of chILD are:

• Alveolar capillary dysplasia
• Genetic surfactant disorders
• Neuroendocrine cell hyperplasia (NEHI)
• Pulmonary interstitial glycogenolysis
• Acquired insult to the lung tissue like drug induced ILD, hypersensitivity pneumonitis, bronchiolitis obliterans or other autoimmune disorders.

What are symptoms of chILD?

• Shortness of breath: Difficulty in breathing or rapid breathing. Child may have flaring of nostrils, inability to talk, decreased activity that suggest difficulty in breathing.
• Chest retractions: there may be rapid indrawing of chest muscles with each breath or head bobbing.
• Chronic cough of more than 3 weeks
• Bluish skin
• Clubbing – widening or rounding at the finger tips or toes.
• Growth problems

What are the causes of chILD?

Most commonly chILD are genetic and these children present in first year of lif with breathing problems. Some of the risk factors that can lead to chILD are:

• Environmental factors: long-term exposure to certain bacteria, viruses, fungi, chemicals, tobacco smoke and air pollution can all lead to lung damage.
• Long-term exposure to allergens like pigeon droppings, pollens that cause symptoms in an individual can lead to hypersensitivity pneumonitis
• Autoimmune diseases like SLE, rheumatoid arthritis, vasculitis
• Medications like cyclophosphamide, methotrexate
• Chronic Aspiration of liquid, food, vomit, saliva or accidental aspiration of irritants like hydrocarbons, acids etc

How do we diagnose these diseases?

A pediatric pulmonologist suspects a child to have chILD based on clinical history and examination. This can be confirmed by doing a Contrast-enhanced CT (CECT) scan or in few cases high-resolution CT scan (HRCT) of the chest.
Various genetic tests are now available to diagnose any genetic cause of ILD.

How do we treat these children with chILD?

There is currently no permanent cure of chILD. Your doctor might prescribe you few medicines to help slow down the lung damage or halt it for some time and help child breath better. These children usually require regular follow ups with a pediatric pulmonologist to monitor the progression of the disease. The pulmonologist then takes necessary action to help your child with his difficulties.
Ventilator support to maintain oxygen levels and pulmonary rehabilitation with regular physiotherapy is a must for these children.

• Make sure your child has taken all the vaccines, even the optional vaccines.
• Avoid second hand smoke
• Discuss and learn all the warning signs of worsening lung functions from your doctor
• Get regular lung function tests and physiotherapy sessions
• Take care of your child’s mental health as they are growing up with a disease.