10 Warning Signs of Primary Immune Deficiency in Children by Dr. Sagar Bhattad

7 min read

Written by Sindhuja Prabhu

Sindhuja Prabhu

10 warning signs of primary immune deficiency in children

How often do you fall sick? How frequently does your child get sick? Does it say anything about their health or an underlying health condition that you may be overlooking? Primary immune deficiency is a real possibility in some children. As a parent, it is natural to worry a lot more than necessary when your child is sick, especially when they fall sick fairly regularly despite all the care and medications. So it is important for parents to look for the warning signs of Primary immune deficiency.

In children, the immune system takes time to grow and mature. For this reason, it is natural for them to fall sick especially during their school years. While most children do outgrow falling sick within a year or two, some may continue to fall sick with alarming regularity. This may need a visit to a pediatrician and a specialist too if needed.

In This Article

What is Primary Immune Deficiency?

We are all born with an immune system. It is almost negligent and immature at birth but slowly improves and gets stronger with age. The more exposure to various pathogens and infections, the stronger and more effective the immune system gets.

When the immune system does not fight the infections effectively, you tend to fall sick more often. You will also require more time or extra reinforcements like medications to help you recover from recurring infections. If this happens to your child, it could be a strong indication of primary immune deficiency also known as PI or primary immune disorder.

How Do You Know It is PI and Not Just the Flu?

How Do You Know It Is PI And Not Just The Flu_

Kids get sick all the time. When the weather changes or if your child interacts more with the outside world, they are bound to catch infections and have a runny nose or cough.

While the symptoms may be similar and confusing, PI has more severe and long-lasting symptoms than the regular flu. If you notice your child has any of the symptoms, you need to consult your doctor at the earliest and take relevant tests to rule out the primary immune deficiency.

If it is in fact primary immune deficiency, the treatment will be very different from that of the regular flu.

Top 10 Warning Signs of Primary Immune Deficiency in Children

Here are 10 important warning signs you should never ignore. These could be harmless but it is always advisable to consult a doctor, clear all the doubts, and let them rule out possible issues.

If you have a child who falls sick often, here are some signs of primary immune deficiency in children that you need to watch out for.

1. Ear Infections

Ear infection in child

All kids get ear infections. Especially if they have a cold or are swimming. However, if your child is having recurrent ear infections – 4 or more times within a single year, it could be more than just an infection. It is something you need to check out at the earliest.

2. Sinus Infections

In case of a sinus infection, your child will experience inflammation in their nasal cavity or passage. It can make it difficult to breathe or cause severe nose blocks and headaches. If your child suffers from such sinus infections twice or more in a year, it could indicate PI.

3. Pneumonia

pneumonia in child

Pneumonia is bacterial or a viral infection that causes lung inflammation. The air sacs can fill with pus due to infection and may become solid if the infection is severe or prolonged. Many children suffer from pneumonia, especially during the flu season. However, if your child has two or more such episodes and requires treatments or hospitalization, it is a warning sign that the immune system is not functioning properly.

[Read : Pneumonia in Children]

4. Affects Growth

If your child is unable to gain weight or grow in height on par with other children or meet normal ranges, it is a strong warning signs of primary immune deficiency that the immune system is weak.

5. Continuous Antibiotics

Continuous antibiotics -Signs of Primary Immune Deficiency

Some infections can have a severe impact on a child and will require antibiotics to help recover. If your child is put on antibiotics regularly, it indicates the immune system is not strong enough to fight infections effectively. If your child is on antibiotics for 2 or more months and the medicines have very little or no effect on the infection, you need to consult your doctor to rule out PI.

6. Abscesses

When the tissue pockets fill with pus, it is called an abscess. It is usually due to a bacterial infection. While mild abscesses might drain out on their own or with mild antibiotics, deep abscesses require strong antibiotics or surgery to drain the tissues. Deep abscesses can cause fatigue, fever, chills, loss of appetite, or weight. If your child has such abscesses frequently, it could indicate PI as the immune system is not functioning properly.

7. Persistent Thrush

oral ulcer- Signs of Primary Immune Deficiency

Thrush is a fungal infection in the mouth. It is usually treated with antifungal medications. If your child has frequent thrush or fungal infections in their mouth or skin that do not heal easily on their own, it is a warning you should not ignore.

8. Deep Seated Infections

If your child has two or more deep-seated infections in a year, that require IV antibiotics, you should not ignore it. You need to let your doctor know how frequent the infections are and rule out a possible primary immune deficiency.

9. IV Antibiotics

IV antibiotics- Signs of Primary Immune Deficiency

Antibiotics are given when infections are severe. Doctors will generally give oral antibiotics. IV antibiotics are given in case of serious infections that require stronger and more instantaneous results. If your child is repeatedly put on IV antibiotics to help clear out infections, then their immune system is weak and not functioning as expected.

10. Family History

Family history and genetics can tell us a lot about our health profile. If someone in the family has primary immunodeficiency, your child could’ve inherited the gene. If you have an older child with a confirmed PI diagnosis or if you have lost a child to repeated infections, you need to check your other children for the same. You need to take relevant tests to rule out PI.

How to Rule Out Primary Immune Deficiency In Your Child?

If your child shows two or more of the above symptoms, you need to consult your doctor and express your concerns. You cannot expect the doctor to keep track of the infections, frequency, and medications given. You need to be proactive, maintain a record, and show them all to your doctor.

If your doctor concurs the infections are severer and repetitive in nature. They will investigate further to identify the cause of the infections. Even if it is not PI, your doctor can diagnose the reason for your child falling sick frequently.

Sometimes, you just need to make a few minor changes and improve your child’s immunity with suitable food and lifestyle changes. In case of primary immune deficiency, your doctor will advise on the course of treatment.

How is Primary Immune Deficiency in Children Treated?

If your doctor confirms PI in your child, your doctor might suggest a bone marrow transplant.

The white cells that are responsible for fighting infections are produced from stem cells. The stem cells are produced in the bone marrow. When you do a bone marrow transplant, better and stronger stem cells are produced; this in turn leads to white cells that can fight infections effectively. With a matching donor bone marrow, your child’s immune system improves and successfully cures diseases like SCID, CGD, LAD, WAS, Hyper IgM syndrome and more.

[Read : Bone Marrow Transplant For Immune Deficiency in Children]

What Are The Tests Commonly Used To Diagnose PI In Children?

Child Doctor Medical Blood Test And Check

The RF and ANA tests are commonly assumed to be tests to help confirm PI in children. Do they actually hold good? Let’s take a look:

1. RF Test

The rheumatoid factor test, also commonly known as the RA test is advisable only if a child has a confirmed case of arthritis. 5% of healthy children test positive for RF and RF positive can also be due to cancer, infections, or other autoimmune conditions. This test can only help confirm RF and rule out JIA. 95% of the children with JIA test negative for RF.

2. ANA Test

This is an autoantibody test, which can again test positive in 5% of healthy children, A positive ABNA test does not indicate an autoimmune condition but is often used to diagnose SLE.

Children fall sick frequently. It is natural to not think much about serious diseases and just assume the immune system is improving. If your child is sick very frequently and requires external support to recover from the infections, it is a strong indication that their immune system is weak and immature.

[Read : Recurrent Infections in My Toddler]


1. Is Autoimmunity in Children Genetic?

Rheumatoid arthritis or rheumatic disease affects people over the age of 40. If your child below the age of 5 has these infections or gets affected by multiple infections, it indicates a weak immune system that can be genetic.

2. Is Immune Deficiency Common?

More children that you are aware of suffer from immune deficiency. In India, 1 in 500 people is affected by PID. Overall, more than 1 million people suffer from PID in India.

3. Can You Prevent Primary Immune Deficiency in Children?

If the warning signs of Primary Immune Deficiency are taken seriously, an early diagnosis is possible. The earlier you start the treatment, the lesser the damage to the body in the long run. Since the exact reason for Primary immune deficiency is unknown, it cannot be prevented.

Read Also: What Is Intravenous Immunoglobulin? How Does It Work in Children With Low Immunity? by Dr. Sagar Bhattad

Sindhuja Prabhu,M.Sc (Psychology),PGDBM

Sindhuja, a mother of two, is an obsessive mom with a keen interest in psychology, especially child psychology. Her quest for knowledge and way with words led her to become a passionate content writer. She transformed her love for writing into a full-fledged career which incidentally also turned up being the perfect stress buster for the last 5 years.Read more.

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