SPECIFICS OF STRESS DISORDERS’ IMPACT ON THE COURSE OF ACUTE RESPIRATORY INFECTIONS IN INFANTS AND PRESCHOOLERS DURING THE FULL-SCALE WAR IN UKRAINE

Introduction. The full-scale war in Ukraine has become a potent factor of "toxic stress," which, through the activation of the hypothalamic-pituitary-adrenal (HPA) axis, causes immune dysregulation and somatization of anxiety states in children. Infants and preschoolers are particularly vulnerable. The relationship between the clinical course of acute respiratory infections (ARI) and specific emotional reactions under the conditions of prolonged armed conflict remains insufficiently studied. The aim of the work was to determine the specifics of the impact of long-term stress disorder manifestations in infants and preschoolers, who have permanently resided in Ukraine for more than 1.5 years during the full-scale war (2023–2024), on the course of ARI by evaluating the frequency of previous recurrent respiratory infections (RRI) and the severity of current symptoms. Materials and methods. A multicenter study included 119 children (aged 6 months to 6 years) with ARI, divided into groups: those who previously fell ill rarely (≤6 episodes/year) and frequently (≥7 episodes/year). The severity of current ARI symptoms was assessed using the WURSS-21 and BSS scales; stress disorders were evaluated using the Public Health Center of the MOH of Ukraine questionnaire for the corresponding age. Statistical analysis was performed using the Mann–Whitney U test and Spearman's correlation. Results. Comparative analysis revealed no significant differences in stress manifestations between the groups (p > 0.05), indicating the universal nature of war-related distress. However, frequently ill children showed a trend towards deeper neurological disorders (tics, stuttering, speech delay). Correlation analysis confirmed a moderate direct relationship (r \approx 0.4; p < 0.01) between symptoms of intoxication (diarrhea in bronchitis) and behavioral regression. It was established that physical discomfort (sputum, loss of appetite) acts as a direct trigger for affective outbursts – anger (r=0.329) and uncontrolled crying (r=0.307). Conclusions. Under war conditions, the factor of military stress dominates over the frequency of somatic diseases. Behavioral regression, triggered by physical discomfort and intoxication, is the leading defense mechanism of the child's psyche in children under 6 years old. The data obtained substantiate the necessity of an integrated approach to ARI treatment during this period, with mandatory psychological support.