RESPIRATORY DISTRESS IN CHILDREN

AIMS:

1. Highlight important anatomical/physiological differences between Children and Adults

2. Define respiratory distress
3. Propose a routine for examination of the Paediatric Respiratory system
4. Look at Children of different ages with respiratory distress, highlighting important
differences in aetiology

ANATOMICAL & PHYSIOLOGICAL CONSIDERATIONS

1. In infants tongue is larger relative to mandibular space

2. Oral cavity is devoid of teeth so airway obstruction can occur more easily
3. The small size of the paediatric airway means that a small decrease in diameter may cause
significant airway obstruction. The smallest diameter is at the level of the cricoid cartilage.
4. Oxygen consumption is inversely related to age: approx. 7ml kg min in a neonate increasing
during childhood to about 3.5ml kg min in adults. This means that airways obstruction or any
gas exchange problem is more likely to cause hypoxia more rapidly
5. At term approximately 1/3 to ½ of adult alveolar numbers (150-250 million at 2 years and
300-400 million at 3 years, adult no’s) Multiplication of alveoli continues to around 8 years.
There is a continued increase in diameter of peripheral airways relative to major airways to
5 years. Lung volumes continues throughout childhood with a final growth spurt in
adolescence)
6. TLC in a 3kg baby 50ml kg, 75 ml kg in adult male, 60 ml kg in adult female
7. Change in orientation of ribcage from a horizontal orientation to downward (caudal) slope
of adult in first 10 years
8. Rib cage is pliable early on, becoming more ossified and less pliable with age.
9. Normal respiratory rate high at birth, decreases with age

WHAT IS RESPIRATORY DISTRESS ?

A constellation of signs and symptoms indicating that the infant or child is finding it hard to breathe.
Or physiology speaking an increased effort is required by the infant/child to try and achieve the
normal functions of breathing ie delivering oxygen to the lungs and from there to the tissues, and
exhaling carbon dioxide from the lungs and thus lowering C02 in the blood.

SYMPTOMS

Dyspnoea, a ‘subjective’ feeling of being out of breath, finding it hard to breathe.

SIGNS

Tachypnoea

Head bobbing

Nasal flaring
Tracheal tug

Intercostal and subcostal recessions

Grunting

Audible wheeze Audible stridor Silent chest

LATE/ASSOCIATED FEATURES & SIGNS

Cyanosis

Lethargy, altered level of consciousness

Shock – prolonged CRP

RESPIRATORY EXAMINATION
For exams think about classic paediatric respiratory conditions that are
Inspection chronic and that have signs

Inspection 1. Bronchiectasis
2. Asthma
Inspection
Always look beyond, make connections between the various signs.
Palpation
Eg. Asthma and signs of atopy (eczema etc)
Percussion
Clubbing (=bronchiectasis), CF and non-CF, iatrogenic interventions
Auscultation
(eg Portacath, PEG, etc)
Others

CAUSES

Think age group

1. Preterms/neonates
2. First 12 – 18 months
3. Thereafter

Think systems:

1. Lung
2. Cardiac
3. Miscellaneous eg, acidosis, metabolic etc

Think level:

1. Upper airway
2. Lower airway