February 22, 2016 - Pediatric Laboured Breathing

Question 1

Signs of Respiratory Failure in a Child

Answer 1

Waxen or cyanotic appearance

Gasping, axious appearance

Fatigued appearance

Marked retractions

Nasal flaring

Grunting

Head bob

Question 2

Wheeze in a Child

Answer 2

Expiratory noise

High-pitched

Caused by small airways (bronchi and bronchioles)

Question 3

Stridor in a Child

Answer 3

More commonly an inspiratory noise, but can be expiratory.

High or low pitched.

Usually larynx and trachea involvement

Question 4

DDx of Wheeze

Answer 4

Bronchiolitis

Asthma

Aspiration

Endobronchitis (cystic fibrosis)

Pulmonary edema

Foreign body aspiration

Granuloma

Bronchomalacia

Question 5

Laryngomalacia

Answer 5

Literally “soft larynx”

The most common cause of stridor in infancy in which the soft, immature cartilage of the upper larynx collapses inward during inhalation, causing airway obstruction.

Typically presents at 2-3 weeks of age, is inspiratory stridor, worse while supine, better while prone, rarely interferes with sleeping, feeding or growth.

Peaks at 3 months and spontaneously resolves by 12-18 months.

Question 6

Red Flags for Stridor

Answer 6

Present at birth

Biphasic

Abnormal voice

Poor feeding / growth

If these are present, the patient needs a laryngoscopy/bronchoscopy

Question 7

DDx for Acute Onset of Stridor

Answer 7

Croup

Bacterial tracheitis

Question 8

Croup

Answer 8

A respiratory infection usually caused by a virus that leads to swelling inside the wind pipe, which interferes with normal breathing and produces the classic symptoms of “barking” cough, stridor, and a hoarse voice.

Question 9

Bacterial Tracheitis

Answer 9

A bacterial infection of the trachea and the airway obstruction that results.

Staphylococcus aureus is common and often follows a recent viral URTI. This is the most serious in young children because of the smaller size of the trachea that becomes easily blocked with swelling.