In history taking, poor feeding is asked. Why?
Poor feeding is a sign of severe illness
Two types of chest wall abnormalities noted in childhood
Pectus excavatum (funnel chest) Pectus carinatum (chicken breast)
True or False: in a young child, it is practical to do inspection and palpation before percussion and auscultation.
False. Inspection and auscultation before palpation and percussion
Components in inspection of Chest and Lungs in children
Color- cyanosis or pallor Respiratory rate
Children rely more on the _________ for breathing
Diaphragm
Criteria for tachypnea according to WHO
0 up to 2 months old = ≥60 cycles/min
2 mos up to 12 mos old = ≥50 cycles/min
12 mos up to 5years old= ≥40 cycles/min
Determine if child is Tachypnic: A 15-month old with a RR of 45cycles/min
Tachypnic ( 12mos-5years old =
≥40 cycles/min)
Determine of the child is Tachypnic: 2 month old with RR of 30 cycles/ min
Normal ( 2months-12months = ≥50cycles/min)
Determine of the child is tachypnic: 1 month old with RR of 62 cycles/min
Tachypnic (0 - 2 months = ≥60cycles/min)
What are the two aspects of the infant’s breathig should be observed?
Audible breathing sounds and Work of breathing
True or False: Increased rate and work of respiration are the most important signs of pneumonia in infants
True
What will be the best sign for ruling OUT pneumonia in infants?
Absence of tachypnea
What will be observed for work of breathing?
Nasal flaring
Grunting
Retractions (Chest indrawing): Supraclavicular, Intercostal and subcostal
Headbobbing
This is an indicator of pulmonary disease before 2 years of age
Retractions (Chest Indrawing)
Retractions can be observed during inspiration or expiration?
during inspiration
What is Hoover’s sign?
Paradoxical (seesaw) breathing in. The abdomen moves outward while chest moves inward during inpiration.
Hoover sign is an indication for what?
Airway obstruction or lower respiratory tract disease in infants
What are the 5 components of APGAR score?
A- Appearance (Color)
P - Pulse (Heart Rate)
G - Grimace (Reflrex irritability)
A - Activity (Muscle tone)
R - Respiratory rate
This is a subjective qualitative evaluation done at 1 and 5 minutes to determine “survivability” of the newborn.
Apgar Score
A newborn was crying loudly and in active motion, has a heart rate of 102bpm, and has acrocyanosis. What is the APGAR score for this newborn? Interpret score.
Apgar score: 9 (1+2+2+2+2)
Normal
Why is thermoregulation very important in newborns?
Variation in respiratory rate occurs if room temperature is very warm or cool: Most often tachypnea, sometimes bradypnea
Other causes of depressed respiration in the newborn
Maternal environment during labor (sedatives, compromised blood supply to the child
Mechanical Obstruction by mucus
Neurological damage (birth trauma: injury to C3,C4, C5)
True or False: Premature infants are more likely to have irregular respiratory patterns
True
Sequence of relatively vigorous respiratory efforts followed by apnea of as long as 10-15 seconds
Periodic breathing
Criteria for Apnea of prematurity
Cessation of breathing is ≥20 seconds
Accompanied by braycardia
Centrally cyanotic (check oral cavity)
What are the normal breath sounds?
Tracheobronchial = tubular sound; air being blown through a tube
Vesicular = soft and low pitched; sound of wind blowing through trees, causing the leaves to rustle
True or False: Bronchial breath sounds heard at the bases of the lungs is normal.
False. Abnormal
What are the adventitious breath sounds?
Crackles = cracking or bubbling sonds
Ronchi = reflect obstruction of larger airways with mucus or secretions; “halak” or harsh breath sounds
Wheeze = whistling soudn; reflect narrowing of smaller airways or bronchioles; Expiratory
Stridor = upper airway obstruction; inspiratory; high pitched, piercing sound
Grunting = Expiration; partially closed vocal cords; sign of severe respiratory distress
True or False. Infant’s chest is normally hyperressonant throughout
True. Dullness = Consolidation (pneumoniar)/ mass
This is due to lack of surfactant resulting to alveolar collapse and reduce distensibility of the lungs
Hyaline Membrane Disease or Respiratory Distress Syndrome
Floppiness of the trachea
Generally bening and self-limiting with age.
PE findings: Wheezing and inspiratory stridor
Tracheomalacia
Caused by parainfluenza virus which causes inflammation of subglottic area
PE findings: Harsh stridorous cough “bark of a seal”; labored breathing; retraction; inpiratory stridor; does not always present with fever
Croup (Laryngotracheobronchitis)
Caused by Haemophilus influenzae type B.
Common in 3-7 years old
Acute, life-threatening: begins suddenly and progresses rapidly to full obstruction of the airway
PE findings: Unable to swallow; drooling from the open mouth; stridor; child sits straight up with neck extended, head held forward
Epiglottitis
True or False: Epiglottits should be treated as a medical emergency and inserting tongue blade is a must.
False. Inserting tongue blade may be deadly.
Caused by respiratory syncytial virus
Most common <6 months
Expiration becomes difficult and prolonge due to hyperinflation of lungs
PE findings: Tachypnea; Generalized retractions; Perioral cyanosis; Increased A-P diameter of thoracic cage; possible wheezing and crackles
Bronchiolitis
Inflammatory response of the bronchioles and alveolar space to an infective agent (bacteria, fungal, or viral)
Pneumonia
Possible PE findings in pneumonia
Inspection: Tachypnea; shallow breathing; nasal flaring
Palpation: Increased fremitus (due to consolidation)
Percussion: Dull (due to consolidation)
Auscultation: Crackles; Occasional ronchi; egophony, bronchophony, whispered pectoriloquy
Inflammation of the mucus membranes of the bronchial tubes.
PE findings:
Inspection = occasional tachypnea; occasional shallow breathing
Palpation = undiminished tactile fremitus
Percussion = resonance
Auscultation = prolonged breath sounds; occasional crackles and expiratory wheeze
Acute Bronchitis
Characterized by airway inflammation: mucosal edema; increased secretions; bronchoconstriction
Asthma
Possible PE findings in Asthma
Inspections: tachypnea; dyspnea
Palpation: tachycardia; diminshed fremitus
Percussion: Hyper-resonance; limited diagphragmatic descent
Auscultation: Prolonged expiration; wheeze; diminished lung sounds
