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Difficult breathing in children

By Dr Hisham AlrabtyPediatrics consultant and

pulmonologist Tripoli children hospital

Definition. Causes: Types: Approach. Diagnosis. DD. Treatment. Prognosis.

Objectives:

It has many definitions but simply it is when child is dyspnic.So what is dyspnea???It is shortness of breath (dyspnea) is the subjective sensation of difficult, laboured, uncomfortable breathing. Breathlessness is another term for dyspnea.It is usually associated with tachypnea.

Definition:

Tachypnea is increased respiratory rate.Upto WHO standards RR is normal when :Not more than 60 c/m in children less than 2 months old.Not more than 50 c/m between 2 and 12 mnths old.Not more than 40 c/m between 1 and 4 yrs old.Not more than 30 c/m between 5 and 12 yrs old.

Respiratory rate:

They could be either: respiratory

or cardiac

or others

Causes and types:

Laryngomalacia. Tracheomalacia. foreign body. Epiglottitis. pneumonia. Asthma. Bronchiolitis. Retropharyngeal abscess. Adenoids.

Respiratory causes:

inadequate delivery to lungs

(hypoxemia): R heart failure (cyanotic CHD). inadequate delivery to body

(pulmonary edema): L heart failure (a cyanotic CHD). Anemia. Vascular rings and slings.

Cardiac causes:

Central hypoventilation: brain edema or CNS infection. Drugs: diazepam. Respiratory muscle paralysis: ascending polyneuropathy.

Others:

History.Clinical examination.Investigations.Imaging.

Approach and diagnosis:

Onset: acute or chronic. Fever: infectious. Associated symptoms: cyanosis. Noisy breathing: croup. Family history: CHD or CF or asthma. Drug history: anticonvulsants. Surgery: cardiac.

History:

Vital signs: tachypnea or tachycardia.Color: cyanosis or pallor.Dysmorphic features: down

syndrome.Signs of RD: working alae nasii and

retractions.Signs of HF: tachycardia and cyanosis.Growth parameters: failure to gain

weight.Chest: rhonchi or basal rales.General: edema or clubbing or

hepatomegaly.

Clinical examination:

CBC: leukocytosis or low hgb level. CRP and ESR: nonspecific inflammatory

reactants. ABG: hypoxia. Blood for c/s: pneumonia. PCR: Viral serology: IGE level: non specific and specific. Skin brick test: asthma triggers. Sweat test: CF.

Investigations:

CXR: consolidation. ECHO: CHD. Gatrograffin study: tracheoesophygeal

fistula. CT and MRI angio: vascular rings. Direct laryngoscopy and bronchoscopy:

FB.

Imaging studies:

Supportive: o2 and fluids. Specific:

1. antibiotics:2. Bronchodilators.3. Steroids.4. Bronchoscopy: rigid one for FB.5. Surgery: CHD.

Treatment:

It does range from excellent to poor depending on the cause.Bronchiolitis has excellent prognosis as well as asthma.And complex CHD has poor prognosis.

Prognosis:

Thanks for attendance