Signs of Respiratory Distress in Children

Original Editor - Jagunath Selvanathan Top Contributors - Jagunath Selvanathan and Kim Jackson  

Introduction

One of the most common reasons an infant is admitted to the neonatal intensive care unit is due to Respiratory distress[1]. Respiratory distress can be recognised as one or more signs of increased work of breathing which will be discussed below.

Signs and symptoms and their causes[2][3]

  • Weak cry
    • sign of fatigue and shows the child is prioritising energy expenditure for work of breathing.
  • Grunting
    • Increase positive end expiatory pressure (PEEP) by closing of the glottis (therefore increasing Functional Residual Capacity (FRC).
  • Tachypnoea
    • Unable to increase Tidal volume and therefore increase Respiratory rate.
  • Cricoid Tug/Tracheal tug
    • Increase pull of diaphragm is transmitted as a downwards tug on the trachea during inspiration.
  • Sternal recession
    • Due to high negative pressures on inspiration.
  • Sub-costal and intercostal recession
    • Due to high negative pressures on inspiration.
  • Nasal flaring
    • To help increase the diameter of the airway.
  • Head bopping
    • Due to high use of sternocleidomastoid and scalene muscles.
  • Clammy
    • Due to high energy expenditure to breathe therefore sweating to regulate temperature.
  • Pallor
    • Not oxygenating effectively.
  • Cyanosis
    • Dependent on haemoglobin and peripheral circulation-indicates poor oxygen saturation levels.
  • Stridor
    • Partial obstruction of upper trachea.
  • Wheeze
    • Narrowing or obstruction of the small airways by secretions or inflammation.
  • Lethargy
    • Being breathless and working hard causes discomfort and agitation. Also reserved energy fro work of breathing.
  • Tachycardia
    • to assist in oxygen transport.
  • Hypoxemia
    • reduced ability to oxygenate.
  • Hypercarbia
    • reduced ability to expire carbon dioxide.

How can Physiotherapy help?[1]

The goals of physiotherapy is to help increase tidal volumes, help clear secretions, help improve oxygenation around the body and manage ventilation.

  • Manual techniques such as vibrations and percussion
  • Postural drainage
  • Saline and Suctioning (saline helps clear secretions)
  • Therapeutic exercise
  • Central Lavage
  • Bronchoalveolar lavage (BAL)
  • Use of various types of equipment to assist in respiratory care e.g. Acapella / PEP mask / Cough Assist devices.
  • Education and advice on self management.

References

  1. 1.0 1.1 Reuter S, Moser C, Baack M. Respiratory distress in the newborn. Pediatrics in review. 2014 Oct;35(10):417.
  2. Taussig LM, Landau LI. Pediatric respiratory medicine. Elsevier Health Sciences; 2008.
  3. Edwards MO, Kotecha SJ, Kotecha S. Respiratory distress of the term newborn infant. Paediatr Respir Rev. 2013 Mar; 14(1):29-36; quiz 36-7.