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Respiratory Problems In Children Notes

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Respiratory Problems in Children Stridor
= An inspiratory noise caused by narrowing of the extrathoracic upper airway
- Common symptom in young children and infants
- In a small number of cases it can represent severe life threatening disorders e.g inhaled FB or epiglottitis
- Stridor may be chronic, due to congenital abnormality or acute, usually due to infection or obstruction

Causes of stridor-

Acute o o o o

Croup (barking cough, coryzal illness) Quinsy (tonsillar abscess) Anaphylaxis Epiglottitis (sudden onset, septic, drooling, unable to speak, no Hib vaccine) o Inhaled FB (toddlers, sudden onset, hx of choking, unilateral signs - requires bronchoscopy) Chronic o Laryngeal anomalies
? Vocal cord palsy - may be associated with brain lesions/trauma
? Papilloma - due to vertical transmission of wart virus causing progressive stridor o Laryngomalacia
? Floppy larynx
? Variable stridor from birth, loudest when crying, disappears when settled
? Caused by prolapse of aryepiglottic folds into upper larynx
? Usually disappears in a few months
? If baby otherwise well - no need for Ix, but if stridor is progressive, interferes with feeding or causes resp. distress then bronchoscopy indicated o Upper airway obstruction
? Severe micrognathia e.g pierre-robin syndrome
? Pharyngeal cysts o Tracheal abnormality
? Subglottic stenosis e.g following prolonged intubation
? Tracheal malacia - abnormality of cartilage ring which may lead to recurrent lobar collapse

Evaluating stridorHistory o How long has stridor been present?
? Since birth in well baby intermittent - likely laryngomalacia
? Since birth in well baby persistent - vascular ring or micrognathia o Is child acutely ill?

Coryzal symptoms followed by a barking cough, worse at night = croup
? V. ill child who cannot speak or swallow suggests acute epiglottitis Hx of choking/FB?
Hx of allergy?o oExamination o Assess severity of work of breathing (subcostal/intercostal recessions + degree of oxygenation o Unilateral wheeze or chest hyperexpansion suggests inhaled FB o Urticarial rash + angioedema suggests anaphylaxis o If child is sitting forwards, unable to swallow and acutely unwell consider epiglottitis (DON'T EXAMINE - CALL ANAESTHETIST) o In chronic stridor assess the shape and size of jaw, listen for murmurs that suggest congenital heart disease where abnormal vessels can compress the airwayInvestigations o FB - CXR for unilateral hyper-expansion or radio-opaque objects
? Rigid bronchoscopy to find and retrieve object o Croup - none required usually o Epiglottitis - until airway is secured do nothing. Blood culture +
FBC o Persistent stridor - barium swallow or microlaryngoscopy

Causes of 'Chestiness' Croup Barking cough Stridor

Acute asthma Known asthmatic, hx of atopy, wheeze, cough

Pneumonia Fever, cough, resp. distress, chest or abdo pain, intercostal recession + signs of consolidation

Viral induced wheeze Wheeze with URTI, some progress to asthma, may respond to bronchodilators Whooping cough (pertussis) Paroxysmal cough followed by vomiting, or Inhaledwhoop FB apnoea Toddlers, hx of choking, unilateral wheeze, sudden onset

Bronchiolitis Age < 2 yrs, coryza, resp. distress, difficulty feeding, apnoea in young infants, wheezing and crackles Heart failure Left to right shunts e.g ASD, VSD-

HistoryCough without SOB Gastro-oesophageal reflux, post-nasal drip, trachea-oesophageal fistula, passive smoking, CF

? features of infection (pyrexia, poor appetite
- ? hx of previous episodes SOB suggesting recurrent asthma
? hx of atopy
? relevant FH - asthma, CF, TB
? underlying condition e.g CHD/prematurity that increases the risk of bronchiolitis

ExaminationTB Contact with TB, not immunized with BCG, haemoptysis, night sweats

Signs of respiratory distress (Grunting, nasal flaring, intercostal recession, head bobbing, tachypnea) Addition noises (Stridor, wheeze, cough) Signs of consolidation (Decreased AE, bronchial breathing, crackles, dullness on percussion, decreased expansion) Signs of chronic resp. condition (clubbing, chest deformity) Evidence of CHD

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