This document provides guidance on evaluating and managing a child presenting with respiratory distress. It defines respiratory distress and lists common causes related to the respiratory system, cardiovascular system, and other organ systems. Specific infectious and non-infectious respiratory conditions are described in detail. The document outlines how to assess severity and differentiate between viral and bacterial infections. Detailed history taking and physical examination techniques are explained. Case examples are presented and management priorities are identified as triaging severity, providing oxygen and IV fluids, monitoring vitals, performing investigations like chest X-ray and blood tests, and considering referral to intensive care if needed.

1. Approach to a child with
Respiratory Distress.
Dr. Deepak Kumar
Ass. Prof. Pediatrics.

2. Learning Objectives
• What is Respiratory Distress?
• Causes of the Respiratory Distress?
• Recognizing severity.
• How to proceed for diagnosis?
History.
Examination.
Investigations.

3. Distress
• Respiratory rate
Age 0-2 months - > 60/minute
2- 12 months- > 50/minute
1yr-5 years - > 40/minute
5yr-12 years - > 30/minute
• With or without fast breathing
- Presence of retractions
- Paucity of breathing/ Apnea
- Presence of Cyanosis

4. What can be the cause of Respiratory
distress

5. Causes....
• Respiratory system
A) Infectious causes
Upper respiratory tract infections
VS
Lower respiratory tract infections-

7. Lower respiratory tract Infections
• Tracheitis.
• Bronchitis.
• Acute Laryngo-Tracheo-Bronchitis (Croup).
• Bronchiolitis.
• Wheeze assoc. lower tract infection.
• Pneumonia- Viral/Bacterial.
• Tuberculosis.

8. B) Non infectious respiratory causes
• Foriegn Body.
• Asthma.
• Chest Trauma
• Gastroesophageal reflux.
• Surgical-
TEF, Diaph Hernia, Cysts

9. Other systems may cause respiratory
distress.....
• CVS
Congenital Heart Disease
ACHD- VSD,ASD,PDA,CoA
CHD- TOF,TGA,TAPVC....
Aquired Heart Disease
RHD, Cardiomyopathies.

10. CHF causes increase in resp rate
Heart Disease
CHF/Low cardiac output
Blood accumulates in pulmonary
Pulmonary edema (RR)
Affects ciliary function/ cell mediators activity
(Repeated Chest infections)

11. Other System
• GIT- Diarrhea, Liver failure , IEMs causes
metabolic acidosis RR
• Renal- acidosis
• CNS- raised ICT.

12. Severity of Respiratory Distress
Respiratory Rate- > 80 in newborns
> 60 in infants and children
Presence of Cyanosis.
Presence of Grunting/Groaning
Use of Accessory muscles/tripod position
Silent Chest

14. GROAN

15. GRUNT

16. IMPORTANT
• All the causes must be known before proceeding to
history taking.
• Should be able to localize system/involvement of more
than one system
• Then differentiate between upper and lower type/
Viral vs bacterial/non infectious type.
• Record detail history of each episode, confirm that
each episode in past was LRTI or not, Use of IVF,
Hospitalization, nebulization, Chest Xray and duration
of illness can be the clues.
• Label Reccurent or persistent pneumonia if fit into ,
diagnosis needed to be re-emphasised.

17. Viral vs Bacterial
• Duration of illness
• Prodrome
• Secretions
• Cough character
• Sputum character
• Other signs

18. Respiratory vs CVS
• Silent tachypnea/ No retractions
• History of CHF in Infants
Feeding Diaphoresis
Feeding Fatigue ( Suck Rest Suck )
Edema in dependent parts
Recurrent LRTIs

19. Recurrent Vs Persistent pneumonia
• Recurrent - > 2 episodes in 6 months or 3 and
more at any duration.
• Persistent - Symptoms > 4 weeks
• Consider other diagnosis -
ex- Tuberculosis, HIV, GER, Surg.

20. • Ask history for Asthma –
History of atopy- rashes, rhinitis/sinusitis
Seasonal Variations
Family History
Smoker/Use of agarbatti/Chulha
Pet in family or around

21. • History for tuberculosis
Prolonged cough >2 weeks.
Unexplained fever.
Weight loss.
Decreased appetite.
Family history of contact.

22. Foriegn body
• Evident/ seen / playing with or eating
• Sudden onset
• Bouts of cough/ choking like episodes

23. Bronchiolitis
• Disease of airways
• Respiratory distress associated with
ronchi/spasm/wheeze.
• Preceded by Viral infection/URI
• Agent- RSV ( Respiratory Synctial Virus )
• First episode
• Age group – 3 months to 3 years.
• Self limiting disease, supportive treatment

24. Ask history for complications
• Severity- Mild/Mod/Sev
• Respiratory Failure
• Chest pain, Sudden worsening of symptoms
(Empyema,Effussion,Pneumothorax)
• Siezures

25. Treatment History
• Past episodes- hospitalization
• Use of nebulization
• Use of MDIs

26. Examination
• Sensorium- irritable, drowsy/lethargic
• Vitals- RR, HR, Pulse, Spo2
• Respiratory rate count for 1 minute
• Look for chest indrawing/ retractions
• Wheeze/Stridor
• Signs of respiratory failure

27. Chest Retractions

28. Wheeze

29. AIRWAY DISEASES

30. Airway Diseases
• EX- Bronchiolitis, WALRI, Asthma

31. Examination Findings
• Due to narrowing of airway
Air entry > Exit = Air Trapping
Expiration prolonged
Hyperinflation of lungs
Abnormal chest shape
Visceroptosis (not organomegaly)
Rhonchi/Spasms/Wheeze

33. • Pneumonia

34. Findings
• Consolidation/Collapse/Effusion
chest depressed on collapsed side
elevated/full on effusion side
• Decreased chest movement
• Crowding/Expansion of ribs
• Rales/Crackles NOT CREPTS
• Crepitation for subcutaneous emphysema

35. • Bronchial Breathing
Inspiratory pause on auscultation at affected area
Harsh and loud breath sound due to consolidation

36. Signs of respiratory failure
• Arrythmia
• Silent chest
• Decrease in RR/ Gasping
• Dip in consciousness
• Cyanosis

37. CVS
• Tachycardia/Bradycardia
• Muffled/Faint heart sounds
• Murmurs
• Hepatomegaly

38. MANAGEMENT
• TRIAGE according to severity
Referral to tertiary hospital
If at Tertiary- transfer to Intensive Care
• Put oxygen, IVF, NPO (to prevent aspiration)
• Vitals monitoring, watch for respirtory failure
• Investigations

39. Investigations.
• Urgent Chest X ray (Life Saving)
• Severe Distress- ABG
• Infectious causes- CBC, Blood culture

43. CASE 1
• 6 month/ Male
• Cough/fever for 2 days.
• Fast breathing for 1 day.
Cough – dry , spasmodic type
Fever- High grade
Associated with running nose, watery eyes.
Fast breathing a/w chest indrawing
No past history of similar episodes
No history of feed diaphoresis and fatigue.
EXAMINATION- ?

44. CASE 2
• 6 years old male
• Cough/fast breathing sudden onset for last 6
hours
• Cough Dry , in bouts.
• No history of any choking/aspiration
• Similar episodes present in past every winter for
last two years.
• Mother has history of chronic rhinitis and rashes
• Relieves by taking nebulization
• Examination- ?

45. CASE 3
• 5 month/Female
• C/O cough and fast breathing for last 15 days.
• Now developed fever.
• Fast breathing noted but no history of
retractions.
• History of sweating over forehead and pauses
while feeding present.
• Examination- ?

46. More cases will be discussed bedside.
Topics will be discussed later
individually

47. THANK YOU
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