stratify risk in children with stridor using IMNCI guidelines.pptx

1. Stratify risk in children with
stridor using IMNCI guidelines
PE 28.15
3rd Final
Dr.Apurva Patel

2. Brief overview of stridor
• Stridor is a high-pitched, often noisy respiratory sound resulting from
turbulent airflow through partially obstructed airways, typically in the
larynx or trachea. It is commonly heard during inspiration but can
occur throughout the respiratory cycle. Stridor may indicate
underlying airway obstruction, and its severity can vary from mild to
severe, necessitating careful evaluation to identify the underlying
cause. Common etiologies include infections, congenital anomalies,
foreign body aspiration, or inflammation. Timely assessment and
management are crucial to address the underlying issues and ensure
proper respiratory function.

3. IMNCI AND ITS RELEVANCE
• IMNCI, or Integrated Management of Neonatal and Childhood Illness, is a comprehensive strategy
developed by the World Health Organization (WHO) and UNICEF to address the major causes of
childhood morbidity and mortality. Its relevance lies in its holistic approach to managing common
childhood illnesses, emphasizing integrated care for both newborns and young children.
•
• Key points of relevance for IMNCI include:
• 1. Holistic Approach:
• 2. Early Identification
• 3. Community-Based Care
• 4. Simplicity and Feasibility
• 5. Prevention and Promotion
• 6. Training and Capacity Building
• 7. Global Impact
• In summary, IMNCI is relevant due to its holistic and community-centered approach, aiming to
improve the overall health and well-being of children, especially in low-resource settings.

4. Criteria for assessing severity in stridor
1. **Sound Characteristics:**
- Evaluate the pitch, loudness, and quality of the stridor. High-pitched and loud stridor may indicate more severe
obstruction.
2. **Breathing Pattern:**
- Observe the child’s overall breathing pattern, including the presence of retractions, nasal flaring, and increased
respiratory rate.
3. **Cyanosis or Pallor:**
- Check for signs of inadequate oxygenation, such as cyanosis (bluish discoloration) or severe pallor.
4. **Activity Level:**
- Assess the child’s activity level and ability to feed. Increased distress during feeding or reduced activity may suggest
more severe stridor.

5. 5.**Positional Changes:**
- Observe if the stridor changes with the child’s position, such as worsening when lying
down. This may indicate dynamic airway obstruction.
6. **Feeding Difficulty:**
- Consider any difficulties in feeding, as this can be indicative of increased respiratory
effort and severity of stridor.
7. **History of Stridor Episodes:**
- Inquire about the frequency, duration, and progression of stridor episodes. Sudden
onset or worsening may suggest a more urgent situation.
8. **Associated Symptoms:**
- Take note of any associated symptoms, such as fever or signs of respiratory distress,
which can contribute to assessing severity.

6. Factors contributing to risk stratification
1. Clinical Presentation
2. Respiratory Distress
3. Age of the Child
4. Underlying Etiology
5. Duration and Progression
6. Positional Changes
7. Vital Signs
8. Feeding Difficulties
9. Past Medical History
10. Response to Interventions

7. Stratify risk in children with stridor using
imnci guidelines
1. **High Risk:**
- Severe stridor at rest.
- Signs of respiratory distress (e.g., retractions, nasal flaring).
- Cyanosis or severe pallor.
2. **Moderate Risk:**
- Moderate stridor with mild respiratory distress.
- Presence of fever.
- Abnormal vital signs (e.g., tachypnea).
3. **Low Risk:**
- Mild stridor without respiratory distress.
- No signs of distress at rest.
- Absence of alarming associated Symptoms

8. Management of stridor according to risk
1. **High Risk:**
- **Immediate Referral:** Children with severe stridor, signs of respiratory distress, or cyanosis require
urgent referral to a higher level of care.
- **Secure Airway:** In some cases, immediate airway management, such as intubation, may be
necessary.
2. **Moderate Risk:**
- **Hospital Admission:** Children with moderate stridor and respiratory distress may need hospital
admission for close monitoring and further evaluation.
- **Oxygen Therapy:** Provide supplemental oxygen to maintain adequate oxygen saturation.
3. **Low Risk:**
- **Observation and Supportive Care:** Children with mild stridor and no significant distress can often
be managed with observation and supportive care.
- **Monitor and Reassess:** Regularly monitor the child’s clinical status and reassess as needed.
Provide hydration and comfort measures.

9. 4. **Causative Treatment:**
- **Identify and Treat Underlying Cause:** Regardless of risk level, address the specific
underlying cause of stridor. This may include antiviral medications for viral infections,
antibiotics for bacterial infections, or bronchodilators for conditions like croup.
5. **Educate Caregivers:**
- **Caregiver Education:** Educate caregivers about signs of worsening stridor, when to
seek medical attention, and any necessary home care measures.
6. **Follow-Up:**
- **Scheduled Follow-Up:** Schedule follow-up appointments to monitor the child’s
progress and ensure resolution of stridor.

10. Thank you