Respiratory dysfunction

Overview of Pediatric Respiratory Dysfunction

Focus on respiratory dysfunctions experienced by children, including chronic and acute illnesses, emphasizing respiratory infections.

Upper Respiratory Tract: Comprises the oropharynx, nasopharynx, pharynx, larynx, and upper trachea.
Lower Respiratory Tract: Includes the lower trachea, bronchi, bronchioles, and alveoli.
Importance of the bronchi/bronchioles lined with smooth muscle, allowing for environmental responsiveness (dilation/constriction).

Mucosal Continuity: The continuous mucosal lining facilitates easy spread of infections in children, especially babies and toddlers.
Common Infections: Viral infections like RSV (respiratory syncytial virus), rhinovirus, and bacterial infections including Haemophilus influenzae, pertussis, and streptococcus.
Seasonal Trends: Increased infections observed in winter months due to close contact in confined spaces.

Immunity Transfer: Infants receive some immunity from maternal antibodies up to about 3 months; however, they are particularly susceptible to certain diseases like pertussis.
Risk Factors: Higher infection rates are influenced by exposure (e.g., older siblings, daycare), airway diameter, and eustachian tube positioning in younger children.

Nutrition and Health: Nutritional deficits, like anemia, can weaken the immune response; adequate rest is crucial for recovery.
Chronic Conditions: Conditions like asthma, bronchopulmonary dysplasia (BPD), severe allergies, and exposure to secondhand smoke can impair respiratory defenses.

Symptoms: Fever and signs of meningismus may arise; high fever can lead to febrile seizures, common in certain families.
Signs of Distress: Infants display respiratory distress differently—head bobbing, retractions, nasal flaring, grunting.
Respiratory Rate Goals: Vary by age; infants <60 bpm, school-age kids <30 bpm, advising continuous assessment of respiratory patterns.

Goals of Care: Ease respiratory effort by managing airway, hydration, positioning, and suctioning techniques.
Pulmonary Hygiene: Chest physiotherapy to manage mucus, using nebulizers and ensuring hydration to keep secretions mobile.

Viral Nasopharyngitis: Related to common cold; management focuses on hydration, moisture, and suctioning.
Strep Pharyngitis: Caused by group A strep; treatment involves antibiotics to avoid complications such as rheumatic fever.
Tonsillitis: Often follows pharyngitis; treatments include comfort measures like soft diets, and in severe cases, surgical intervention.
Otitis Media: Fluid accumulation in the middle ear; often managed with a watchful waiting approach unless recurrent.

Types of Croup: Defined by barky cough and stridor; variants include acute epiglottitis which is a medical emergency requiring immediate intervention.
Management: Use of cool moist air, corticosteroids, and nebulized treatments to reduce airway swelling.

Bronchiolitis: Primarily caused by RSV, characterized by wheezing and respiratory distress; can necessitate invasive interventions like intubation.
Cystic Fibrosis: Genetic disorder leading to thick mucus build-up; requires rigorous management of respiratory and nutritional needs, with newer therapies improving outcomes.

Signs of Respiratory Failure: Inability to maintain adequate gas exchange; hypoxemia and hypercapnia are key indicators.
Intervention Strategies: Include medications, airway management, and providing oxygen support as needed.

Impact of Tobacco Smoke: Exposure increases respiratory illness risk, and education on smoking cessation is vital for family care strategies.
Status Asthmaticus: Severe asthma exacerbations requiring aggressive management.
COVID-19 Considerations: Awareness of post-viral complications like multisystem inflammatory syndrome in children (MIS-C) following COVID-19.