Common Respiratory

Illnesses in Children
What do you want to ask in history?
• What symptoms? Clarify terms
• Duration of symptoms
• Timing of symptoms (day/ night)
• Preceding/ concomitant symptoms
• Triggers (exercise/ foods/ pets/ smokers)
• Interval symptoms
• Atopy: hayfever, allergies/ food intolerances, asthma, eczema
• PM Hx: previous admissions
• Birth Hx: prematurity
What is ‘respiratory distress’?
• Tachypnoea
• Cyanosis
• Head bobbing (infants)
• Nasal flaring
• Added noise (Grunting, wheezing, stridor)
• Tracheal tug
• Recession/ retraction (subcostal/ intercostal)
Respiratory distress- head bobbing
Respiratory distress
Respiratory distress- grunting
Respiratory distress- recession
Respiratory distress- stridor
Case history- 1
• GP referral
• 1-year-old boy is brought to PAU by his parents because of ’difficulty
breathing’
• What other questions do you want to ask?
Case history- 1
• Parents report baby “struggling to breath”
• Fever, cough and coryzal symptoms started 2 days ago
• Feeding- normally bottle fed, 4oz 3 hourly, now 1-2oz 4 hourly
• Reduced wet and dirty nappies

• Birth Hx: premature- 34 weeks gestational age, short NICU stay

• Social: father smokes at home
Chest X-ray
Differentials
• Bronchiolitis
• Pneumonia
Bronchiolitis
• Inflammation of lower respiratory tract → mucous production
• Usually <2 years old
• Most common cause: RSV
• Can also present as apnoeas
• Symptoms/ severity peaks 3-5
• Cough symptoms can lasts for weeks
Management
• Supportive management
• Oxygen
• Feed/ hydration
• Palivizumab*
Case history- 2
• 2-year-old boy is brought to A&E department by his parents because
of noisy breathing
• What other questions do you want to ask?
• Mild coryzal symptoms- runny
nose and cough for the past 2
days
• Woke up in the middle of night
with cough and noisy breathing
Differentials
• Croup
• Epiglottitis
• Bacterial tracheitis
• Bronchiolitis
• Foreign body
Croup
• AKA laryngotracheobronchitis (inflammation of upper respiratory
tract)
• Causes: viral infection (most commonly parainfluenza)
• Age: 6months– 6 years
• Common symptoms: harsh barking cough, hoarse voice and
inspiratory stridor
Assessment
• Examine from distance
• Avoid causing more distress
• Do NOT examine throat

• Severity:
• C- Cyanosis
• R- Recession (chest)
• O- Oxygen saturations (<92%)
• UP- upper airway obstruction (stridor)

Other signs: level of consciousness, lethargy

Management
• Anti-pyretics/ analgaesia
• Adequate fluid intake
• Oral dexamethasone (150micrograms/kg) or nebulized budesonide
• Severe croup: nebulized adrenaline
Case history- 3
• 4-year-old boy presents to outpatient clinic with episodes of wheeze
and troublesome cough for past 2 years
• What other questions would you like to ask?
• Episodes are more common during winter months or at night

• PM Hx: frequent hospital admission with wheezy episodes requiring

nebulisers
• FHx: mother- hay-fever, father – eczema
• Social: parents uses vape, dogs at home, migrated from Pakistan at
age 1
Examination findings
Differentials
• Asthma
• Viral-induced wheeze
• Lower respiratory tract infection
• Immunodeficiency
• Cystic fibrosis
• Tuberculosis
Asthma
• chronic airway inflammation
• Reversible obstructive airway changes
Diagnosis
• Clinical diagnosis
• Peak expiratory flow rate
• Spirometry
Management- acute
• Assess severity
• Salbutamol
• Ipratropium
Management- acute
•
Management
Other causes of wheeze
• Foreign body
• Tracheo-broncho-malacia
• External compression (vascular ring)
• Reflux with aspiration
Case history- 4
• 1-year old, presents with 2-days history of productive cough and fever
• Known to have recurrent chest infections
• What other questions do you want to ask?
• Had multiple courses of antibiotics for chest infections
• Recurrent shiny and foul-smelling stool
• Birth history: 39/40 weeks gestational age, birth weight 3.55kg (50th
centile)
Examination findings
• 8kg (4th centile)
• Audible wet sounding cough
• Finger clubbing
• Bibasal crackles on auscultation
Differentials
• Cystic fibrosis
• Primary ciliary dyskinesia
• Asthma
• GORD
• Primary immunodeficiency
Cystic fibrosis
• Autosomal recessive; mutation of
CF transmembrane conductance
regulator (CFTR) gene
• Defective chloride channel →
impaired secretion of Cl- (higher
intracellular Cl-) → Na and H2O
enters cells → thick mucus/
secretions
• Different physiology in sweat
glands
What are the consequences?
• Respiratory tract
• Thick mucus → reduced mucociliary clearance → bacterial colonisations
• Bronchiectasis → cor pulmonale
• Gastrointestinal tract
• Thicker stools → meconium ileus
• Rectal prolapse, intussusception, volvulus, obstruction
• Biliary tract
• Concentrated and sluggish bile
• Pancreatic insufficiency
• Stagnation in pancreatic ducts
What are the consequences?
• Diabetes
• Infertility
• Psychological problems
Diagnosis
• Newborn screening (Day-5 Blood spot test)
• Immunoreactive trypsinogen (IRT)
• Sweat test
• High chloride concentration
Management
• Respiratory
• Clearing lung secretions
• Infections
• GI
• Enzyme and vitamin replacement
• laxatives
Thank you for listening.
Any questions?