Health

How to assess respiration in a baby who screams every time when approached?  “Stranger anxiety” normally develops in the second half of the first year of life. The child’s alertness to your presence is certainly a positive sign. Observing the child from across the room provides valuable information. General appearance, state of hydration, respiratory rate, …

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How to know which of the numerous children with respiratory symptoms will progress to respiratory failure?  Identifying patients with projected respiratory failure or impending respiratory failure is one of the most important skills for a pediatric clinician. A detailed history can give information about the vulnerability of the child to respiratory decompensation. Children who are …

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Why are children at greater risk for respiratory failure?  Infants and children require more oxygen per kilogram of body weight than adults. Anatomic factors put infants at particularly high risk for respiratory failure. Infants breathe almost exclusively through their noses, so nasal obstruction can cause significant respiratory signs and symptoms. The caliber of infant airways is small, …

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Can respiratory failure be present without respiratory distress?  Absolutely. Children may hypoventilate because of reduced level of consciousness (ingestion, metabolic derangements, and head trauma) or neuromuscular dysfunction. After prolonged respiratory distress, children may become fatigued, and their work of breathing may appear normal in the presence of significant hypoventilation. Elevation of the P co 2 from hypoventilation may …

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Are there different types of respiratory failure?  Some clinicians divide respiratory failure into two categories. The hypoxemic type is generally caused by mismatch of ventilation and perfusion in the lung. Hypoxemic respiratory failure from mismatch of ventilation to perfusion is often associated with normal or low P co 2 . Other patients with respiratory failure have an overall …

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When to anticipate respiratory failure?  Consider respiratory failure when there is: • An increased respiratory rate, particularly with signs of distress (e.g., increased respiratory effort including nasal flaring, retractions, seesaw breathing, or grunting) • An inadequate respiratory rate, effort, or chest excursion (e.g., diminished breath sounds or gasping), especially if mental status is depressed • Cyanosis with abnormal …

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Why is it so important to know about respiratory failure in children?  Children are at greater risk of respiratory failure than adults, so identifying those at risk, and intervening before respiratory failure occurs, is a critically important skill for pediatric clinicians. Respiratory symptoms are among the most common reasons children are taken to emergency departments …

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