The Paediatric Consultation
R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne in Scott-Brown's Essential Otorhinolaryngology, 2022
A compromised airway has to be addressed as a matter of extreme urgency because it quickly affects all the organ systems. Airway compromise leads to an increase in the work of breathing. The key signs of increased work of breathing include: Stertor (snoring sound)Stridor (high-pitched sound—can be inspiratory or expiratory)Wheeze (usually expiratory)Use of accessory muscles of breathingTracheal tuggingNostril flaringFatigueSilent chestDecreased level of consciousnessOpisthotonic position (sign of severe obstruction)
Pediatric Sleep Disorders
Mark A. Richardson, Norman R. Friedman in Clinician’s Guide to Pediatric Sleep Disorders, 2016
A comprehensive head and neck examination should be performed in all children with the potential for OSA. Evaluation of the nose for the size of the nasal passageways, septal deformity, turbinate hypertrophy, anatomic obstruction or evidence of rhinorrhea pathologic exudates, sinus infection, or polyps is important. Examination of the mouth should include assessment of the tonsil size (1+, small to 4+, nearly touching), size of the uvula, tonsil pillars, tongue base, oropharyngeal, and palatal shape and size. The tongue should be depressed to visualize the inferior poles of the tonsils. Facial structure is important. Adenoid faces characterized by a long narrow facial structure are often seen in children with OSAS. Midface hypoplasia and retrognathia can be detected (Table 2). Evaluation of the neck to rule out obstructive masses or deviation of the airway is necessary. Evaluation of the patient for stertor (nasopharynx, oropharynx, and hypopharynx), stridor (cartilaginous airway), or evidence of other pulmonary disease is also important. OSA is noted with increased frequency in children with a variety of syndromes (Table 3).
Neonatal Nasal Obstruction
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
Swelling of the nasal mucosa in newborn infants can cause significant airway problems, particularly when feeding, as neonates are obligate nasal breathers. Idiopathic neonatal rhinitis is characterized by mucoid rhinorrhoea with nasal mucosal oedema in the afebrile newborn. This results in stertor, poor feeding and respiratory distress.43 Structural abnormalities should be excluded. Treatment of neonatal rhinitis depends on the severity of symptoms. Nasal bulb suction with saline drops in the first instance is recommended. A short course of nasal steroid drops would be the next step. This should be closely monitored to avoid the potential side effects from systemic absorption.
Prehospital Pediatric Respiratory Distress and Airway Management Training and Education: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
John Lyng, Matthew Harris, Maria Mandt, Brian Moore, Toni Gross, Marianne Gausche-Hill, J. Joelle Donofrio-Odmann
EMS clinicians should be educated to use a consistent and reproducible approach to patient assessment. One such approach is the “pediatric assessment triangle,” a cognitive model that guides clinicians to assess a patient’s work of breathing, circulation, and appearance (see Figure 1). Framing pediatric assessment using the “pediatric assessment triangle” construct has been shown to improve field management of children (6). Within this framework, assessing the patient’s work of breathing includes physical examination for visual cues of accessory muscle use, retractions, excessive secretions, head bobbing, and cyanosis or pallor; auditory cues of stertor, stridor, and abnormal lung sounds; and assessment of the quality and rate of respirations.
Related Knowledge Centers
- Exhalation
- Laryngomalacia
- Stridor
- Inhalation
- Respiratory Sounds
- Snoring