From the Guidelines
Signs of respiratory distress in children include grunting, nasal flaring, head nodding, tracheal tugging, intercostal retractions, and very fast breathing for age, as defined by a child aged 2–11 months breathing at ≥70 breaths/min or a child aged 12–59 months breathing at ≥60 breaths/min 1. These signs are indicative of severe respiratory distress and can be associated with severe hypoxemia, a key predictor of child pneumonia. Some key signs to look out for include:
- Grunting: repetitive “eh” sounds during early expiration against a partially closed glottis
- Nasal flaring: consistent and repetitive outward movement of the ala nasi during inspiration
- Head nodding: the head consistently moves upward and downward in synchrony with respiration
- Tracheal tugging: the soft tissue over the trachea consistently pulls inward during inspiration
- Intercostal retractions: the tissue between the ribs consistently pulls inward during inspiration
- Very fast breathing for age: a child aged 2–11 months breathing at ≥70 breaths/min or a child aged 12–59 months breathing at ≥60 breaths/min It is essential to seek immediate medical attention if these signs are observed, as respiratory distress can rapidly progress to respiratory failure 1. While waiting for help, keep the child in a position that makes breathing easier and avoid agitating them, as crying increases oxygen demand. Additionally, oxygen saturation below 92% on room air is concerning and should be monitored closely 1. The presence of these signs indicates a higher likelihood of respiratory decompensation and should be taken seriously. In clinical practice, it is crucial to follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present, as outlined in the diagnosis and management of bronchiolitis guidelines 1.
From the Research
Signs of Respiratory Distress in Children
The signs of respiratory distress in children can vary depending on the underlying cause, but common indicators include:
- Altered breathing pattern
- Forced breathing efforts or obstructed breathing
- Chest indrawing
- Stridor
- Cough, fever, and difficulty in breathing or fast breathing
- Wheezing
- Mediastinal shift with severe respiratory distress
- Slow or irregular breathing in absence of any pulmonary sign
- Respiratory distress with cardiac findings 2, 3
Causes of Respiratory Distress
Respiratory distress in children can be caused by various conditions, including:
- Upper airway obstruction
- Pneumonia
- Lower airway obstruction
- Transient tachypnoea of the newborn
- Respiratory distress syndrome
- Pneumonia
- Meconium aspiration syndrome
- Persistent pulmonary hypertension of the neonate
- Pneumothorax
- Acute asthmatic crisis 2, 3, 4, 5
Assessment and Management
Assessment of a child with respiratory distress involves rapid evaluation of airway patency, breathing, and circulation, followed by specific management strategies, such as:
- Restoration of airway patency
- Supporting breathing with high flow oxygen and assisted ventilation
- Restoration of circulation using fluid boluses and inotropes
- Endotracheal intubation or tracheostomy for upper airway obstruction
- Needle thoracotomy and drainage of pneumothorax
- Administration of antibiotics for febrile children 2, 3
- Use of Continuous Positive Airways Pressure (CPAP) and mechanical ventilation in some cases 2, 6