Key Questions to Investigate Shortness of Breath in a 2-Year-Old Child
When evaluating shortness of breath in a 2-year-old child, focus your investigation on identifying the specific respiratory pattern, associated symptoms, and potential triggers to determine the underlying cause and severity.
Initial Assessment Questions
Respiratory Pattern and Severity
- What is the child's current respiratory rate? (Normal for 2-year-old: 20-40 breaths/minute) 1
- When did the breathing difficulty start? Was onset sudden or gradual?
- Is the breathing difficulty constant or intermittent?
- Is there any color change (cyanosis or pallor) during episodes? 2
- Are there any abnormal breathing sounds (wheezing, stridor, grunting)?
- Is there visible chest retractions, nasal flaring, or use of accessory muscles?
- Does the child have difficulty speaking or feeding due to breathing problems?
Associated Symptoms
- Does the child have a cough? If yes:
- Is it dry or productive?
- When does it occur? (Day, night, with activity, only with colds) 2
- How long has the cough been present?
- Has the child had fever? If yes, how high and for how long?
- Has there been any vomiting or choking episodes?
- Is there nasal congestion or discharge?
- Has the child been unusually tired or lethargic?
- Has there been any change in the child's level of consciousness or responsiveness? 2
Triggers and Patterns
- When does the child breathe hard? (At rest, with minimal activity, only with exertion) 2
- Does the breathing difficulty worsen at certain times (night, early morning)?
- Is there any relationship to feeding?
- Does the breathing difficulty improve or worsen with position changes?
- Has the child been exposed to any potential triggers (allergens, irritants, smoke)?
Medical History Questions
Previous Respiratory Issues
- Has the child had previous episodes of breathing difficulty?
- Has the child been diagnosed with asthma, bronchiolitis, or other respiratory conditions?
- Has the child had pneumonia before? How many episodes and were any requiring hospitalization? 2
- Has the child had any previous hospitalizations for breathing problems?
Birth and Development History
- Was the child born prematurely?
- Were there any breathing problems at birth or in the neonatal period?
- Has the child met developmental milestones appropriately?
Medical History
- Does the child have any known allergies?
- Is the child taking any medications currently?
- Has the child received all age-appropriate vaccinations?
- Does the child have any congenital heart or lung conditions?
Environmental and Family History
Environmental Exposures
- Is there smoking in the home or frequent exposure to secondhand smoke?
- Have there been recent renovations or new furniture in the home?
- Are there pets in the home?
- Has there been any recent travel?
- Has the child been exposed to anyone with respiratory infections?
Family History
- Is there a family history of asthma, allergies, or other respiratory conditions?
- Do siblings or other household members have current respiratory symptoms?
Sleep-Related Questions
Sleep Patterns
- Does the child snore or have noisy breathing during sleep?
- Have you noticed pauses in breathing during sleep?
- Does the child wake up gasping or choking?
- Does the child sleep restlessly or wake frequently? 2
Foreign Body Concerns
Choking Risk
- Was there any witnessed or suspected choking episode?
- Has the child had access to small objects or food items that could be aspirated?
- Was there a sudden onset of symptoms without other explanation?
Red Flag Questions
Emergency Indicators
- Has the child had any episodes of turning blue (cyanosis)?
- Has the child been unable to drink or feed due to breathing difficulty?
- Has there been any marked decrease in activity or responsiveness?
- Has the child had any seizures or loss of consciousness with breathing difficulties? 2
Follow-up Questions Based on Initial Responses
If wheezing is present:
- Does the child respond to bronchodilators (if previously prescribed)?
- Is there a pattern to the wheezing episodes?
If stridor is present:
- Is the stridor inspiratory, expiratory, or biphasic?
- Is it worse when the child is agitated or calm?
If fever is present:
- How high is the fever?
- How long has it been present?
- Has the child received any antipyretics?
Remember that accurate assessment of respiratory rate requires counting for a full minute when the child is calm, as inaccurate counting can lead to significant errors in clinical decision-making 1. Always prioritize assessment of airway patency, breathing effectiveness, and circulation when evaluating a child with respiratory distress 3.