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Questions and Answers
What is a common sign of deterioration in an unwell infant or child?
What is a common sign of deterioration in an unwell infant or child?
Which of the following conditions is characterized by wheeze, mucus plugging, and hypoxia?
Which of the following conditions is characterized by wheeze, mucus plugging, and hypoxia?
In managing bronchiolitis, what is the primary aim of treatment?
In managing bronchiolitis, what is the primary aim of treatment?
What is considered a pre-terminal sign in a sick child?
What is considered a pre-terminal sign in a sick child?
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What respiratory rate indicates severe respiratory distress in an infant aged 2-5 years?
What respiratory rate indicates severe respiratory distress in an infant aged 2-5 years?
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Which symptom is NOT commonly associated with respiratory illnesses in children?
Which symptom is NOT commonly associated with respiratory illnesses in children?
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What condition is characterized by inflammation of the bronchioles, typically caused by RSV?
What condition is characterized by inflammation of the bronchioles, typically caused by RSV?
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What is a potential consequence of hypoglycaemia in an unwell child?
What is a potential consequence of hypoglycaemia in an unwell child?
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Which of the following respiratory conditions mainly presents with low-grade fever and possible apnoea?
Which of the following respiratory conditions mainly presents with low-grade fever and possible apnoea?
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Which feature is common to all respiratory illnesses in children?
Which feature is common to all respiratory illnesses in children?
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What anatomical feature contributes to respiratory distress in infants up to 6 months?
What anatomical feature contributes to respiratory distress in infants up to 6 months?
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What indicates serious respiratory compromise during labored inspiration in children?
What indicates serious respiratory compromise during labored inspiration in children?
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Which of the following is a characteristic of an infant's airway compared to that of an adult?
Which of the following is a characteristic of an infant's airway compared to that of an adult?
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Which skin color change is specifically caused by inadequate oxygenation in children?
Which skin color change is specifically caused by inadequate oxygenation in children?
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What could loose teeth in a young child potentially cause?
What could loose teeth in a young child potentially cause?
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What abnormal skin condition may indicate patchy areas of pallor and cyanosis in infants under 2 months of age?
What abnormal skin condition may indicate patchy areas of pallor and cyanosis in infants under 2 months of age?
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Which sign reflects shunting of blood away from the skin in children?
Which sign reflects shunting of blood away from the skin in children?
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What is a true statement regarding the head size of infants?
What is a true statement regarding the head size of infants?
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What distinguishes the respiratory system of infants compared to adults?
What distinguishes the respiratory system of infants compared to adults?
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Why is pulse oximetry particularly important in managing unwell children?
Why is pulse oximetry particularly important in managing unwell children?
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What does mottling in the skin indicate in infants?
What does mottling in the skin indicate in infants?
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Which anatomical feature of infants contributes significantly to their respiratory distress?
Which anatomical feature of infants contributes significantly to their respiratory distress?
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What is a common consequence of nasal passages filling with mucus in infants?
What is a common consequence of nasal passages filling with mucus in infants?
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What is indicated by pallor in the skin of a seriously ill child?
What is indicated by pallor in the skin of a seriously ill child?
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What is the typical size of an infant's head compared to their adult size?
What is the typical size of an infant's head compared to their adult size?
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What skin change could indicate inadequate oxygenation in children?
What skin change could indicate inadequate oxygenation in children?
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What is the primary purpose of frequently reassessing an unwell infant or child during the paediatric primary survey?
What is the primary purpose of frequently reassessing an unwell infant or child during the paediatric primary survey?
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Which of the following symptoms may indicate dehydration or shock in an unwell child?
Which of the following symptoms may indicate dehydration or shock in an unwell child?
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Which respiratory condition is characterized by acute inflammation of the airways and is rare in children under 5 years?
Which respiratory condition is characterized by acute inflammation of the airways and is rare in children under 5 years?
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In managing a child with bronchiolitis, which treatment aim is emphasized?
In managing a child with bronchiolitis, which treatment aim is emphasized?
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What respiratory rate is indicative of severe respiratory distress in a child aged 2-5 years?
What respiratory rate is indicative of severe respiratory distress in a child aged 2-5 years?
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Which sign or symptom is NOT typically associated with bronchiolitis?
Which sign or symptom is NOT typically associated with bronchiolitis?
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Which of these is considered a pre-terminal sign in a sick child?
Which of these is considered a pre-terminal sign in a sick child?
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Which symptom is commonly associated with respiratory illness in children and indicates compromised breathing effectiveness?
Which symptom is commonly associated with respiratory illness in children and indicates compromised breathing effectiveness?
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Which factor primarily affects the respiratory rate in a child with respiratory illness?
Which factor primarily affects the respiratory rate in a child with respiratory illness?
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What is a common characteristic feature of the first wheezy episode in infants with bronchiolitis?
What is a common characteristic feature of the first wheezy episode in infants with bronchiolitis?
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Study Notes
Unwell Infant and Child: Anatomical & Physiological Differences
- Infants & Children have disproportionately sized heads, with an infant head being 2/3 of its adult size
- The tongue of a child is large, and they are nasal breathers until 6 months, with nasal congestion readily reducing airflow
- Loose teeth are also a foreign body hazard in infants and children as their airway is much smaller than adults
Airway Differences
- The occiput in infants is large and prominent, contributing to airway issues
- Infants have a small face with narrow nostrils that can restrict breathing, causing recession during labored inspiration
- Nasal passages narrow easily, which can be a sign of serious respiratory compromise in infants
P.A.T. Circulation to Skin
- Pallor (white skin) can occur as blood is shunted away from the skin
- Cyanosis (blue discolouration) is caused by insufficient oxygen, with infants normally having slightly blue hands and feet, especially under 2 months or when exposed to the cold
- Mottling (patchy paleness and cyanosis) can indicate an issue with blood vessel tone in the extremities
Paediatric Primary Survey (DR ABCDE)
- Airway: Ensure airway is patent
-
Breathing: Check respiratory rate according to age
- ≤ 40/min for ages 2-5 years
- ≤ 30/min for ages > 5 years
- Circulation: Assess pulse, capillary refill, skin warmth, according to age
- Disability: Use the AVPU scale to assess level of consciousness. Also check pupil response and blood sugar levels
- Exposure: Remove clothing to fully expose child for assessment
Signs of Deterioration
- Increased work of breathing (recession, increased respiratory rate)
- Cyanosis
- Bradycardia (pre-terminal sign in a sick child)
- Altered mental status / drowsiness
- Hypo / hypertonia
- Dehydration / signs of shock
- Hypoglycaemia
Respiratory Illness and Emergencies
- Common, usually self-limiting illnesses
- Tachypnoea (rapid breathing) is a key symptom for most respiratory issues
Respiratory Issues in Children
- Asthma: Inflammation of the airway causing tightness, wheezing, mucus plugging, hypoxia and dehydration. Usually affects children over 5 years
-
Bronchiolitis: Inflammation of the bronchioles, usually caused by RSV, peaked during autumn and winter
- Often affects babies between 2-5 months
- Symptoms worsen in the first 72 hours before starting to improve
- Other household members may also exhibit similar symptoms
Bronchiolitis Management
- DR ABCDE assessment, prioritize airway and breathing
- Provide respiratory support and encourage hydration and feeding
- Administer oxygen if SpO2 is persistently low
- Transport promptly if necessary.
Anatomical and Physiological Differences in Children
- Children have large heads, with a newborn's head already reaching 2/3 of its adult size.
- Infants have small nostrils and are nasal breathers until 6 months old, which makes them susceptible to respiratory distress if their nostrils are blocked with mucus.
- Loose teeth in infants and children can be a choking hazard due to the smaller airway.
Airway Differences in Children
- Children have a prominent occiput (back of the head).
- They have a small face and narrow nostrils, which can become recessed during labored breathing, a sign of serious respiratory compromise.
Assessing Circulation in Children
- Pallor: White or pale skin indicating blood shunting away from the skin.
- Cyanosis: Blue skin discoloration caused by insufficient oxygenation. Note that cyanosis can be normal in infants under 2 months old or those exposed to cold environments.
- Mottling: Patchy areas of pallor and cyanosis on the hands and feet due to abnormal vessel tone in the capillary bed.
Paediatric Primary Survey
- Airway: Ensure an open airway.
- Breathing: Assess respiratory rate based on age.
- Circulation: Assess pulse, capillary refill, and skin warmth based on age.
- Disability: Use the AVPU scale (Alert, Voice responsive, Pain responsive, Unresponsive) to evaluate consciousness. Check pupil response and blood sugar levels.
- Exposure: Fully expose the child for a complete assessment.
- Reassess frequently, ideally within 2 minutes.
Signs of Deterioration in Children
- Increasing work of breathing (recession, rapid respiratory rate).
- Cyanosis.
- Bradycardia (slow heart rate, a pre-terminal sign).
- Altered mental status or drowsiness.
- Hypo or hypertonia (decreased or increased muscle tone).
- Dehydration or signs of shock.
- Hypoglycemia (low blood sugar).
Respiratory Illnesses and Emergencies
- Childhood respiratory illnesses are common and usually self-limiting.
- Tachypnoea (rapid breathing) is a common feature in respiratory illness.
- Respiratory illnesses include: asthma, bronchiolitis, upper respiratory tract infections (URTIs), lower respiratory tract infections (LRTIs) including pneumonia, croup, and epiglottitis.
Asthma
- Acute inflammation of the airways, leading to wheezing, mucus plugging, hypoxia, and dehydration.
- Asthma is rare in children under 5 years of age.
- Key indicators of severity:
- Respiratory rate: >40/min in ages 2-5 years, >30/min in ages >5 years.
- Hypotension (low blood pressure): >110 in adults.
- Exhaustion.
- Abnormal partial pressure of carbon dioxide (PaCO2) >25/min in adults. (Normal range is 4.6-6.0 kPA).
Bronchiolitis
- Inflammation of the bronchioles.
- Acute, self-limiting infection usually caused by respiratory syncytial virus (RSV).
- Most prevalent during autumn and winter.
- Characterized by a "coryzal baby" (peak age 2-5 months) with a first wheezy episode.
- Most severe within the first 72 hours, gradually improving thereafter.
- Other household members may also exhibit similar symptoms.
Signs and Symptoms of Bronchiolitis
- Reduced oxygen saturation (SpO2)
- Increased respiratory rate.
- Recession (inward pulling of the chest).
- Irregular breathing.
- Inspiratory crackles.
- Expiratory wheeze.
- Low-grade fever.
- Possible apnoea (temporary cessation of breathing).
Management of Bronchiolitis
- Follow DR ABCDE sequence, prioritizing airway and breathing, and then transporting the child.
- Treatment focuses on respiratory support, feeding, and hydration.
- Administer oxygen for persistent low oxygen saturations.
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Description
Test your knowledge on the anatomical and physiological differences in infants and children. This quiz covers airway differences and the significance of circulation to the skin in unwell young patients. Understand how these factors impact respiratory health and overall care for children.
