Pediatric Respiratory Care
Today, we're focusing on our smallest patients. Children aren't just small adults when it comes to respiratory care - their anatomy, physiology, and even the way they respond to illness create unique challenges and considerations.
Anatomy and Physiology: The Big Differences in Small Airways
Children's respiratory systems differ from adults in several important ways:
1. Airway Size and Structure
Smaller diameter airways: A 1mm reduction in airway diameter (from swelling or secretions) increases airway resistance 16-fold in children! That's why conditions like croup can cause serious distress so quickly.
Shorter, softer trachea: More susceptible to collapse or kinking
Proportionally larger tongue: Can more easily obstruct the airway
Higher laryngeal position: Makes them less prone to aspiration but more challenging to intubate
2. Respiratory Mechanics
Chest wall is more compliant: Less able to maintain negative intrapleural pressure
Fewer alveoli: Newborns have about 1/10 the number of adults
Immature respiratory muscles: Tire more quickly during distress
Higher metabolic rate: Requires more oxygen per kilogram of body weight
Higher respiratory rates: Normal varies by age (see chart below)
3. Developmental Timeline
Normal respiratory rate by age:
Newborn: 30-60 breaths per minute
Infant (1-12 months): 25-40 breaths per minute
Toddler (1-2 years): 20-30 breaths per minute
Preschool (3-5 years): 20-25 breaths per minute
School age (6-12 years): 18-22 breaths per minute
Adolescent: 12-20 breaths per minute
Did You Know? A newborn takes approximately 40 million breaths in their first year of life! That's nearly 10% of all the breaths they'll take in their entire lifetime.
Common Pediatric Respiratory Conditions
Bronchiolitis
What it is: Inflammation of the small airways (bronchioles), typically caused by respiratory syncytial virus (RSV)
Age group most affected: Infants under 12 months
Key signs:
Increased work of breathing
Nasal flaring
Wheezing
Poor feeding
Retractions
Treatment approach:
Primarily supportive care (oxygen, hydration)
Suctioning to clear nasal passages
Most cases do not require bronchodilators
Severe cases may need hospitalization for respiratory support
Croup (Laryngotracheobronchitis)
What it is: Viral infection causing inflammation of the upper airway, particularly the larynx and trachea
Age group most affected: 6 months to 3 years
Key signs:
Barking cough (the classic "seal bark")
Inspiratory stridor
Hoarse voice
Symptoms often worse at night
Treatment approach:
Cool mist or night air often helps
Oral corticosteroids to reduce inflammation
Racemic epinephrine via nebulizer for moderate to severe cases
Keeping child calm (crying worsens symptoms)
Parent tip: The classic "steamy bathroom" treatment where parents run a hot shower to create steam while sitting with their child is no longer widely recommended. Research shows cool mist actually works better for most cases of croup.
Asthma
What it is: Chronic inflammatory disorder causing airway hyperresponsiveness and variable airflow obstruction
Age considerations:
Diagnosis can be challenging before age 5
Triggers and presentations may differ from adults
More likely to be intermittent than persistent in young children
Treatment modifications:
Age-appropriate inhalers and spacers
Different medication dosing
Greater emphasis on trigger avoidance
More careful medication side effect monitoring
Special challenge: Teaching proper inhaler technique to youngsters requires creativity. For young children, using mask attachments with spacers and turning it into a game can help.
Foreign Body Aspiration
What it is: Inhalation of a foreign object into the airway
Age group most affected: 6 months to 4 years (they explore with their mouths but don't have molars to chew small objects)
Common culprits: Nuts, seeds, popcorn, small toys, beads, buttons
Key signs:
Sudden coughing, choking, or gagging episode
Wheezing (often unilateral)
Decreased breath sounds on affected side
Sometimes completely asymptomatic after initial event!
Urgent intervention needed:
Bronchoscopy for removal
Can cause long-term complications if missed
Unique Aspects of Pediatric Respiratory Assessment
The Art of Observation
In pediatrics, observation before touching is crucial. Watch for:
Position of comfort (often leaning forward, tripod position)
Work of breathing (retractions, nasal flaring)
Level of activity and alertness
Color (central cyanosis vs. acrocyanosis)
The Importance of Respiratory Rate
Count for a full minute if possible
Count before disturbing the child
Know age-appropriate norms
Trend is as important as absolute number
Auscultation Tips
Warm your stethoscope!
Use distraction techniques
Listen through a thin shirt if the child is upset
Consider listening while child is sleeping
Start with areas less likely to tickle or frighten
Respiratory Therapies: Kid-Sized Approaches
Oxygen Delivery
Pediatric considerations:
Children often fight masks – consider nasal cannula when possible
Blow-by oxygen is less effective but better than nothing when a child won't tolerate other methods
Creative disguises for oxygen masks (animal faces, superhero themes) can improve acceptance
High-flow nasal cannula has revolutionized pediatric respiratory support
Aerosol Therapy
Modifications for success:
Age-appropriate interfaces (masks vs. mouthpieces)
Shorter nebulization times when possible
Bubble blowers or toys can encourage proper breathing patterns
Consider metered-dose inhalers with spacers and masks for young children
Airway Clearance
Techniques by age:
Infants: Modified postural drainage, gentle percussion
Toddlers: Incorporate play (blowing cotton balls, bubbles)
School-age: PEP devices, flutter valves
Adolescents: Autogenic drainage, high-frequency chest wall oscillation
*Disclaimer: This blog post is for educational purposes only. Always consult with healthcare professionals for medical advice regarding pediatric respiratory concerns. <3