Pediatric Respiratory Distress: Croup, Epiglottitis and Bronchiolitis

A child with respiratory distress can deteriorate quickly because swelling and secretions narrow an already small airway. The first bedside task is to locate the problem and judge whether the child is compensating, not to assign a diagnosis from one breath sound. Observe appearance, position, alertness, colour, ability to vocalize or feed, respiratory rate, work of breathing, air entry, and oxygen saturation while minimizing distress. Croup and epiglottitis affect the upper airway. Stridor, cough and voice quality, drooling, swallowing, and posture help distinguish them. Bronchiolitis obstructs the small lower airways with edema and mucus, producing tachypnea, wheeze or crackles, retractions, and feeding difficulty. Retractions can occur in all three conditions, so interpret them with the whole pattern. Keep the child with the caregiver and allow the position of comfort, usually upright. Crying, restraint, forced supine positioning, and nonessential procedures can worsen upper-airway obstruction. A child who becomes quieter while tiring may have less airflow, not less obstruction. Reduced air entry, soft or disappearing stridor, cyanosis, apnea, exhaustion, or decreasing responsiveness indicate possible respiratory failure. Immediately activate the hospital emergency or...