Remote Primary Health Care Manuals

Acute assessment of breathing problems in children

A medical consult is recommended where there is no specific protocol for a condition

  • Always consider sepsis — signs and symptoms can include
    • High or low temperature
    • Fast breathing
    • Fast pulse
    • Low BP or dizziness
    • Confusion and/or agitation
Red Flags — Urgent Medical Consult
  • Baby under 2 months with a breathing problem
  • Baby under 3 months with fever (Temp more than 38°C) — mandates empirical antibiotic therapy
  • Apnoea — stops breathing for short periods (mainly infant)
  • Increased work of breathing (any age)
  • Oxygen saturation less than 90% on room air or less than 94% on oxygen and not improving
  • Hyperglycaemia in children with rapid breathing
  • Persisting tachycardia for age
  • Not interested in what is happening, lethargic (drowsy)
  • Not able to eat/feed
  • Seizures (fits)

Check

  • Calculate age-appropriate REWS
    • Adult — AVPU, RR, O2 sats, pulse, BP, Temp
    • Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL
  • If REWS score 3 or more — urgent medical consult
  • If available POC Test — WBC, electrolytes
  • History and head-to-toe exam
  • Immunisation status

Table 1.12   Some causes of breathing problems in children

Signs and symptoms

Possible cause

Fast breathing, cough, tachycardia, fever (Temp more than 38°C), looks unwell

Chest infection

Cough, fast breathing, wheeze, runny nose — age 2–11 months

Bronchiolitis

Cough, fast breathing, wheeze, runny nose, fever — age 1 year and over

Viral induced wheeze — medical consult

Frequent night cough

Asthma

Frequent chest infections, chronic moist or productive cough

Chronic Suppurative Lung Disease

Coughing in spells, with or without whoop

Vomiting, going red in face, cyanosis (blue lips), apnoea (stopping breathing) with coughing spells

Whooping Cough — medical consult

Noisy breathing, wheeze

Story of choking on something

Inhaled foreign body — medical consult

Choking

Barking cough, stridor (noisy when breathing in)

Croup — medical consult

Fast breathing, tachycardia, pallor, cyanosis, sweating, difficulty feeding

Known heart problems, fast breathing, sweating, thready pulse, fatigue, oedema

Fever (infection elsewhere) may expose underlying heart problems

Heart failure — medical consult

Rapid breathing without signs of increased work of breathing

Often with abdominal pain, vomiting and tachycardia

Diabetic ketoacidosis — medical consult