There are a number of causes that disturb the regulated exchange of oxygen in the child’s lungs and need to be clarified. A respiratory disorder is the most common cause of death in children under one year of age. In children, respiratory distress is manifested by nasal wings, rapid breathing, chest retractions and so-called rocking breathing. A blue discolouration of the lips and nails or mucous membranes only occurs when the child’s undersupply is far advanced and when the oxygen saturation of the blood is less than 4g/dl. Disturbances of consciousness, such as restlessness or clouding, also indicate a relatively pronounced undersupply of the child.
As a first measure, the child should be calmed down in any case, because every patient with shortness of breath panics, and this makes the shortness of breath even worse. If the shortness of breath is stable, i.e. the child is responsive, shows increased work of breathing with nasal wings etc., it is advisable to secure the air in the room. This can be done by opening windows, loosening the child’s clothing around the neck, providing access to fresh air and doing breathing exercises with the child (set a calm breathing rate). A doctor should be consulted as soon as possible. In the case of unstable breathing difficulties (child is blue/cyanotic, no longer responsive), intubated ventilation should always be performed in an intensive care unit.
Common causes and their therapy
Causes of respiratory distress in a child can include the so-called pseudo-Krupp syndrome. This is a viral inflammation of the mucous membrane of the larynx and the bronchi. The viruses that usually cause this are: parainfluenza viruses, influenza viruses, rhinoviruses and RSV.
In addition to shortness of breath, the child also has a rushing sound of breathing (inspiratory stridor), hotness and barking cough. Depending on its severity, Pseudo-Krupp syndrome is divided into four different stages. The aim of treatment is to reduce the swelling of the mucous membrane.
This is done with simple methods, such as moistening the air you breathe with a wet washcloth on your nose or running the shower, but you must also consider the administration of cortisone. In very severe cases, the pseudo croup attack must be treated by intubation with oxygen or adrenaline. To be separated from the pseudo croup is the so-called epiglotittis, which is mainly caused by Haemophilus Influenza B bacteria.
This is an inflammation of the epiglottis, which can be accompanied by a thickening and thus to an airway obstruction. Again, the child usually has an inspiratotic stridor. In addition, there is also increased salivation, aphonia and high fever.
This is an absolute emergency, which must always be treated in hospital and always in preparation for intubation with artificial respiration. The therapy is done by antibiotic treatment by infusion. If you suspect a foreign body in your child’s nose, a further cause of a respiratory emergency is an asthma attack.
This is characterised by the presence of shortness of breath, coughing and dry breathing sounds known as gulling and humming, which can be heard by the doctor using a stethoscope. In most cases, viral infections, particular physical exertion and contact with an allergenic substance are the cause of an asthma attack. It is important to ask at the time of diagnosis whether there have been asthma attacks before, whether there is an occurrence in the parents or siblings or whether there is a general tendency to allergies (hay fever, neurodermatitis etc.)
in the family. As a first measure, the upper part of the child’s body should be raised, the child should be calmed down, oxygen should be given by nasal cannula and salbutamol should be administered to dilate the bronchi. Depending on the severity of the asthma attack, it may also be necessary to administer cortisone or salbutamol continuously.
It is important to be aware of the side effects of this intensive therapy, which can manifest themselves in restlessness, trembling and reduced potassium blood levels (hypokalemia). Children who suffer from chronic coughing, recurring pneumonia and sometimes symptom-free intervals may have inhaled a foreign body (peanut, etc.) unnoticed by their parents.
In this case, only the removal of the foreign body by bronchoscopy can help. In the event of an acute obstruction of the airways through inhalation, the sitting child should be struck three times with the flat of the hand on the back between the shoulder blades. For small and school children the Heimlich manoeuvre should be performed.
For this the helper stands behind the patient and grasps him with both arms. The helper forms a fist with one hand and places it between the patient’s navel and chest. With the other hand he grasps the fist and pulls it up at an angle with a jerk.
The resulting overpressure is intended to transport the foreign body upwards. According to the latest findings, if these manoeuvres remain unsuccessful, the child should be ventilated, the aim being to supply the child with the necessary oxygen and to transport the foreign body further into the lungs instead of outwards. The idea is that at least one lung can be ventilated in this way and that the life of the child can be saved.