Paediatrics - Queensland Health - Queensland Government

Respiratory problems
3. Clinical assessment
• Obtain complete patient history of particular importance is:
- - a history of URTI symptoms in a child that is basically well
- - history of chest conditions such as asthma, pneumonia
- - if wheeze is present
- - if child has stopped breathing (apnoea) for short periods of time
-- how well is the child / infant feeding
•
•
Perform standard clinical observations + O saturation
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Perform physical examination:
- - inspect for signs of respiratory distress (grunting, nasal flaring, sternal and /
or intercostal / subcostal recession)
- - inspect middle ear
- - inspect for cyanosis (lips, tongue, extremities) present in severe cases
- - auscultate chest for presence of wheezes / crackles
4. Management
• Consult MO who will consider treating similar to:
-- acute asthma, if wheeze is prominent, however in infants bronchodilators are
unlikely to be effective
-- pneumonia, if fever and rapid breathing is prominent
-- O if SpO < 95%
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• If child / infant is not feeding well, fluids may be required NG or IV
5. Follow up
Patients who are not evacuated / hospitalised should be reviewed daily
Consult MO if the patient is not improving
6. Referral / consultation
Consult MO on all occasions bronchiolitis is suspected
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Controlled copy V1.0
Pneumonia - child
Recommend
If baby < 3 months of age contact MO immediately
Severe dehydration is unusual in pneumonia unless there are abnormal fluid losses
from frequent diarrhoea or vomiting
Background
Children with co-existent illnesses are more at risk. Examples are bronchiolitis and
chronic lung disease e.g. due to prematurity
Related topics
Upper respiratory tract infection - child
Immunisation program
Bronchiolitis
1. May present with
• Cough dry or with sputum, fever, tachycardia
• Rapid breathing, nasal flaring, grunting respirations and chest recession in infants,
cyanosis, apnoea in infants
Primary Clinical Care Manual 2011