See also

Acute asthma
Bronchiolitis
Croup
Pneumonia
Minimising distress in healthcare settings
Normal ranges for physiological variables

Key points

1. In general, children with respiratory distress should have minimal handling
2. The assessment of severity can mostly be made without touching the child. Parents can be asked to uncover the child’s chest/abdomen
3. Careful observation of the child is important. Oxygen saturations may be misleading

Assessment

*Signs of increased work of breathing

• Retractions (intercostal, suprasternal, costal margin)
• Accessory muscle use eg nasal flaring, sternocleidomastoid contraction (head bobbing), forward posturing
• Grunting

Accessory muscle anatomy

Other considerations

• Fever may be associated with an increase in respiratory rate and heart rate
• Respiratory sounds and auscultatory findings can be useful in assessing children with respiratory presentations. For example, wheeze in Asthma and Bronchiolitis, and stridor in Croup and Acute upper airway obstruction. Reduced air entry is an important sign
• In addition to assessing respiratory status, it is important to assess feeding and hydration as these may be affected early in respiratory illness
• Effortless tachypnoea may be due to compensation for an underlying metabolic acidosis eg sepsis, DKA

Management

Management of individual conditions can be found under specific guidelines

Consider consultation with local paediatric team when

Any child with severe respiratory distress should be discussed with a senior clinician

Consider transfer when

Management is beyond the capability of the local health care facility

For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services

Additional notes 

Example videos of increased work of breathing 

Last updated September 2024