Final - Peds Flashcards
Signs of respiratory problems
- Lack of breath support
- Breathy, broken speech
- Weak cough
- Audible breathing
- Bluish tinge to skin around mouth, nail beds
- Poor endurance
signs of respiratory problem specific to children
- Frequent rests with motor tasks
- Poor sleeping
- Decreased appetite
normal chest development in an infant
- 1/3 of trunk cavity
- Triangular in shape
- short neck
- Narrow upper chest
- Flared lower ribs
- Narrow intercostal spacing
- Belly Breather
normal chest development of adult
- > ½ trunk cavity
- Rectangular shape
- Wide upper chest
- Lower ribs integrated with abdominals
- Wide intercostal spacing
see comparison of infant to adult chest
how does gravity influence normal chest development?
skeletal development
muscle activation
pectus excavatum
*“Funnel Chest”/Concave
*Depresses lower sternum
*Causes breathing restrictions when severe
pectus carinatum
- “Pigeon” chest
*Chest wall is rigid
*Can also impact respiration when severe
*May result in fatigue and SOB
flattened chest wall due to:
- Weakness
- Paralysis of intercostal muscles
- Prolonged supine positioning
flared ribs due to:
oblique muscle weakness or paralysis
what is asymmetry caused by:
muscle weakness on one side of the trunk
kyphosis due to:
●Low tone in the trunk
●Paraspinal and abdominal muscle weakness
●Hamstring tightness
● Abnormally shaped spine
respiratory development in utero
● 4th week- start
● 16th week- bronchioles form
● 20th week- surfactant released
● 28th week- matured and child may be able to breath on own
why does infant breathing require more work
- Narrow airway –easily obstructed
- Nose breather-
- Larynx is higher –so baby can breathe and swallow at same time
- Diaphragm is main muscle of respiration
- Diaphragm fatigability
- Increased respiratory rate
- Increased O2 consumption
- Less efficient chest wall mechanics
development of breathing - child to adult
- Ribs stay more horizontal than adults until approximately 7 years of age
- Number of alveoli increases until approximately 8 years of age, then rate slows
- Lymphatic tissue (i.e. adenoids) grow rapidly –many children need removed
- Type I fibers
- Develops use of intercostal muscles, abdominal muscles, and accessory muscles of respiration
trunk muscles have dual function
- breathing and postural support
- breathing always wins
- need to optimize posture for motor function to be efficient
Weakness of respiratory and postural
muscles may cause:
- Thoracic stiffness (immobile chest)
- Rib Flaring
- Hypoventilation
- Increased work of breathing
- Inefficient cough
- Risk of aspiration
- Poor breath support for vocalization
Ribcage Development in Children with Cerebral Palsy
*Chest high (elevated)
*Chest flattened anteriorly
*Rib flaring
Down Syndrome
- Trunk weakness/Hypotonia
- Rib flaring
- scar tissue – from cardiac surgeries
- Decreased size of nasal passageways
Myelomingocele –dependent on level of innervation
- Arnold Chiari II, inspiratory stridor, apnea, respiratory distress
- Trunk Weakness – insufficient diaphragm support/dependent on level of innervation
- Hypotonia – insufficient diaphragm support/dependent on level of innervation
sequence of normal breathing
*First: with easy onset, subtle rise of abdomen
*Second: lateral costal expansion
*Third: gentle rise of the upper chest primarily in the superior and anterior planes
Normal Respiratory Patterns
*Abdominal breathing
*Abdominal thoracic breathing
*Asynchronous breathing (normal for crying baby)
Abdominal Breathing
- Normal for infants
- See expansion in abdominal wall rather than in thorax
- Respiration shallow and rapid
- May be retained in some children with disabilities
abdominal thoracic breathing
- Begins at 6-8 months when a child can:
- sit up against gravity
- actively rotate trunk
- actively extend trunk
- See thoracic expansion during breathing
- Begin utilization of intercostal mm
Asynchronous Breathing
- See when infant or young child cries or with a lot of effort of breathing
- Upon inspiration, see abdominal expansion with thoracic depression
- Can result in retraction of the sternum
when can diagnosis of congenital heart defects occur?
prenatally, perinatally, after discharge home, or into adolescence
congenital heart defects signs and symptoms
abnormal respiratory signs, increased RR, labored breathing, diaphoretic, tachycardia, edema around eyes, decreased urine output (dry diaper), eating problems, growth and developmental delays
acyanotic
VSD and ASD
L –> R
Pink
Mixing of oxygenated blood
cyanotic
Tetralogy of Fallot, left hypoplastic heart syndrome
R –> L
Blood not getting O2
Blue
Heart defects associated with Down Syndrome
ASD
VSD
– observed
which heart defect typically needs surgery
AVSD
What are the potential effects of a congenital heart defect on development and PT intervention?
- poor postural control
- delayed motor skill development
- decreased endurance
- scars
- family coach on what child is able to do
pulmonary complications commonly seen in NICU
- Respiratory Distress Syndrome (RDS) – restrictive lung disease
- Bronchopulmonary Dysplasia (BPD)
– restrictive lung disease - Chronic Respiratory Failure (CRF)
Respiratory Distress Syndrome
- AKA Hyaline Membrane Disease (HMD)
- commonest cause of preterm neonatal mortality
- RDS occurs primarily in premature infants; its incidence is inversely related to gestational age and birth weight
RDS - Mortality
30% infant deaths, 50-70% preterm infant deaths
RDS Causes
○Pulmonary immaturity
○Deficiency of surfactant
Respiratory Distress Syndrome Symptoms
- Periodic breathing – 5-10 second pauses in breathing
- Apnea – absence of breathing for more
than 20 seconds OR more than 10 seconds with cyanosis, pallor, or bradycardia
*Bradycardia
RDS - Bradycardia
*HR < 100 bpm – life threatening if untreated
Normal HR
- newborn: 120-160 bpm
- premature infant: 120-180 bpm
what is the most common chronic lung disease in infants
bronchopulmonary dysplasia
what is bronchopulmonary dysplasia
*Unresolved or prolonged RDS
*Scarring of lung tissue & thickening of pulmonary arterial walls
*Dependence on supplemental oxygen
*Severe BPD increases incidence of Developmental Delay
significance for working with kids with bronchopulmonary dysplasia
*Increased airway resistance
*Large increase in the work of breathing
*Frequent respiratory infections
what is chronic respiratory failure defined as?
treatment with mechanical ventilation for more than 28 days
what is chronic respiratory failure caused by?
*BPD
*Inadequate force generation of respiratory muscles caused by muscle disease (DMD)
*SCI
*Chest wall defects
*Muscle fatigue
*CHF
*Airway abnormalities
what is respiratory syncytial virus?
-Most common cause of respiratory illness in
infants and young children
-Can be severe in babies younger than 6 months
old, babies that are born prematurely, and babies
with congenital heart or lung disease
-also severe in older adults, adults with
compromised immune systems, or those with
asthma
***obstructive lung disease
what is highly correlated with later diagnosis of asthma
RSV in infancy
what is cystic fibrosis
- Obstructive lung disease
- Most commonly inherited life-shortening illness in the Caucasian population- no longer true due to advances in medicine
- early detection with newborn screening
- Autosomal recessive, CFTR gene-discovered
diagnosis of cystic fibrosis
Sweat test – elevated sodium chloride
Pulmonary function test
Genetics
CF usually dx in infancy
asthma
- most common childhood illness
- > 3 million children in US dx/yr
- more common in boys, but then more common in women
- 3 X more common in black children
diagnosis of asthma
- History
- Physical exam including auscultation
- Pulmonary Function Test
- Response to methacholine challenge
symptoms of asthma
*SOB
*Chest tightness
*Coughing
* Seasonal challenges
What are the Potential Effects of
Pulmonary conditions on development
*Decreased activity level
*Secondary musculoskeletal
changes
RDS Management
- Oxygen supplementation and assisted
ventilation - Prophylactic surfactant administration
- Maternal steroids –> Administered prior to delivery to facilitate production of surfactant
RDS Management: ECMO
- Technique of cardiopulmonary bypass used to
support heart and lung function - Used for newborns with respiratory failure
- Lungs allowed to recover without
mechanical ventilation - Risk of systemic and intracranial
hemorrhage –> Due to systemic heparin administration
BPD Medical Management
- Respiratory support - mechanical vent.
- Nutrition and fluid management
- Diuretic drugs
- Bronchodilator drugs
- Steroid therapy
PT Role in BPD
● Infection control
● Chest PT
● Musculoskeletal considerations
● Strengthening muscles of respiration
● Positioning
● Anticipate and assist to meet developmental
milestones
management of CF
- Limit effects of airway obstruction
- Nutrition and enzyme supplementation
- Pulmonary function tests and x-rays
- PEP mask
- Lung transplant
PT role in CF
- Chest PT-postural drainage & percussion
- MSK considerations
- Developmental activities
- Nutrition counseling
Asthma Management - Pharmacologic
- Short term relief
- Long term
management - Possible side
effects of asthma
medications
PT role in asthma
- Consultation and promotion of safe
participation in fitness activities and
recreational sports - Short term physical therapy to improve
activity tolerance - Physical therapy to address secondary
musculoskeletal impairments
review child postural drainage positions
