Paediatric Resp

Question 1

Pseudoglandular stage

Answer 1

•Branching of bronchi to form terminal bronchioles

5-16 weeks

Question 2

Canalicular stage

Answer 2

Respiratory bronchioles form and divide into 3-6 alveolar ducts
16-26 weeks

Question 3

Terminal sac stage

Answer 3

Primitive alveoli form and capillaries establish close contact
26 weeks to birth

Question 4

Alveolar period

Answer 4

Mature alveoli increase in size and number

Childhood

Question 5

Features in children

Answer 5

•Neonate has a high larynx- nose breathers until 8 months
•The tongue is disproportionately large
•prominent ociput
•tongue is disproportionately
large in relation to mouth
•Larynx is higher in neck
•narrowest portion at cricoid

Question 6

Features in children 2

Answer 6

•Ribs of a newborn are horizontal and intercostals are weak
•Very compliant chest wall
•Angle of insertion of diaphragm less acute
•Diaphragm fatigues easily
•Premature babies may not have a cough reflex (<32 weeks)
Airways are soft and pliable.
•Very small diameter airways.
•Fewer B2 receptors than in adults due to paucity of smooth muscle.
Collateral ventilation pathways not established until the child is 6 years old.
Infants and young children ventilate the uppermost lung preferentially. This has important implications for positioning.

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Question 7

I for physio

Answer 7

Lobar collapsed due to plugging

•Increase or retention of secretions

Question 8

Physio techniques

Answer 8

Positioning
•Percussion
•Vibration
•“Lung squeezing”
•Manual hyperinflation- with caution and only if absolutely necessary
•Suctioning
•Lavage
•Humidification