Paediatric Respiratory Conditions Flashcards
State Common Paediatric Respiratory pathologies
- Bronchiolitis
- Chest Infections –
a. Acute Laryngotracheobronchitis (Croup)
b. Epiglottitis
c. Pneumonia
d. Pertussis (whooping cough) - Inhaled foreign body
- Cystic Fibrosis
- Primary Ciliary Dyskinesia
- Asthma
Define Bronchiolitis
Most common severe LRT disease in infancy
Caused by human respiratory syncytial virus (RSV
Clinical Presentation of Bronchiolitis
- Initial presentation is common cold type symptoms
- Develops into a dry irritating cough, wheezing, ↑ RR, & signs of respiratory distress (intercostal recession, tracheal tug)
- CXR – hyperinflation, areas of collapse or pneumonic consolidation
- Auscultation – widespread inspiratory crepitation’s & expiratory wheezes
General management of bronchiolitis
- Humidified O2
- Ribavirin antiviral
- Ventilation if required
Physiotherapy management of Bronchiolitis
- Careful & regular assessment
* Techniques should be applied only when sputum retention or mucus plugging is a problem
Define Croup (Acute Laryngotracheobronchitis)
Viral infection of the upper airway in 6months-4 years
Clinical presentation of Croup
• Initial presentation is common cold type symptoms (runny nose)
Develops into fever, harsh barking cough & hoarse voice, stridor on inspiration & signs of respiratory obstruction. Severely affected may develop respiratory failure. May also be a temperature but this is usually below 38.5o if the infection is viral
General management of Croup
• Humidified O2
• Glucocorticoids (dexamethasone & budesonide)
• Nebulised adrenaline
Respiratory support (CPAP etc.)
Physiotherapy management of Croup
- Contraindicated in the non-intubated child
* May be required should the child be intubated for secondary complications e.g. sputum retention
Define Epiglottitis
Very dangerous condition occurring in 1-7years
Caused by Haemophilus Influenzae
Rare since the introduction of ‘Hib’ vaccine
Clinical presentation of epiglottitis
Sudden onset of severe sore throat & high temperature. Rapid development of stridor & dysphagia with the child being unable to swallow saliva & drools. Acute & possibly fatal obstruction of airway can develop
general management of epiglottitis
Child should not be disturbed in any way or their throat assessed as it could lead to acute life threatening obstruction
Nasal intubation or occasionally a tracheostomy
Physiotherapy management of epiglottitis
Contraindicated in the non-intubated child
May be required should the child be intubated for secondary complications e.g. sputum retention
Causes of Pneumonia
Different causes – Staphylococcus aureus (neonates), RSV (infant) & Mycoplasma, Streptococcus pneumoniae or Haemophilus influenzae (child)
Clinical presentation of pneumonia
• Present with pyrexia (fever), dry cough, ↑RR, & recession of ribs & sternum
CXR – consolidation
General management of pneumonia
- Fluids
- Humidified O2
- Broad spectrum antibiotics
Physiotherapy management of pneumonia
- Careful & regular assessment
* Appropriate airway clearance techniques
Causes of Whooping cough (pertussis)
Caused by Bordetella pertussis
Last epidemic in UK in 2012
Clinical presentation of whooping cough
- Cough becomes paroxysmal, worse at night. Spasms of coughing may cause hypoxia (ow oxygen levels at tissue level) & apnoea (Absence of breathing for more than 15 seconds)
- At the end of coughing there is inspiratory stridor.
- Often bouts of coughing lead to vomiting & expectoration of sputum
- Coughing phase can last 6-8 weeks
General management of whooping cough
- Most managed at home
- Treatment is supportive
- Minimal handling to reduce disturbance which may precipitate coughing spasms
Physiotherapy management of whooping cough
- Contraindicated during the early stages as may induce coughing
- May be required should the child be intubated for secondary complications e.g. sputum retention
Define CF
Most common inherited recessive condition in Caucasians & affects 1 in 2500 births
Chromosome 7, which encodes for the CF transmembrane conductance regulator (CFTR), is defective. This leads to a problem in ion transport which results in low or abnormal salt concentration → increased mucus viscosity
Clinical presentation of CF
Impaired mucociliary clearance → recurrent chest infections with gradual lung destruction. Primary areas affected are respiratory tract & digestive tracts but it is a multisystem disorder
General management of CF
- MDT approach (dietician, CF nurse, PT, Drs, Psychologists)
- Drug therapy
- Organ transplant in later life
Physiotherapy management of CF
- At point of diagnosis chest clearance techniques are introduced & taught to parents/carers
- Education of self management as child grows up
Define primary ciliary dyskinesia
Rare genetic disorder (1 in 15-30,000)
Leads to either abnormal structure of the cilia; normal structure of the cilia, but abnormal function; absence of cilia
Results in recurrent infections of ears, nose, sinuses & lungs, & fertility issues
General management of PCD
- Drug therapy
- Monitoring of hearing +/- hearing aids
- Assisted conception may be needed in adulthood
Physiotherapy management of PCD
At point of diagnosis chest clearance techniques are introduced & taught to parents/carers
Education of self-management as child grows up
Define Asthma
Increased responsiveness of smooth muscles in bronchial walls to various stimuli causing constriction & airway inflammation
Hypertrophy of mucous glands may lead to mucous plugging, airway obstruction, which may become chronic & severe
Risk factors for asthma
• Children are more likely to develop it if parents or close relatives are asthmatic or atopic
Other links are those from low socioeconomic background, outdoor pollution, dietary factors & passive smoking
General management for asthma
Drug therapy
Physiotherapy management for asthma
- Education of child & parents about condition
- Advise on exercise/exercise programmes
- Chest clearance techniques if there is sputum
