Pediatric Flashcards
1-3 months chest wall structure and shape
Ribs cartilaginous
- Good for birth not for breathing as high pressure can pull ribs into the lungs
- High chest wall compliance
Ribs horizontal and close together
- Intercostals ineffective (not formed appropriate length-tension relationship to produce effective chest wall movement)
Chest shape
- Tight anterior chest wall - triangle shape
-Round in transverse plan
Lungs at 1-3 months
Immature alveoli structure and function
- Less efficient gas exchange
Decreased lung compliance
- Requires larger pressure to expand
- Strong elastic recoil on expiration
- Increased susceptibility to atelectasis
Less alveoli to recruit –> Poor respiratory reserve
Airways at 1-3 months
Softer
- More susceptible to collapse (Malacia)
Narrow
- Easily obstructed by edema, mucus, spasm or foreign objects
Respiratory muscle use and energy stores at 1-3 months
Diaphragm breathers
- Unable to recruit accessory muscles
- Anything that interferes with diaphragm excursion can results in respiratory distress
Less proportion of type 1 fibres
Less glycogen supplies and depleted quickly
At 1-3 months, kids are primary __ breathers.
Pros and cons of this?
- Primary nose breathers
- Allows them to feed without breaking suction - Increased danger of nasal plugging with secretions
○ Clear more via sneezing
RR in infant vs adult
Infant: 30-60, adults 12-20
How can illness cause respiratory in infants?
- Virus causes increased secretions
- Nose plugged, harder to breathe and eat
- Decreased energy and possible dehydration
- Secretions and Inflammation plug small airways causing increased airway resistance and areas of lung collapse, impairing gas exchange
- Unable to effectively increase TV and increase RR
- Prolonged effort –> fatigue
Cant maintain effective respiratory effort or secretion clearance
Changes to respiration at 3-6 mo
Respiratory mechanics improve through muscle development as child learns to reach
Anterior chest opens up, chest shape become more rectangular
Remain primarily diaphragmatic breathers with emerging accessory muscle use
RR decreases
TV increases
Changes to respiration at 6-12mo
Most significant stage in chest development
Gravity act on ribs, rotating them downwards
- Intercostals are more efficient
Major changes in lung volume, airway size, RR, TV and pulmonary reserve
New danger: putting everything into mouth
Changes to respiration at 1-8years
Ribcage continues to develop into more mature structure by 7-8 yrs
Continue alveoli growth
Collateral ventilation develops
- Pores of Kohn by 1-2
- Canals of lambert 6-8yrs
New risk: rapid growth of lymphatic tissue causing upper airway obstruction
Subjective CardioResp assessment
- Labour and delivery
○ C Section they have more fluid in lungs vs vaginal birth - Gestational age and weight
- Corrected age (if premature)
○ Used up to 2 years - APGAR score out of 10
○ Indicates how baby was doing just after birth
○ Muscle tone, respiratory effort, HR, responsiveness, color (2points each) - Length of hospital stay
- General health
- Development, mobility and cognition
- Childs baseline normal for feeding, sleeping, ability to interact and play
- Current status of feeding, sleeping interaction, irritability
○ Trouble eating may suggest trouble breathing - Parental report of signs of distress, color changes
Observation
○ Head - bobbing (increase use of Scalene and SCM to breathe)
○ Face - alertness, comfort, color
○ Nose - nasal flaring
○ Mouth - open or closed, cyanosis,
○ Neck - tracheal tug
- Chest - sternal depression, intercostal/subcostal indrawing
Inspection in children
- Observation
Breathing pattern and level of effort - Audible sounds - wheezing, stridor and grunting
- Intensity and quality of crying
○ Loud crying is a sign of good breathing - Respiratory rate and HR
- Oxygen saturation
- Respiratory insufficiency
○ Gaze avoidance
○ Sleepiness
○ Altered engagement
○ Lack of play
○ Irritability - Structural changes
○ Pectus excavatum
§ Depression in anterior chest
○ Pectus carinatum
§ Protrusion of chest
○ Scoliosis >60 –> thoracic restriction and decreased lung volumes
○ Barrel chest in chronic conditions - Finger clubbing
Palpation in children
- Chest wall movements less prominent in infants compared to older children and adults
Thin chest wall makes tactile fremitus easy to palpate
Percussion in children
unreliable in younger children due to hyperresonance
Auscultation in children
- Less precision as sounds easily transmitted though thin chest wall
- May be harder to localize adventitia
Useful to assess changes in air a=entry pre and post treatment
- May be harder to localize adventitia
Bronchopulmonary Dysplasia
- Chronic lung disease in premature infants
- Clinical presentation can include crackles, wheezes, cyanosis, hypoxemia, increased lower respiratory tract infections, abnormal Chest Xray (scarring)
Can have lifelong impact on respirator function
Croup
- Inflammation and edema of upper airway, frequently caused by virus
- Symptoms: harsh, barking voice, hoarse voice, stridor and/or wheeze
Physio contraindicated in acute attack
- Symptoms: harsh, barking voice, hoarse voice, stridor and/or wheeze
Bronchiolitis
- Inflammation of lower airways, frequently caused by a virus
- Increased inflammation and secretions can result in local obstruction and atelectasis, air trapping, increased work of breathing or respiratory decompensation
- Physio indicated for local persistent atelectasis
Congenital heart defect
Depending on the condition, child may have lower acceptable O2 saturation and limited activities
Neuromuscular disorder
- Muscular dystrophies
- Spinal muscular atrophy
- Spinal cord injuries
- Cerebral palsy
Respiratory issues in neuromuscular disorders
- Poorly developed chest structure and/or. Scoliosis
- Chronic hypoventilation with little or no reserve
- Inability to take deep breaths
- Ineffective cough
- Poor energy reserve – rapid fatigue
- Increased risk of aspiration due to poor muscle control
