Approach To a Child with
Dr Nor Azlina Bt Mohammad Rashid
To describe the respiratory system and
common respiratory diseases and conditions
To diagnose respiratory distress based on
history, physical examination and
Formulate appropriate diagnosis
Describe the respiratory system
Depict signs of respiratory distress in a real
List normal respiratory rate for different ages
Define respiratory failure
Describe obstructive and restrictive
Differentiate clinical presentation of
obstructive airway conditions from restrictive
Describe upper respiratory tract problems in
Describe lower respiratory tract problems in
Describe respiratory conditions presented
Differentiate clinical features of
tracheolaryngobrochitis (croups) from acute
Describe conditions presented with wheezing
in children and infants
Emphasize on Childhood Asthma
Describe congenital respiratory anomalies in
Lobar divisions of the lungs
The anatomy of the respiratory
To provide adequate gas exchange between
the circulating blood and the atmosphere
Work of breathing- the work performed by the
respiratory pump ; how much the volume of
lung changes hence the respiratory muscles
generate a given pressure
Flow of gases through the airways is inhibited
Intrathoracic- wheezing, best heard during
Long deep breaths
Hyperinflated and tympanitic to percussion
obstructive airway problems
Alveoli are unable to expand fully
Disease of the pulmonary parenchyma,
pneumonia, fibrosis and consolidation
Disease affecting pleura interfere pulmonary
Musculoskeletal , neuromuscular diseases
Rapid shallow breathing , grunting, dull to
Restrictive pulmonary condition
Clinical manifestation of respiratory
Mechanical failure: increased ventilatory
requirements and physical effort to fulfill
these requirements—tachypnea, retractions,
excessive use of accessory muscles
Failure of respiratory control -apnea
Alterations in the arterial PO2 and PCO2
Both parameters are regulated by the central
Can result from failure of mechanical function f
the lungs and chest wall or in the respiratory
Terminal respiratory unit
Divide your group, each group present a
patient with common respiratory problems
stated in the learning objectives .
Present upper respiratory tract problems
Present lower respiratory tract problems
List common etiology including viral agents,
bacteria, allergent and smoke inhalation.
Describe and discuss preventive measures
for your patient
Relate to immunization programs
Ahmad a 3 year old boy was playing with his
small toy car with his elder brother. Suddenly
he coughed and turned cyanosed. He
appeared very apprehensive, held his throat
and extend his neck.
What is the mechanism of respiratory failure?
What is your immediate action?
Aminah, a 2 years old toddler girl was playing
fireworks with her elder brothers and cousins
at the balcony. Suddenly the firework
exploded unexpectedly and produced
excessive smoke. Aminah suddenly cough
and her voice became muffled.
What is the mechanism of Aminah’s
Samy, a 2 days old premature infant who was
born at 30 weeks gestational age was noted
to be cyanosed by a nurse. There was
absence of chest movement.
What is Samy’s clinical condition?
What is your immediate action?
What is the mechanism of his respiratory
Ah Kow, a 4 years old boy has been visiting
the casualty many times this year with
complaint of cough and difficulty to breath.
His condition is releived by oxygen nebulized
salbutamol . He has cough almost every night
during sleep. Sometimes his mother heard
What is the mechanism of Ah Kows
How do you confirm the diagnosis?
What are the other histories that you would
like to elicit?
How do you categorize the severity of his
What is your plan of management?
What are the relevant investigation?
Aminah a 2 year old toddler has been having
mild cough and rhinorrhea for the past 2
days. It was associated with low grade fever.
Suddenly her mother noticed that she breath
noisily with fast breathing.
What is Aminah’s clinical condition?
What are the relevant physical finding that
you would like to look for?
Outline the principle management.
Kamala, a 9 month old Down syndrome infant
is brought by her mother to the pediatric
clinic. Her mother complaint that she has
cough and shortness of breath for the past 2
days. It was associated with high grade fever.
She refused to breastfeed.
What physical signs do you want to look for?
What do you aspect to find on the
examination of the respiratory system?
What is the clinical condition?
What investigation do you want to perform?
Outline the principle of management.
What is the mechanism for Kamala’s
What is the most likely etiological agent?
What is the possible complications?