Welcome to the St. Emlins blog. I’m Iain Beardsell, and I’m joined by our resident pediatric expert, Natalie May. Today, we’re discussing a challenging but crucial topic for those in Emergency Medicine: managing pediatric patients with shortness of breath.

Understanding Pediatric Shortness of Breath

Shortness of breath in children is a frequent and often intimidating presentation in the emergency department, especially during winter. This guide aims to provide a systematic approach to assess and manage these young patients effectively.

When managing a child with shortness of breath, it's essential to stay calm and use a structured approach:

1. Level of Consciousness: Determine if the child is alert or needs immediate resuscitation.

Administering oxygen is a safe and effective initial treatment for children with shortness of breath. It is unlikely to cause harm and can be crucial for stabilizing the patient while further assessments are made.

Gathering a detailed history from the parents is essential:

• Chronology of Events: Determine how long the child has been short of breath.

This information helps in deciding the appropriate therapy and whether the child needs hospital admission.

Bronchiolitis is a common winter illness in children under two, often caused by respiratory syncytial virus (RSV). Key signs include:

• Respiratory distress with significant use of accessory muscles.

Viral Wheeze often presents similarly but occurs in slightly older children. Differentiating between bronchiolitis and viral wheeze involves assessing the severity and duration of symptoms.

Management:

• Oxygen: Provide supplemental oxygen if saturation levels are low.

Admission Criteria:

• Severe respiratory distress.

Croup is another common viral illness presenting with a characteristic seal-like barky cough and inspiratory stridor. It often worsens at night, causing significant distress to both the child and the parents.

Management:

• Dexamethasone: A single oral dose (0.15-0.6 mg/kg) is effective in reducing airway inflammation and improving symptoms.

Safety Netting:

• Provide parents with clear instructions on when to return to the hospital, especially if symptoms worsen during the night.

Though less common than viral infections, bacterial pneumonia should be considered, particularly if the child presents with:

• Fever.

Management:

• Chest X-ray: Useful for diagnosis if bacterial infection is suspected.

Children with respiratory distress often have poor oral intake, leading to dehydration. Assess feeding history and urine output:

• Supportive Feeding: Nasogastric or intravenous fluids may be required.

Infants are obligate nasal breathers, and nasal congestion can severely impact their breathing. Simple measures such as nasal saline drops can alleviate congestion and improve breathing.

Always consider the possibility of an inhaled foreign body, especially if the presentation is sudden and there is no clear viral cause. A chest X-ray or bronchoscopy may be required for diagnosis and management.

Managing pediatric shortness of breath requires a calm, structured approach, leveraging skills from adult practice and adapting them for pediatric patients. Key steps include:

• Initial Assessment: Stay calm and systematic.

Remember, there is always senior support available, whether from a senior emergency physician or a pediatric colleague. By staying cool and methodical, you can effectively manage these challenging cases and provide excellent care for your young patients.

Stay tuned to the St. Emlins blog for more in-depth discussions on pediatric emergencies and other critical topics in emergency medicine. Stay calm, stay curious, and keep learning.