Respiration in Children

Respiration in Children

1. Characteristics of the Upper Respiratory Tract

• Nose and Pharynx:

• Short, narrow nasal passages -> easily obstructed.

• Nasal mucosa: Thin, delicate, rich in blood and lymph vessels, lined with ciliated columnar epithelium.

• Sinus and turbinate development in the nasal mucosa starts at 5 years old (not 3 years old).

• Maxillary sinuses develop from 2 years old.

• Pharynx:

• Narrow and short, vertical, funnel-shaped, soft and smooth cartilage.

• Develops most significantly during the first year and puberty.

• Boys have a longer pharynx than girls (not vice versa).

• Waldeyer’s Ring:

• Includes: Palatine tonsils, 2 Tubal tonsils, 2 Pharyngeal tonsils (adenoids), Lingual tonsil.

• Fully developed at 4-6 years old.

• Only the adenoid is present in infants under 1 year old.

• Larynx:

• Located 2 vertebrae higher in infants than in adults.

• Vocal cords are longer in boys than girls from the age of 12.

2. Characteristics of the Lower Respiratory Tract

• Trachea and Bronchi:

• Narrow lumen, poorly developed elastic tissue.

• Cartilage rings are soft, easily deformed.

• Mucosa has many blood vessels.

• Lungs:

• Weight: 50-60g in newborns, increases 10 times by age 12.

• Volume: 65-67ml in newborns, increases 10 times by age 12.

• Lymph nodes around the hilum of the lungs include: tracheal nodes, bronchiolar nodes, bronchopulmonary nodes, nodes of the bifurcation of the trachea.

• Pleura:

• Thin, easily dilated.

• The pleural cavity can easily change due to the weak attachment of the parietal pleura to the chest wall.

• Thoracic Cage:

• Short, cylindrical, anteroposterior diameter almost equal to the transverse diameter.

• Ribs lie horizontally and perpendicular to the spine.

• Diaphragm is high, and intercostal muscles are underdeveloped.

3. Respiration in Children

• Breathing Pattern:

• Infants and breastfed babies: Abdominal breathing.

• 2-year-olds: Mixed chest-abdominal breathing.

• 10-year-olds: Boys abdominal breathing, girls chest breathing.

4. Upper Respiratory Tract Infections (URTIs)

• Cause: Viruses have a high affinity for the respiratory tract, easily spread, high rate of asymptomatic carriers, weak and short-lived immunity to viruses.

• Frequency: Average 5-8 URTIs per year in children in Vietnam.

• Contributing Factors:

• Age: Under 3 years old.

• Weather: Winter and spring.

• Environment: Crowded, damp, dusty.

• Nutrition and Illness: Prematurity, malnutrition, anemia.

• Allergic predisposition, secretory body type.

• Management of URTIs:

• Mild: No pneumonia, home care.

• Moderate: Pneumonia, antibiotic treatment at home, clinic.

• Severe: Severe pneumonia, treatment at hospital.

• Very Severe: Very severe pneumonia or very serious illness, emergency treatment at hospital.

5. Danger Signs:

• Children aged 2 months to 5 years:

• Unable to drink.

• Seizures.

• Lethargy, difficult to wake up.

• Stridor at rest.

• Severe malnutrition.

• Children under 2 months:

• Poor feeding/refusal to feed.

• Seizures.

• Lethargy, difficult to wake up.

• Stridor at rest.

• Wheezing.

• Fever or low temperature.

6. Pneumonia (PNA)

• Signs:

• Children aged 2 months to 5 years:

• Chest retractions (severe pneumonia).

• Rapid breathing (pneumonia).

• Children under 2 months:

• Severe chest retractions/rapid breathing from 60 breaths per minute (severe pneumonia).

• Indications for antibiotics:

• Pneumonia (not severe) from 2 months to 5 years: Use one of the following antibiotics for 5-7 days: oral cotrimoxazole, oral amoxicillin, penicillin G.

• Severe pneumonia from 2 months to 5 years: Send to hospital, give one initial dose of antibiotics (one injection of penicillin or one dose of cotrimoxazole) before sending.

• Children under 2 months:

• Severe URTI: Penicillin G, Penicillin G + Gentamycin, Chloramphenicol, Cephalosporin.

• Suspected staphylococcal URTI: Benzyl penicillin + Gentamycin, Chloxacilin + Gentamycin.

7. Bronchiolitis (BL)

• Definition: Inflammation of small bronchi, alveoli, and surrounding tissue in both lungs -> impaired gas exchange, airway obstruction.

• Contributing Factors:

• Children under 1 year, especially newborns.

• Birth weight below 2500g.

• Malnutrition.

• Chronic respiratory illness.

• Cold weather, high humidity.

• Environmental pollution.

• Allergic predisposition, secretory body type.

• Indications for chest X-ray:

• Suspected foreign body.

• Unclear clinical presentation.

• Tubercular or severe pneumonia.

• Suspected airway obstruction complications.

• Pneumonia unresponsive to outpatient treatment.

• Common complications:

• Airway obstruction, chronic airway obstruction.

• Atelectasis.

• Pulmonary congestion.

• Lung abscess.

• Necrotizing pneumonia.

• Respiratory arrest.

• Heart failure.

• Samples used for diagnostic testing of the cause:

• Nasopharyngeal aspirate, endotracheal aspirate, bronchoalveolar lavage fluid, pleural fluid, blood.

• Treatment principles:

• Antimicrobial therapy.

• Respiratory failure management.

• Management of fluid, electrolyte, and acid-base balance disturbances.

• Management of symptoms and complications.

• Initial antibiotics:

• Children under 5 years, suspected pneumococcal, HI: Amoxicillin, Amoxicillin – a. Clavulanic (5 days).

• Children under 5 years, suspected Mycoplasma pneumoniae: Macrolide (Erythromycin, Azithromycin, Clarithromycin).

• Severe pneumonia/very serious illness: Penicillin + Aminosid (Penicillin G/Ampicilin/Amox – clavulanic combined with Gentamycin/Amikacin). If unsuccessful: Ceftriaxon/other Cefa III (at least 5 days).

Note: The information in this article is for informational purposes only. You should consult a doctor for accurate diagnosis and treatment.