Differential Diagnosis of Abnormal Pediatric Respiratory Rate From “Approach To A Child In Respiratory Distress

What follows is from Approach to a Child in Respiratory Distress, Nov 27, 2016 from PedsCases  by Sarah Buttle with the help of Dr. Tom Kovesi:

Signs of respiratory distress in a child’s vitals include tachypnea, tachycardia, and hypoxia.

The WHO considers respiratory rate to be an essential marker for acute respiratory illness in infants and children.

According to the WHO approved standards, tachypnea is defined as over 60 breaths per minute and an infant under two months of age, over 50 in an infant to to 12 months, over 40 in a child aged 1 to 5, and over 30 in a child over five years of age.

You may observe the child using accessory muscles to assist with breathing or you may see some costal or intercostal in drawing or sternal retractions. Other observable signs that suggest increased work of breathing include tripod position, leaning forward propped up by their arms, in an attempt to make breathing easier.

On physical exam, you may hear the child running or making other accessory sounds of breathing such as Strider or wheeze the child may have decreased air entry, or crackles on inspiration, depending on the underlying cause of respiratory distress. Assessing air entry is particularly important. Child in our scenario as tachypnea tripod and cyanosis and inability to speak.

Differential Diagnosis

The differential diagnosis of a child in respiratory distress is broad. We feel it is useful to use a structured approach when considering this presentation.

Pulmonary causes are the most frequent underlying etiologies of respiratory distress. Common and/or important upper airway pathologies include a laryngeal foreign body, croup, epochal otitis, and retro pharyngeal abscesses. Lower airway pathologies that can cause respiratory distress include acute asthma exacerbations, acute respiratory distress syndrome, infections such as pneumonia or tuberculosis, bronchiolitis and a lower airway foreign body plural pathologies include pneumothorax, pneumothorax and pleural effusion can also present as respiratory distress.

Of non-pulmonary causes, cardiac causes of respiratory distress are among the most important to consider. The child in respiratory distress may be experiencing congestive heart failure or pulmonary edema.

Other important diagnoses to consider include central nervous system disturbances, meningitis, metabolic acidosis*, and anaphylactic reactions.

*Metabolic acidosis presenting as only tachypnea may be a sign of sepsis or of diabetic ketoacidosis.


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