respiratory distress in children is causedby either upper or lower airway diseases. upper airway obstruction is recognized bythe presence of stridor, a high pitch sound often audible without a stethoscope, mainlyon inspiration but can also be heard on expiration. aspiration of a foreign body, especially frequentin the 1-3 age group, must be ruled out. a history of aspiration may be offered by thepatient or family. remember to get imaging â€“ while the foreign body may be lucent,look for signs of hyperinflation. another serious cause of upper airway obstructionis viral laryngotracheobronchitis or croup. patients with croup have a stridor and usuallyhave a cough that sounds like a seal barking. a dose of systemic corticosteroid will alleviatethe obstruction for the course of the illness,
but nebulized epinephrine may sometimes benecessary to reduce the edema quickly to relieve the acute respiratory distress. a rare butsevere complication of croup is bacterial tracheitis. lower airway obstruction presents with shortnessof breath, a prolonged expiratory phase, wheezing and accessory muscle use. in children over two years old, viral inducedasthma is the most common cause for this presentation. inhaled bronchodilators are used for symptomaticrelief, but corticosteroids are essential to settle the lower airway inflammation.bronchiolitis is caused by a viral infection in infants less than 12 months of age andwhile it may present very similarly to asthma,
it does not respond to bronchodilators orcorticosteroids. recommended management include supportive care such as intravenous hydration(if the infant is too distressed to feed) oxygen supplementation (if the oxygen saturationis below 90%) and ventilatory support (for impending respiratory failure).pediatric pneumonia often presents after symptoms of viral upper respiratory infections, butwith fast breathing and lung crackles. lung radiography confirms the diagnosis and thepattern of infiltrate or consolidation may guide antibiotic selection.