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From Thin Air Assess the breaths your child takes We are in the midst of the winter season and at the peak of viral illness along with the associated complications of ear infections, pneumonia and sinus infections. How do parents know when a cold is no longer a cold or when a cough turns into pneumonia? Not so easy, is it? Children make many noises. So when are those noises something to worry about? Let’s start with your first anatomy and physiology lesson. The human body draws air into the chest by suction. When the chest wall expands, you take a deep breath of air. This air comes in through the nose and mouth, the back of the throat (the pharynx) and into the windpipe (the trachea). The air then travels from larger airways called bronchi to smaller ones named bronchioles. I hope your old Latin is coming back to you! The air then rushes into the small air sacks (the alveoli) where the true exchange of oxygen between the lungs and the blood takes place. When you breathe out, the chest wall collapses and forces air from the lungs and out to the nose and mouth. After blood is oxygenated, it circulates, with the help of the heart of course, to all the cells of the body. Oxygen gives the skin and tissue a very nice pink glow. Breathing is controlled automatically and the drive to breathe is one of the most basic. This seems simple enough but remember this is only Anatomy and Physiology 101. Now that you know the basics, how does this help you as a parent? You know quite a lot already that will help you evaluate your child’s breathing. The younger the child, the more difficult is the assessment. Here are the basic steps in assessing your child’s respiratory status. Color: Children should have a pink color to their skin. In darker-skinned people, use the lips and nail beds to evaluate color. A blue color is a sign of decreased oxygen and needs immediate attention. This is the time to use 911. Respiratory effort: Look how hard your child is working to breathe. Panting, grunting and nasal flaring (like a dog that has just finished a long run) are signs of respiratory distress. Retractions are the use of extra muscles such as those between the ribs and around the neck. If these muscles are being used, you may see the muscles being pulled inward. These movements show how hard a child is breathing. Cough: This is a natural mechanism for clearing secretions. Every child will have to cough sometime. Most are not serious. However, if a cough persists or is associated with wheezing or signs of respiratory distress, get some help. Simple things such as a cold or postnasal drip associated with allergies can cause cough. Cough can originate from within the chest, below the neck, or within the upper airways, above the neck. This is a simple way to think about it. Cough below the neck involves the bronchi and lungs, while cough above the neck involves the nose and sinuses. A “rattlely” cough does not necessary mean it is in the chest. A cough that is barky is associated with the vocal cords and larynx. Croup is associated with a barky cough and occasionally “stridor.” Stridor is the sound produced by turbulent flow of air through a narrowed segment of the respiratory tract. It is a sign of airway obstruction in a child. It typically originates from the larynx (voice box), above the neck. It is more pronounced during inspiration (breathing in) rather than on expiration (breathing out). If a child has any signs of respiratory distress associated with stridor, a trip to the emergency room is necessary. Wheezing: This is a high-pitched whistling sound produced by air flowing through narrowed breathing tubes, especially the smaller ones deep in the lung. The clinical importance of wheezing is that it is an indicator of airway narrowing. Wheezing is most obvious when exhaling (breathing out). Wheezing most often comes from the small bronchial tubes (breathing tubes deep in the chest). Therefore, it is noise from below the neck. Common problems associated with wheezing are asthma, but other conditions that narrow the small airways will cause the same sound. Sniffling: This problem may seem obvious, but nasal congestion can be a real problem for small infants who need to eat and breath at the same time. In addition, infants are classified as “obligate nose breathers” and may forget to open their mouths to breath. Clearing out the nose of secretions may be the cure in the short-term treatment of a cold. Allergy is a common cause of nasal congestion and tends to be a more chronic condition. Hopefully, this will help in your medical assessment of your child’s breathing. When in doubt, never hesitate to get help. Make a phone call of see your child’s physician. Many times, a picture IS worth a thousand words. Use your video camera and bring it in to your physician for review. It is much easier to show the video than to describe a sound or a your child’s breathing pattern. Most parents do worry about their ability to evaluate their child’s breathing. You are not alone. Good luck. Dr. Clyde Wesp is a pediatrician with Southern Orange County Pediatric Associates with offices in Lake Forest, Laguna Hills, Rancho Santa Margarita, Ladera Ranch and San Clemente (Talega) and is affiliated with Saddleback Memorial Medical Center, Mission Hospital and Children’s Hospital of Orange County. If you have any questions or comments for Dr. Wesp you can email him at askdrwesp@netscape.net. |
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