Child with Breathing Difficulty

First actions / assessment

• Assess ABCDE first. In general use minimal handling and observe before touching the child: work of breathing, respiratory rate, recession, grunting, nasal flaring, head bobbing, stridor, wheeze, ability to speak/cry/feed, colour, mental state, posture, hydration, and oxygen saturation. Clarify age, prematurity, chronic cardiopulmonary disease, duration, fever, cough, coryza, wheeze, noisy breathing, choking episode, allergen exposure, chest pain, trauma, feeding difficulty, wet nappies, previous asthma or viral wheeze, and sick contacts. Examine airway sounds, chest expansion, symmetry, air entry, added sounds, cardiac rate/perfusion, hydration, and ENT signs. Severity is more important than exact diagnosis initially. Consider bronchiolitis in infants with coryza plus cough/wheeze or crackles
• croup if barking cough/hoarse voice/stridor
• asthma or viral-induced wheeze if expiratory wheeze and increased work of breathing