Chapter 21: Respiratory Dysfunction in Children

Respiratory Dysfunction in Children covers the assessment and management of common upper respiratory tract infections, including acute nasopharyngitis, streptococcal pharyngitis, and tonsillitis, detailing postoperative care for tonsillectomies to prevent hemorrhage. Significant attention is given to croup syndromes like laryngotracheobronchitis and the medical emergency of acute epiglottitis, emphasizing the need for airway protection and calm environments. The summary explores lower airway infections, particularly respiratory syncytial virus (RSV) and bronchiolitis, outlining isolation precautions, hydration strategies, and oxygenation support using high-flow nasal cannulas. It further analyzes pneumonia classifications, pertussis (whooping cough), and tuberculosis testing and treatment. A major portion of the chapter is dedicated to long-term respiratory dysfunction, specifically asthma, detailing its pathophysiology involving inflammation and bronchospasm, the stepwise approach to pharmacologic therapy (corticosteroids, bronchodilators, and rescue medications), and the importance of environmental trigger control and proper inhaler technique with spacers. The complex genetic disorder cystic fibrosis is examined in depth, explaining the exocrine gland dysfunction that leads to thick mucus production, pancreatic insufficiency, and chronic lung disease, along with the necessity of airway clearance therapies, enzyme replacement, and high-calorie nutrition. Environmental hazards such as foreign body aspiration, smoke inhalation, and passive tobacco smoke exposure are addressed alongside acute respiratory distress syndrome (ARDS). The text concludes with critical protocols for recognizing respiratory failure and performing pediatric cardiopulmonary resuscitation (CPR), adhering to current American Heart Association guidelines for chest compressions and ventilation to prevent cardiac arrest.