Assessment of severity of respiratory conditions

  • Background:

    • This is an important aspect of clinical examination of all children.
    • In general, children with respiratory distress should have minimal handling.
    • Don't focus too much on the SaO2 monitor - look at all the signs.
    • The assessment of severity can mostly be made without touching the child.
      (Ask the parents to expose the chest).

     

     Mild 

     Moderate

     Severe

     Behaviour

      Normal

    Some/intermittent irritability  

    Increasing irritability and/or
    lethargy

     

    Tachypnoea*
    (at rest - ie not crying)

    Normal or mildly increase respiratory rate
    (normal values by age)

     

    Increased respiratory rate

    Increased or markedly reduced
    respiratory rate as the child tires.

    Signs of  increased work of breathing

    Retraction
    (intercostal, suprasternal, costal margin)

    Paradoxical abdominal breathing

    Accessory muscle use

    Nasal flaring
    Sternomastoid contraction
    Forward posture

     

    None or minimal 

    Moderate

    Marked increase in accessory
    muscle use with prominent
    chest retraction.

     Oxygenation

    Oxygenation is only of limited utility in judging severity in many paediatric respiratory conditions. Don't just focus on the SaO2 monitor. Look at the other signs.

       

    Cyanosis

    SaO2 <85%

    Heart Rate*

    Normal or slight increase

     

    Mildly increased

    Significantly increased or
    bradycardia

    Blood Pressure

    Normal

    Increased

    Increased or
    decreased late.

     

    * Fever is associated with an increase in respiratory rate.   Fever will also cause increased heart rate.