Clinical Practice Guidelines

Assessment of severity of respiratory conditions

  • See Also

    Asthma

    Bronchiolitis

    Croup

    Pneumonia

    Minimal handling

    Normal Ranges for Physiological Variables

    Key Points

    1. In general, children with respiratory distress should have minimal handling.
    2. The assessment of severity can mostly be made without touching the child. Parents can be asked to expose the child.
    3. Don't focus too much on the SaO2 monitor - look at all the signs.

    Assessment:

     

     Mild 

     Moderate

     Severe

     Behaviour

     Normal

     Able to talk normally

    Some / intermittent irritability  

    Some limitation of ability to talk

    Increasing irritability and / or 
    lethargy

     Marked limitation of ability to talk or unable to talk

    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 (head bobbing)
    Forward posture
     

    None or minimal 

    Moderate retractions and / or accessory muscle use

    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.

       

    O2 saturations less than 90% (in room air)

    Any O2 requirement in croup is classed as severe

    Cyanosis

    Heart Rate

    Normal or slight increase

     

    Mildly increased

    Significantly increased or
    bradycardia

    Blood Pressure

    Normal

    Increased

    Increased or
    decreased late.

     

    Other Considerations:

    • Fever is associated with an increase in respiratory rate and heart rate
    • Respiratory sounds and auscultatory findings can be useful in assessing children with respiratory presentations. For example wheeze in Asthma and Bronchiolitis, and stridor in Croup and Upper Airway Obstruction
    • In addition to assessing the child's respiratory status, it is important to assess feeding and hydration as this may be the first symptom in a child with a respiratory illness.

    Management

    Management of individual conditions can be found under the specific guideline.

    Consider consultation with local paediatric team when:

    Any child with severe respiratory distress should involve a senior clinician.

    Consider transfer when:

    If management of severity is beyond the capability of the local health care facility.

    For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.

    Last Updated January 2019