When to Seek Medical Care for Your Child: Part 3 ("I Can't Breathe!")

As parents, we are always concerned about the health of our children. One of the most common questions that I get is:

“When should I seek medical care for my child?”

My simple response is:

”Whenever you feel the need!”

This is part 3 in continuation of “When to Seek Medical Care for Your Child”. I will discuss trouble breathing in this current posting.

“I can’t breathe!” is never the phrase that you want to hear coming out of your child’s mouth. But, yet, this happened to me one evening a number of years ago. I will never forget how he said it and how he looked. He really scared me.

My son came into our bedroom in the late evening and had what I recognized immediately as croup. He had the barky cough that sounded like a seal which I had heard many, many times in my career as a physician. As a pediatric intensive care physician, this issue was familiar territory for me. I would usually see kids at the far end of the severity spectrum, requiring a breathing tube in their airway to allow easier breathing, as their airway would be narrowing and closing from the virus causing croup.

So, as I contemplated putting him in a steamy shower and taking him outside in the cool night air (which are home remedies for the croup cough), I ultimately decided to call “911”. What made me decide to call for an ambulance? What got me scared? Well, as a pediatric intensivist, I am acutely aware of the signs of trouble breathing or respiratory distress.

When one is assessing trouble breathing or respiratory distress, there are specific signs to look for. Sometimes they are mild and sometimes they are more severe. If you have any concerns or questions, it is prudent to seek medical advice.

Here are the signs that I look for (note that the normal breathing rate differs by age):

1. Retractions: use of accessory breathing muscles that cause the upper part of the tummy, just below the rib cage, or area above the collarbones/breast bone, at the lower part of the neck, to "suck in"

2. Nasal flaring: the nostrils widen with each breath inward

3. Cyanosis (turning "blue"): where the area round the mouth/lips appears bluish or ashen (if this happens, your child should be seen immediately)

4. Rapid breathing rate (number of breaths in a minute = count the number of breaths in 15 seconds and multiply by 4) - fast breathing can be a symptom of breathing problems (relative to age):

Infant (birth - 1 year of age): 30 - 60 breaths per minute

Toddler (1 - 3 years of age): 24 - 40 breaths per minute

Preschooler (3 - 6 years of age): 22 - 34 breaths per minute

School-age (6 - 12 years of age): 18 - 30 breaths per minute

Adolescent (12 - 16 years of age): 12 - 16 breaths per minute

So, when my son came into our bedroom that night, he exhibited a number of signs of respiratory distress and I knew that he needed immediate medical attention…more than what I could provide at home. Once he was given the proper medications and treatments, he did well and everyone was relieved!

Have you ever witnessed anyone in respiratory distress before?

If you have any questions about this or other topics, please feel free to comment in the comment section.

Stay tuned for a future discussion about changes in behavior and suspected poisonous ingestions to follow…

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