Respiratory problems in children-When to take a symptom seriously Edward Snelson Consultant – Sheffield Children’s Hospital Foundation Trust

In the next 45 minutes… An overview of respiratory problems in children A guide to assessing children with cough, wheeze and shortness of breath Questions and answers

Who I am and what I can offer

Respiratory illnesses in children Colds Viral Wheeze (alias WAVE etc) Bronchiolitis Bacterial lobar pneumonia Atypical pneumonia Asthma Things that pretend to be respiratory but really are not Behavioural/ chronic cough

More useful Well vs unwell Alert vs subdued etc Hydration Fever Respiratory rate Recession Absence of breath sounds Less useful Cough Colour of sputum Crepitations Percussion Feeding

Jason – 5/12 old – brought by Mum to surgery with poor feeding Looks well and occasionally smiles Wet mucous membranes Taking about 1/2-2/3 normal feeds Wet cough typical of bronchiolitis Mild recession Scattered crepitations R>>L

Jasmine – 12 month old with a coryza and first episode of wheeze Runny nose for 4/7, coughing for 2/7 Has felt warm but no temperature recorded Drinking bottles but refusing solids Overnight started to wheeze Looks well but audibly wheezy Mild recession Wheeze and coarse crepitations throughout chest

Jasmine – same child attends age 18/12 with a further episode of wheeze

What do I call my wheeze? Bronchiolitis Viral Wheeze WAVE – Wheeze Associated Viral Episode Wheezy bronchitis Viral Episodic wheeze Asthma Leave it unlabelled?

The Big Questions

When do I use antibiotics? Never in bronchiolitis LRTI = Fever Cough Respiratory distress

When do I try inhalers <12 months rarely >12 months usually Only if the effect is assessed Only if technique is taught

When do I refer? Significantly unwell Moderately distressed Failure to respond to inhalers Chronic cough If you need help

Chest X-rays

Chest X-rays: pros and cons Pros: Simple Relatively small radiation dose Can confirm a diagnosis Cons: Inconvenient for parents Can be misleading May be normal despite pathology May appear abnormal when not so Findings do not necessarily alter management Resource implications

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In Summary… Clinical diagnosis is King Bronchiolitis should be managed as simply as possible Interval symptoms are important Chronic cough means daily chronic cough