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

2. 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

3. Who I am and what I can offer

5. 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

7. 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

8. 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

10. 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

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

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

14. The Big Questions

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

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

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

18. Chest X-rays

19. 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

20. ?

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