Recognizing Pediatric Respiratory Distress

Treating pediatric patients can be nerve-wracking, especially if providers have minimal experience with treating children. That’s why Benjamin Martin, EMT-P, MPA, Lieutenant at Henrico County (Va.) Division of Fire, felt compelled to share his experiences with pediatric patients so other providers could feel better prepared for their next pediatric call.

Last week in Charlotte, N.C., Martin gave his presentation “Rapid Recognition of Acute Pediatric Distress Patterns” at the EMS Today conference. Martin revealed what he calls an inconvenient truth: you were lied to in EMT school—kids are like small adults. They have fundamental physiological and anatomical differences requiring different dosing and equipment sizes, but the treatment methods used for adults bascially mirror treatments for children.

Identifying patterns 

Martin began his presentation with a quote from author and physician Ron M. Walls: “In human factors analysis, failure to recognize a pattern is often precursor to medical error.” Martin emphasized the importance of being able to accurately identify patterns that determine the cause of a child’s respiratory emergency. If you don't have them memorized, medical error is inevitable. 

If respiratory distress isn't immediately evident, particularly for an infant or toddler who can't yet communicate their difficulty breathing, the following are identifying symptoms a child would present during such an episode: nasal flaring; uncorrected noisy respiration; mottling, pallor, or cyanosis; altered mental status, and a heart rate below 60 or above 180.

Of course, it is important to assess the child’s general appearance (alertness, ability to make eye contact, spontaneous motor activity, quality of speech/crying), breathing (abnormal breath or lung sounds, chest retractions, grunting or wheezing), and circulation (color, temperature, capillary refill, pulse quality).

With that said, Martin made a point to encourage providers to also listen to the parents. They know their children best—they know what’s normal and abnormal behavior for them, and they might be able to provide more insight into their condition than your initial assessment of the child’s presenting symptoms.

Be sensitive to their emotions 

“It is critical throughout the pediatric assessment that health care providers are cognizant of the emotional and physiological needs of the child, their family members, and themselves,” Martin said.

Parents are often more frightened than their sick or injured children are during an emergency. Martin stresses not to dismiss their fear, though it may be easy to while doing your routine assessment. “Engage, educate, and respect the parents,” he said.

This can be done through simple actions like allowing mom or dad to hold their child’s hand during the assessment or showing a scared kid how you’re going to take his or her blood pressure by doing it to their favorite stuffed animal first.

Know the patterns

Below are some common pediatric emergencies accompanied by respiratory distress that Martin reviewed. He emphasized that providers should be well-familiarized with each of their respiratory distress patterns to ensure accurate treatment of the pediatric patient.

• Bronchiolitis (RSV)
• Croup
• Epiglottitis
• Febrile seizures
• Asthma
• Meningitis