The baby's shortness of breath

Respiratory distress is a fairly common symptom in children. Thus, dyspnea in a child due to various reasons is detected in more than 35% of cases.

Respiratory mechanism in babies continues to be formed for several years, so it immediately reacts to almost any impact of external and internal factors. As a result, the rhythm, frequency and depth of breathing is disturbed. Often shortness of breath in a child is caused by such natural causes as severe crying, anxiety or fear, unusual physical activity. If breathing is difficult at rest, during sleep, or accompanied by other suspicious symptoms, then in this case, consultation with a pediatrician is really necessary.

Causes of the wheezing

Dyspnea in a child can occur due to these causes:

• infectious and inflammatory processes, affecting the respiratory organs (pneumonia, bronchitis, bronchial asthma, alveolitis of fibrosing type, etc.);
• diseases of the cardiovascular apparatus, disorders of the nervous system;
• severe intoxication, gastrointestinal diseases;
• acute respiratory viral infections, acute respiratory infections;
• hypovitaminosis, anemia;
• metabolic disorders;
• pulmonary edema of toxic origin;
• allergic processes;
• Thoracic curvatures (both congenital and acquired);
• psycho-emotional imbalance;
• overweight, sedentary lifestyle.

Dry cough with shortness of breath in a child does not always indicate problems with the respiratory system or infectious processes. Often such symptoms are a consequence of digestive disorders, heart disease or thyroid disease.

In infants, the problem can be provoked by a banal runny nose. Among non-pathological causes - excessively dry air in the room, the presence of toxic vapors (chlorine, hydrogen sulfide, ammonia, bromine, etc.).

Risk factors

Dyspnea in a child can be provoked by both physiologic and pathologic factors. Among the likely physiologic factors:

• Running and vigorous walking, jumping, tumbling, especially with reduced tolerance to physical activity.
• Severe anxiety, fear, hyperexcitability of the nervous system, stress.
• Overeating, flatulence.

Pathologic factors primarily include diseases of the respiratory system:

• bronchial asthma;
• pneumonia;
• bronchitis, tracheitis, laryngitis;
• pulmonary edema;
• allergic rhinitis, adenoiditis;
• cystic fibrosis;
• tumors, tuberculosis.

The mechanism of the appearance of dyspnea in this case is due to a disorder of pulmonary ventilation, impaired gas exchange, hyperventilation.

Other provoking factors include:

• Cardiovascular pathologies, including congenital heart disease (stenosis, aortic valve insufficiency, mitral valve insufficiency, tetrad of Fallot, aortic coarctation), pericarditis or myocarditis, cardiomyopathy;
• febrile condition, anemia, severe pain;
• Inhalation of a foreign body (including food particles).

Pathogenesis

The main mechanisms of dyspnea development in children:

• Obstructive dyspnea → Occurrence of an obstruction in the airway.
• Restrictive dyspnea → Limitation of the expanding capacity of lung tissue.
• Alveolar-capillary deficit → Gas exchange disorder due to restriction of the respiratory surface area.

Basic classification of dyspnea in a child:

• Obstructive dyspnea:
  • Inspiratory (characterized by problematic inhalation);
  • expiratory (accompanied by problematic exhalation).
• Restrictive dyspnea and alveolar-capillary deficit (mixed dyspnea, impaired efficiency of external respiration).

Among the most common causes of breathing difficulties in children:

• for inspiratory dyspnea - acute stenotic laryngotracheitis (viral croup), laryngeal foreign body, epiglottitis, laryngeal diphtheria, pharyngeal abscess;
• for expiratory dyspnea - bronchial asthma, bronchiolitis, obstructive bronchitis;
• In mixed dyspnea - pneumonia, pneumothorax, pulmonary edema, exudative pleurisy.

Epidemiology

Dyspnea in a child is one of the most common complaints of parents when visiting a pediatrician. In this case, most often we are talking about difficulty breathing. The problem can equally often bother both boys and girls. The average frequency of occurrence of the symptom is more than 30%.

The lungs of a newborn child have a mass of about 50 g. Over the years, the organ grows and develops, increasing by the age of 20 about 20 times. Due to the anatomical features of the respiratory tract and thorax in children of the first year of life, diaphragmatic breathing dominates, which has its own nuances:

• The nasal passages of babies are relatively narrow, and the mucosal tissue is delicate and sensitive, containing a large vascular network.
• The tongue may press slightly on the epiglottis area, causing the child to breathe through the mouth, especially at times of increased exertion.
• In infants in the first year of life, the tonsils and adenoids, as well as the lymphopharyngeal ring, are still underdeveloped. Their growth is noted in the 4th-10th year, including excessive enlargement, provoking frequent development of tonsillitis, adenoiditis, and viral infections.

The appearance of breathing problems in preschoolers is most often due to the immaturity of the respiratory and nervous system.

Symptoms

Dyspnea in a child is often accompanied by a feeling of pressure and congestion in the chest, difficult inhalation and/or exhalation, a feeling of lack of air. Externally, the following signs draw attention:

• pale skin, or redness of the facial area;
• palpitations;
• increased restlessness, irritability, refusal to eat;
• elevated body temperature;
• coughing without subsequent relief;
• nausea, up to vomiting (no relief);
• swelling;
• Blueing of the nasolabial triangle, lips;
• spatial disorientation;
• slurred speech, trouble swallowing;
• seizures.

The above symptoms may not always appear and with different intensity, which depends on the cause of the respiratory disorder.

If we take into account the frequency of occurrence and duration of attacks, dyspnea can be categorized into these basic types:

• acute (short-lived, occurs sporadically);
• subacute (lasts longer than acute - for several hours and up to a day);
• chronic (bothers you regularly, for a long time).

Depending on the nature of labored breathing, there are expiratory, inspiratory and mixed dyspnea.

Expiratory dyspnea in a child is manifested by difficulties in performing deep breaths, which is associated with any obstacles to the withdrawal of air flow from the lungs. It may be about narrowing, spasm, edema of the bronchi, which, in turn, is due to chronic or acute inflammatory processes in the bronchi, lesions of the interalveolar septa. Such a problem is often found in children suffering from emphysema, bronchial asthma, obstructive pulmonary disease.

Inspiratory dyspnea in children is accompanied by problematic breathing, which often occurs when a foreign body penetrates the respiratory tract, in heart disease, tumors, edema of the respiratory system.

Mixed breathing difficulty is a problem with both inhalation and exhalation, which may be due to severe damage to the respiratory system or cardiovascular system. This symptom is characteristic of severe pneumonia, respiratory failure and heart failure.

The ultimate degree of breathing difficulties is considered suffocation: the child begins to literally suffocate, the rhythm, frequency and depth of respiratory movements are disrupted. This condition can be observed in laryngeal spasm, neglected rickets, bronchial asthma, allergic respiratory edema, hyperexcitability of the nervous system, severe infectious processes or serious cardiac pathologies. Newborn infants may suffer from suffocation due to postnatal traumatic injuries.

Shortness of breath when coughing in a child often occurs in bronchial asthma - in some cases, this combination of symptoms is called the "coughing" form of asthma. In addition, the problem can cause and some infectious agents - in particular, mycoplasma, chlamydia, Haemophilus influenzae, pneumococcus, moraxella, toxocariasis, causative agents of paracoccal pertussis and whooping cough. Simultaneously, coughing and difficulty breathing are found in hypertrophy of adenoids, rhinosinusitis, gastro-esophageal reflux. In the latter case, acidic contents from the stomach are thrown into the upper respiratory tract, which provokes its irritation.

Temperature, shortness of breath, cough in a child are often signs of various pathological processes, including cold, flu, pneumonia or coronavirus infection. Such pathologies in many cases cause an increase in body temperature, general weakness, respiratory problems, as a reaction of the body to the introduction of an infectious agent.

If breathing is difficult due to any of the pathological causes, the child becomes difficult to inhale and/or exhale not only in an active, but also in a calm state. He complains of lack of air, or parents themselves notice that the baby begins to perform convulsive, restless breaths, there are whistles and wheezes. Infants often refuse to eat, since they can not swallow fully, they suffocate, quickly tire. Among the auxiliary signs: lethargy, pallor of the face.

Dyspnea in bronchitis in a child is usually accompanied by a dry or wet cough, deterioration of general health as a result of intoxication. Other probable symptoms:

• body temperature rises to 39°C;
• alternating chills, sweating;
• there's a lot of lethargy, fatigue.

Dyspnea in obstructive bronchitis in a child is complemented by audible at a distance wheezing from the lungs. Breathing is stiff, sputum in most cases does not drain.

Dyspnea without fever in a child can be associated with impaired circulation, deterioration of cardiac function, which is usually accompanied by increased fatigue, a feeling of pressure in the heart area, headache, dizziness.

Barking cough, shortness of breath in a child often indicates the development of laryngotracheitis. Sputum separation in such cases is not observed, after the attack may be followed by a characteristic spasmodic breath. The cause of this phenomenon lies in the swelling of the vocal cords, which, in particular, causes simultaneous coarsening and hoarseness of the voice. Dyspnea in laryngotracheitis in children can be dangerous and indicate the development of croup, a condition that requires urgent medical attention.

If a child has shortness of breath without coughing or other suspicious symptoms, it may be a consequence of anemia, fatigue, lack of sleep. Provoking factors in such situations are insomnia, stress, improper mode of study and rest, improper nutrition. Moreover, regular fatigue entails a failure of immunity, which increases the vulnerability of the child's body to infection. Lack of sleep hampers the heart and lung system, which invariably affects respiratory function.

Dyspnea after bronchitis in a child often becomes the only residual symptom, which gradually disappears within 1-2 weeks. If the violation is not eliminated independently, or other unfavorable signs appear, it is necessary to urgently consult with the attending physician. Among such pathological signs:

• pale or blue skin;
• palpitations;
• severe lethargy, nausea;
• swallowing problems;
• seizures;
• the onset of coughing.

Dyspnea in laryngitis in a child is usually a complication of a cold, which is due to the anatomical features of the child's larynx. In such a situation often draws attention barking cough, associated with difficulties in conducting airflow through the narrowed laryngeal lumen. This is the first call indicating an increased risk of developing stenotic laryngotracheitis - the so-called croup. Dyspnea in croup in children is quite a dangerous condition that can cause suffocation and complete cessation of breathing. If we are talking about croup of the first degree, then here parents can help the child on their own. But in more complex situations, immediate assistance of medical specialists will be required.

Shortness of breath with a runny nose in a baby under 3 months of age is due to the imperfection of the respiratory system. Usually infants rarely get colds, but babies who are artificial or mixed feeding are more vulnerable. Due to the narrowness of the nasal passages and the accumulation of secretions in them, there is a lack of oxygen, which causes shortness of breath.

Allergy shortness of breath in a child may also be accompanied by fever and weakness. Some children tend to be allergic to food, medicines or other substances (dust, wool, pollen, etc.). During an allergic reaction, histamine is released, which causes the corresponding symptoms.

Diagnostics of the wheezing

Analyzing the complaints and collecting anamnesis, the doctor should pay attention to how the child himself describes the sensation of respiratory problems. It is also important to pay attention to the speed of the attack, the effect on the well-being of changing the position of the body, the presence of other symptoms.

Laboratory diagnostics may include:

• total blood count;
• sputum bacteriogram;
• a test for coronavirus infection;
• Allergy tests.

Additional instrumental studies:

• electrocardiography;
• bronchoscopy;
• fluorography;
• Spirography;
• Cardiac ultrasound;
• Thyroid ultrasound.

If necessary, resort to consultations with other specialists: pulmonologist, otolaryngologist, cardiologist, gastroenterologist, infectious disease specialist, allergist, etc.

Treatment of the wheezing

If dyspnea in a child has a physiological origin, it is necessary to calm him down as much as possible, provide a supply of fresh air. If pathological causes of the disorder are suspected, or breathing is difficult (the child suffocates), then you should immediately call an emergency medical team.

Dyspnea in acute respiratory viral infections in a child is a reason to visit a pediatrician, because with viral infections, breathing problems can indicate the development of pneumonia, bronchitis, tracheitis, false croup.

If the child complains of dizziness and a feeling of fatigue at the same time, you should also consult a pediatric cardiologist.

In infectious diseases of the respiratory system, antibacterial agents are prescribed:

• Beta-lactam antibiotics:
  • Amoxicillin as powder for preparation of oral solution (125 mg/5 mL, 250 mg/5 mL), or as 250-500 mg tablets;
  • Amoxiclav (125 mg amoxicillin with 31.25 mg clavulanic acid, 250 mg amoxicillin with 62.5 mg clavulanic acid/5 ml), or as 500 mg tablets with 125 mg;
  • Ceftriaxone as powder for preparation of injectable solution (250 mg);
  • Cefotaxime in the form of powder for preparation of injectable solution, 250 mg in a vial;
  • Ceftazidime in the form of powder for preparation of solution for injection, 250 mg per vial.
• Other antibacterial drugs:
  • Azithromycin (250 or 500 mg capsules, 200 mg oral solution per 5 mL);
  • Clarithromycin (500 mg tablets);
  • Clindamycin in 150 mg capsules, injectable solution (150 mg as phosphate);
  • Vancomycin (injectable solution 250 mg, 500 mg, 1000 mg).

It may also be used (as indicated):

• combined cough suppressants, mucolytics, bronchodilators, expectorants;
• anti-inflammatory non-steroidal drugs;
• inhaled corticosteroid medications;
• physical therapy;
• phytotherapy;
• L.F.T., manual therapy.

If dyspnea in a child is accompanied by signs of respiratory failure, it is important to stabilize the condition as soon as possible with oxygen therapy or non-invasive ventilation. In bronchial asthma, drugs that dilate the bronchi, steroids are used. In each individual case, the decision on this or that therapeutic tactic is made by the doctor who carried out diagnostic measures.