Any parent worries about a sick child, but that anxiety magnifies during the night hours. Parents contact on-call physicians or nurses during the night most commonly for fevers, but the second most common reason is breathing problems, such as "wheezing." Over the phone, the physician or nurse can get a good idea whether your child needs to be seen urgently or not.
A pediatrician's top concern would be that your child is in respiratory distress, and measuring your child's respiratory rate is the easiest and most accurate assessment for respiratory distress. Respiratory rates of 60 or more times a minute in infants and toddlers or 40 or more times a minute in older children indicates respiratory distress.
With expirations, you might notice their ribs more pronounced, with a "hollow" area just above their breast bone and their noses flaring somewhat like a rabbit. Importantly, children in respiratory distress cannot sleep because they are laboring too hard to breathe. If your child is in respiratory distress, he needs immediate medical attention, and if not, then your pediatrician will have time to ask about other symptoms.
The definition of "wheezing" is not intuitive. It is not a whistling sound caused by nasal congestion, nor is it the rattle you can feel in your child's chest, which is congestion in the large airways. It is a high-pitched musical sound heard during expiration which indicates a restriction of the very small airways that lead to the air pockets of the lung, or the alveoli. It is usually accompanied by a short, dry cough. Except in infants, wheezing is mainly caused by asthma, and a history or family history of allergies and asthma is common.
Croup is a condition that might be mistaken for asthma and wheezing. It occurs in small children at night and is notable for a cough that sounds like a seal barking with a gasping sound as the child breathes in. It is caused by inflammation of the upper airway, the trachea, just below the glottis that separates the trachea and esophagus. Although it is frightening to witness, it usually subsides with the cool, moist, night air of your back porch.
Grunting is a much less certain sign. It can occur in respiratory distress, particularly in infants, but it can also be caused by congestion and fever. So grunting alone is not a dependable sign as to the degree of illness of your child and is only useful in the context of the other signs of respiratory difficulty.
When to Be Concerned
A child with respiratory distress is in need of emergency medical care, and a 2004 government study by the Healthcare Cost and Utilization Project found respiratory difficulties to be the most common reason for hospital admission from emergency departments 2. If you are concerned about your child's breathing difficulty, contact your pediatrician or his on-call service immediately.
- "Pediatric Emergency Medicine: Concepts and Clinical Practices"; Roger M. Barkin, M.D., M..PH., editor; 1992
- Healthcare Cost and Utilization Project; "Reasons for Being Admitted to the Hospital through the Emergency Department for Children and Adolescents, 2004"; Chaya Merrill, M.P.H., and Pamela L. Owens, Ph.D.; 2007
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