Acute dyspnea (peds)

Background

• Breathing complaints common in pediatrics
• Infants/children have higher predisposition to respiratory failure relative to adults
  • Higher resting metabolic rate requires more oxygen
  • Anatomical differences (e.g. smaller diameter airways) predispose to respiratory failure
  • Vast majority of pediatric cardiac arrests are secondary to respiratory problem
• Included here are other respiratory chief complaints, such as tachypnea, irregular breathing, abnormal respiratory sounds or appearance, cyanosis, which parents may have noticed

Differential diagnosis

Pediatric Shortness of Breath

Pulmonary/airway

• Airway obstruction
  • Anaphylaxis
  • Angioedema
  • Aspirated foreign body
  • Asthma exacerbation

• Structural
  • Bronchopulmonary dysplasia
  • Choanal atresia
  • Neoplasm
  • Subglottic stenosis
  • Tracheoesophageal fistula
  • Tracheomalacia
  • Spontaneous pneumothorax

• Infectious
  • Bacterial tracheitis
  • Bronchiolitis (peds), URI
  • Croup
  • Epiglottitis
  • Pertussis
  • Pneumonia
  • Cystic fibrosis exacerbation

• Trauma
  • Rib fractures
  • Flail chest
  • Traumatic pneumothorax
  • Pulmonary contusion

• Other
  • Inhalation exposure
  • Meconium aspiration syndrome
  • Pulmonary edema
  • Pulmonary hypertension, cor pulmonale
  • Respiratory distress syndrome

Cardiac

• Congenital heart disease
• Vascular ring
• Cardiac tamponade
• Congestive Heart Failure (peds)
• Myocarditis (peds)

Other diseases with abnormal respiration

• Normal neonatal periodic breathing (misinterpreted by caregivers as abnormal)
• Brief resolved unexplained event
• Anemia
• Abdominal distension (e.g. SBO, liver failure
• Neonatal abstinence syndrome
• Decreased perfusion states
  • Pediatric shock
  • Sepsis (peds)
  • Dehydration (peds)
• Metabolic acidosis
  • Diabetic ketoacidosis (peds)
  • Inborn errors of metabolism
  • Salicylate toxicity
• CO Poisoning
• Diaphragm injury
• Renal Failure
• Electrolyte abnormalities
• Organophosphate toxicity
• Tick paralysis
• Fever (Peds)
• Panic attack
• Porphyria