Summary

Acute respiratory distress in children is difficulty breathing or inadequate breathing, which can be caused by many conditions affecting the airways, lungs, or breathing muscles. Think of breathing as your child's body getting oxygen in and carbon dioxide out—when something interferes with this process (blocked airways, lung problems, breathing muscle weakness), your child has to work harder to breathe, causing respiratory distress. This is a medical emergency that can progress rapidly to respiratory failure (inability to breathe adequately) and death if not treated promptly. The most common causes vary by age—in infants, it's often bronchiolitis or pneumonia; in older children, it's often asthma, pneumonia, or croup. The presentation can be subtle in infants (may just be grunting, nasal flaring, or poor feeding) or more obvious in older children (obvious difficulty breathing). The key to management is recognizing respiratory distress early (increased work of breathing, tachypnea, use of accessory muscles, grunting, nasal flaring), assessing severity, providing immediate support (oxygen, positioning, may need ventilation), treating the underlying cause, and monitoring closely. Early recognition and treatment are crucial—respiratory distress can progress rapidly to respiratory failure.

Key Facts

• Definition: Difficulty breathing or inadequate breathing
• Incidence: Very common (thousands of cases/year)
• Mortality: Low (<1%) with prompt treatment, higher if delayed
• Peak age: Infants and young children (highest risk)
• Critical feature: Increased work of breathing, tachypnea, signs of distress
• Key investigation: Clinical assessment (usually sufficient)
• First-line treatment: Oxygen, treat underlying cause, may need ventilation

Clinical Pearls

"Work of breathing is key" — Look for increased work of breathing (use of accessory muscles, intercostal recession, subcostal recession, tracheal tug, head bobbing). This is more important than just the respiratory rate.

"Infants show different signs" — Infants may show subtle signs (grunting, nasal flaring, poor feeding) rather than obvious difficulty breathing. Always look for these signs in infants.

"Don't wait for cyanosis" — Cyanosis is a late sign. If a child is cyanotic, they're in severe respiratory failure. Treat before they become cyanotic.

"Respiratory distress can progress rapidly" — Children, especially infants, can deteriorate very quickly. Don't wait—if you suspect respiratory distress, assess and treat urgently.

Why This Matters Clinically

Respiratory distress is a medical emergency that can progress rapidly to respiratory failure and death if not treated promptly. Early recognition (especially in infants where signs may be subtle), immediate support (oxygen, positioning), and treating the underlying cause are essential. This is a condition that all clinicians caring for children need to recognize and manage urgently, as delayed treatment can be fatal.

Structured Approach: ABCDE

A - Airway

• Assessment: May be compromised (obstruction, decreased consciousness)
• Action: Secure if compromised (may need intubation)

B - Breathing

• Look: Increased work of breathing, signs of distress
• Listen: Wheeze, crackles, stridor, decreased air entry
• Measure: SpO2 (may be low), respiratory rate (usually high)
• Action: Oxygen urgently, may need ventilation

C - Circulation

• Look: May have signs of shock (if severe)
• Feel: Pulse (may be fast), BP (usually normal, may be low if severe)
• Listen: Heart sounds (usually normal)
• Measure: BP (usually normal), HR (may be high)
• Action: Monitor if severe

D - Disability

• Assessment: Mental status (may be altered if severe)
• Action: Assess if severe

E - Exposure

• Look: Respiratory examination, look for cause
• Listen: Auscultation
• Action: Complete examination, identify cause

Specific Examination Findings

Work of Breathing Assessment (Critical):

Auscultation:

Special Tests

Natural History (Without Treatment)

Untreated Respiratory Distress:

• High risk of respiratory failure: Almost certain if severe
• High mortality: If not treated promptly
• Poor outcomes: If not treated

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Early treatment: Better outcomes
• Mild-moderate: Usually recover quickly
• Treatable cause: Better outcomes
• No complications: Better outcomes

Poor Prognosis:

• Delayed treatment: Higher risk of respiratory failure
• Severe distress: Higher risk of respiratory failure
• Respiratory failure: Higher mortality
• Very young: May have worse outcomes

Prognostic Factors

Key Guidelines

1. BTS Guidelines (2019) — British guideline on the management of asthma. British Thoracic Society

Key Recommendations:

• Oxygen for all
• Bronchodilators for asthma
• Steroids for asthma
• Evidence Level: 1A

2. NICE Guidelines (2015) — Bronchiolitis in children: diagnosis and management. National Institute for Health and Care Excellence

Key Recommendations:

• Supportive care
• Oxygen if needed
• Evidence Level: 1A

Landmark Trials

Multiple studies on asthma treatment, oxygen use.

Evidence Strength

What is Respiratory Distress?

Respiratory distress is when your child has difficulty breathing or isn't breathing well enough. Think of breathing as your child's body getting oxygen in and carbon dioxide out—when something interferes with this (blocked airways, lung problems, weak breathing muscles), your child has to work harder to breathe, causing respiratory distress.

In simple terms: Your child is having trouble breathing and needs help. This is a medical emergency, but with prompt treatment, most children recover completely.

Why does it matter?

Respiratory distress is a medical emergency that can progress rapidly to respiratory failure (inability to breathe adequately) and death if not treated promptly. Early recognition and treatment (oxygen, treating the cause) are essential. The good news? With prompt treatment, most children recover completely.

Think of it like this: It's like your child struggling to breathe—they need urgent help, but with the right treatment, they usually recover quickly.

How is it treated?

1. Immediate Care (Most Important):

• Oxygen: Your child will get oxygen immediately to help them breathe
• Why: To support their breathing while we treat the cause
• Don't wait: Even before we know exactly what's causing it

2. Identify the Cause:

• Examination: Your doctor will examine your child to find out what's causing the breathing difficulty
• Tests: Your child may have tests (chest X-ray, etc.) if needed
• Why: To guide the right treatment

3. Treat the Cause:

• If asthma: Your child will get medicines to open the airways (bronchodilators) and reduce inflammation (steroids)
• If pneumonia: Your child will get antibiotics
• If bronchiolitis: Your child will get supportive care and oxygen
• If croup: Your child will get steroids
• If other causes: Treated as appropriate

4. Support Breathing (If Needed):

• If very severe: Your child may need help breathing (CPAP, BiPAP, or a breathing tube)
• Why: To support their breathing if they can't breathe well enough on their own
• When: If they're in respiratory failure or exhausted

The goal: Support your child's breathing (oxygen, ventilation if needed) and treat whatever's causing the breathing difficulty.

What to expect

Recovery:

• Most cases: Start improving within hours with treatment
• Symptoms: Should improve as the cause is treated
• Full recovery: Most children recover completely within days

After Treatment:

• Oxygen: Your child will continue to get oxygen until they can breathe well on their own
• Medications: Your child may need medications (depending on the cause)
• Monitoring: Close monitoring until your child is stable
• Going home: When your child is stable and breathing well

Recovery Time:

• Mild cases: Usually recover within hours
• Moderate cases: Usually recover within days
• Severe cases: May take longer, may need more support

When to seek help

Call 999 (or your emergency number) immediately if:

• Your child is having difficulty breathing
• Your child is breathing very fast
• Your child's skin is blue (cyanosis)
• Your child is very unwell
• Your child is exhausted from breathing
• You're very worried about your child

See your doctor if:

• Your child seems to be working hard to breathe
• Your child is breathing faster than normal
• Your child has symptoms that concern you
• You're worried about your child

Remember: If your child is having difficulty breathing, especially if they're breathing very fast, working hard to breathe, or their skin is blue, call 999 immediately. Respiratory distress is a medical emergency, but with prompt treatment, most children recover completely. Trust your instincts—if you're worried, seek help immediately.