Disorders of the respiratory tract account for a major part of paediatric medicine both in hospital and in general practice. There are 5 key common presentations that the practitioner should be familiar with and we will focus on these first. Next, we will discuss the investigations we use in the care of children. Last, we provide a mini-catalogue of diseases and condi-tions that you will need to know about, and be able to treat.
We have discussed the general approach to history and examination for patients with respiratory illness. Here are some additional points that you will need to take note of during your consultation.
· General information: neonatal period and any prior endotracheal intubations; growth and general body proportions; weight loss; immunizations.
· Age of onset of symptoms or problem.
· Have there been any triggers to this illness?
· What makes the problem worse? Exercise (e.g. asthma), sleep (e.g. adenotonsillar hypertrophy and snoring)?
· What makes the problem better? (Bronchodilators in asthma.)
· Other symptoms: haemoptysis; cough; sputum production; choking; gastro-oesophageal reflux; apnoea; coryza; chest/abdominal pain.
· General information: growth parameters; clubbing; lymphadenopathy; temperature; level of consciousness; colour; and arterial pulse oximetry saturation; pulse rate.
· Rate, pattern of breathing (episodic, periodic, apnoea), duration of expiration, and use of accessory muscles (+/– recession).
· Nose and speech: crease across the bridge of the nose and nasal discharge (e.g. allergic rhinitis); hyponasal speech (e.g. palate and nasal problems); nasal or mouth breather; nasal flaring.
· Facial appearance: size of midface, lower jaw, tongue (e.g. craniofacial syndrome).
· Tonsillar hypertrophy.
· Cough (paroxysms, barking, high-pitched).
· Neck retraction and external compressive mass.
· Breathing cycle: inspiratory stridor indicates extrathoracic airway obstruction; expiratory prolongation or wheeze indicates intrathoracic airway obstruction.
· Breath sounds.
· Chest appearance (Harrison’s sulcus), and percussion.
· Sputum pot.