URTI
Croup
Pneumonia
Pertussis
Chronic
Post-bronchiolitis or pertussis
Aspiration of feed
Gastro-oesophageal reflux
Recurrent
Asthma
Cystic fibrosis
Bronchiectasis
Croup, 6 months to 6 years
Epiglottitis, 1–6 years
Bacterial tracheitis
FB, toddler
Acute allergic reaction
Chronic
Usually congenital causes (e.g. laryngomalacia)
Bronchiolitis, 1–9 months
Atopic asthma
Asthma – non-atopic
Transient wheezing in infancy – usually resolves by 5 years
Croup
Gastro-oesophageal reflux
Inhaled foreign body, typically toddler
Heart failure
History
Find out if symptoms are acute or chronic. Consider the child’s age.
- If there is a wheeze, clarify what the parents mean by this.
- Ask about duration of symptoms.
- What is the timing? Asthma and croup are worse at night.
- Are symptoms recurrent? Think cystic fibrosis, bronchiectasis and asthma.
- What is the type of cough?
- If there is fever, infection is likely, either viral or bacterial. Remember specific infections (e.g. pneumonia, TB).
- Are there any feeding difficulties? Or any weight loss?
- Was there choking? Think of a foreign body (FB).
- Take a PMH and a family history (e.g. cystic fibrosis, asthma).
- Ask about smoking in the household, family or other carers.
- Check the growth and immunisation record.
Examination
Ask yourself: is this an ill child? Look for:
Respiratory distress, cyanosis, intercostal recession, tracheal tug, tachypnoea, lethargy, low oxygen saturation, dehydration.
- Take the temperature, pulse and respiration rate.
- Listen to the cough. Is it barking or spasmodic? Is there stridor?
- Assess severity of stridor (at rest or only when the child is active?).
- Distinguish between croup and epiglottitis (see below).
If you suspect epiglottitis or an inhaled foreign body do not examine the throat or you may precipitate complete obstruction.
- Listen to the chest for wheezes, other sounds or evidence of consolidation. Unilateral wheeze suggests a FB.
- If you suspect asthma, perform a peak flow test if possible.
Croup and Epiglottitis
Stridor is a noise that occurs on inspiration because of partial upper airways obstruction; it can be acute or chronic. Croup is a common cause and often seen in general practice.
Croup is a laryngo-tracheal infection usually caused by para-influenza virus. It is more common in winter and starts with URTI. The typical barking cough and stridor develop later. Most episodes can be managed at home. Refer to hospital if:
Ill child with cyanotic spells
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
