It’s here! Upper respiratory season has officially arrived and I have started to see coughing, wheezing and some children with respiratory distress. While coughs really worry parents, coughs are actually protective and are natures way of protecting our lungs. But, I am constantly talking to parents about coughs and watching for respiratory distress.
The need to watch a child for respiratory distress is one of the most important discussions I have with parents, especially so for those with infants and toddlers. who will be getting all sorts of upper respiratory infections this winter, including RSV. I remember being an intern and suddenly being immersed in an ER full of coughing children. I was told, “you will know a child in respiratory distress when you see them”, and that was true. Once you see one you never forget.....so check out the video on The Kid;s Doctor TV of a recent patient I admitted to the hospital with respiratory distress! You should NEVER see your child using their tummy, chest and neck muscles to breath! This pulling is called retracting. This child was really “working” to breath when they showed up in my office as the last patient of the day (true). Fortunately, he is fine now after a few days in the hospital, but he was really sick and his mother was rightfully scared and worried.
When talking about coughs and respiratory distress I tell parents that many times the “visual is MORE important than the audible”. Your child may have a terrible cough, which can be even louder than an adult. They cough up mucous, or even vomit up some mucous and be just fine. On the other hand even a small little cough can be so tight that a child is having a hard time breathing.
So, when assessing your child’s cough, always lift up their shirt/gown etc. and LOOK at their chest. Make sure they are not “working to breath”. You should not see those rib muscles moving in and out and they should not be using their tummies to breath. I look at every chest at this time of year.....all clothes off.
Next look at their color, remember red is good and blue is bad. A child will often cough so hard they turn red in the face, but they should never have a dusky or bluish color. Again, the sound is not as important as how they look.
This is just the beginning of a long season, but this video is worth more than a thousand words and the mother of this little boy allowed me to video him in hopes of letting others know what they DON’T want to see.