Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Emergency evaluation and immediate management of acute respiratory distress in children

Debra L Weiner, MD, PhD
Section Editor
Gary R Fleisher, MD
Deputy Editor
James F Wiley, II, MD, MPH


Respiratory distress is one of the most common chief complaints for which children seek medical care. It accounts for nearly 10 percent of pediatric emergency department visits and 20 percent of hospitalizations [1].

Respiratory distress in children, particularly neonates and infants, must be promptly recognized and aggressively treated because they may decompensate quickly. Factors that contribute to rapid respiratory compromise in children include smaller airways, increased metabolic demands, decreased respiratory reserves, and inadequate compensatory mechanisms as compared to adults. Respiratory arrest is the most common cause of cardiac arrest in children and outcomes are poor for patients who develop cardiopulmonary arrest as the result of respiratory deterioration [2-5].

The initial assessment and stabilization of children with respiratory and circulatory distress including airway management techniques, rapid sequence intubation (RSI), causes of respiratory compromise in children, and conditions causing respiratory distress in newborns are discussed separately:

(See "Initial assessment and stabilization of children with respiratory or circulatory compromise".)

(See "Basic airway management in children".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon Nov 24 00:00:00 GMT 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Krauss BS, Harakal T, Fleisher GR. The spectrum and frequency of illness presenting to a pediatric emergency department. Pediatr Emerg Care 1991; 7:67.
  2. Donoghue AJ, Nadkarni V, Berg RA, et al. Out-of-hospital pediatric cardiac arrest: an epidemiologic review and assessment of current knowledge. Ann Emerg Med 2005; 46:512.
  3. Gerein RB, Osmond MH, Stiell IG, et al. What are the etiology and epidemiology of out-of-hospital pediatric cardiopulmonary arrest in Ontario, Canada? Acad Emerg Med 2006; 13:653.
  4. Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 2006; 295:50.
  5. McNally B, Robb R, Mehta M, et al. Out-of-hospital cardiac arrest surveillance --- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010. MMWR Surveill Summ 2011; 60:1.
  6. Recognition of respiratory distress and failure. In: Pediatric Advanced Life Support Provider Manual. Chameides L, et al (Eds), American Heart Association, Dallas, 2011, p.37.
  7. O'Dempsey TJ, Laurence BE, McArdle TF, et al. The effect of temperature reduction on respiratory rate in febrile illnesses. Arch Dis Child 1993; 68:492.
  8. Gadomski AM, Permutt T, Stanton B. Correcting respiratory rate for the presence of fever. J Clin Epidemiol 1994; 47:1043.
  9. Margolis P, Gadomski A. The rational clinical examination. Does this infant have pneumonia? JAMA 1998; 279:308.
  10. Poets CF, Southall DP. Noninvasive monitoring of oxygenation in infants and children: practical considerations and areas of concern. Pediatrics 1994; 93:737.
  11. Dieckmann RA. Pediatric assessment. In: APLS: The Pediatric Emergency Medicine Resource, Gausche-Hill M, Fuchs S, Yamamoto L. (Eds), Jones and Bartlett, Sudbury 2004. p.20.