Common Respiratory Conditions in Children

Bacterial Tracheitis

Bacterial infection of the trachea causes inflammation and the formation of thick, purulent secretions that can obstruct the airway. This is considered a severe form of upper airway infection, often following viral croup (parainfluenza virus). The most common pathogens are Staphylococcus aureus (including MRSA), Streptococcus pneumoniae, and Haemophilus influenzae. This typically affects boys aged 3-7 years. They present with:

• High fever
• Toxic appearance
• Stridor (usually biphasic)
• Croup-like cough but worsening symptoms despite treatment
• Respiratory distress with possible airway obstruction
• Often no response to usual croup treatments (like nebulized epinephrine)

They also show on lateral X-ray, irregular tracheal narrowing and subglottic narrowing with possible presence of tracheal membranes or secretions ("croup" vs. bacterial tracheitis). Direct visualization via endoscopy confirms thick purulent secretions and tracheal inflammation. Treatment is mainly focused on airway management (supportive care with fluids and oxygen) and antibiotics (empiric IV antibiotics covering Staph aureus and other bacteria, e.g., vancomycin + ceftriaxone or clindamycin). In some cases, they may require intubation due to the risk of airway obstruction. Prognosis is typically good with early recognition and appropriate treatment. However, it can be potentially life-threatening if untreated due to airway obstruction.

Epiglottitis: The Big Concern

Epiglottitis refers to the condition where there is acute inflammation of the epiglottis and surrounding supraglottic structures. This is a life-threatening airway emergency. The most common cause is Haemophilus influenzae type B (Hib). It presents with:

• High fever
• Severe sore throat
• Dysphagia, drooling
• Muffled "hot potato" voice
• Stridor (inspiratory)
• Tripod positioning (sitting, leaning forward, neck extended, chin out)
• Tachypnea, anxiety, cyanosis (late)

On X-ray, it presents with the thumbprint sign on lateral neck X-ray (enlarged epiglottis). This is a confirmatory test, but not the first step. On laryngoscopy, it would show an edematous, cherry-red epiglottis. The first step is to ensure that the airway is protected via endotracheal intubation (in the OR if the patient is able to be moved)

Stridor: When Breathing Makes Noise

Stridor refers to a high-pitched sound caused by turbulent airflow through obstructed or narrowed upper airway structures, including the larynx, pharynx, or trachea. This distinctive sound can indicate several underlying conditions.

Common causes of stridor include:

• Croup (laryngotracheobronchitis)
• Epiglottitis
• Structural lesions
• Foreign body obstruction
• Tracheomalacia
• Laryngospasm

Croup: The Distinctive Barking Cough

Croup is characterized by fever, runny nose (rhinorrhea), a distinctive barking cough, and inspiratory stridor. The good news is that this illness is typically mild and self-limited, meaning it resolves on its own with supportive care.

Croup is most commonly caused by the parainfluenza virus, though it can result from various viral or bacterial infections. X-rays may reveal subglottic narrowing of the airway.

Treatment is typically supportive with severe cases treated with nebulized racemic epinephrine.

Pneumonia: When the Air Sacs Become Inflamed

Pneumonia causes inflammation of the alveoli (tiny air sacs) and interstitial tissues in the lungs. During a physical examination, healthcare providers use pulmonary auscultation to detect abnormal sounds such as crackles, wheezes, or decreased breath sounds, which can indicate the presence of pneumonia.

Bronchitis: Inflamed Airways

Bronchitis involves inflamed bronchi and is a common cause of cough in children. This condition is typically caused by bacterial infections, including:

• Haemophilus influenzae (H. flu)
• Streptococcus pneumoniae (strep pneumo)
• Moraxella catarrhalis

Bronchiolitis: A Common Concern in Young Children

Bronchiolitis is a common lower respiratory tract infection of the bronchioles that primarily affects children under two years of age. This condition is most commonly caused by respiratory syncytial virus (RSV). During examination, providers may hear wheezes or crackles when listening to the child's lungs. Treatment is with oxygen, nasal suctioning. If respiratory failure is imminent, advanced airway and ventilatory support are required.