IMCI training video:Exercise C - How to assess a child with cough and difficult breathing

Karin Källander

12 Feb 201412:04

Summary

TLDRThis script offers a comprehensive guide for assessing children with cough or difficult breathing, focusing on identifying pneumonia among common respiratory issues. It emphasizes the importance of determining the duration of coughing, recognizing fast breathing rates relative to the child's age, and observing for signs like chest indrawing and stridor. The script also provides practical steps for counting breaths and checking for breathing difficulties, ensuring early detection of severe respiratory infections.

Takeaways

🔍 Initial assessment of a child should include checking for general danger signs and inquiring about the presence of a cough or difficulty breathing.
🤒 A child with a cough might be suffering from pneumonia or another severe acute respiratory infection, necessitating further assessment.
🕒 The duration of the child's cough is critical, as a chronic cough lasting over 30 days could indicate tuberculosis, asthma, or whooping cough.
🏃‍♂️ Fast breathing is a key indicator of pneumonia; it's essential to count the child's breaths per minute to determine if it's rapid.
👶 Age-specific cutoff rates for fast breathing are crucial: 50 breaths per minute for children aged 2 months to 12 months, and 40 breaths per minute for those aged 12 months to 5 years.
👁️‍🗨️ Observing the child's breathing movement on the chest or abdomen is necessary, and the child should be calm during this observation.
👶 For a 7-month-old child, 90 breaths per minute indicate fast breathing, which is a sign of potential pneumonia.
🫁 Chest indrawing is a significant sign that occurs when the effort to breathe in is much greater than normal, and it should be assessed when the child is breathing in.
👂 Listening for stridor, a harsh noise made during inhalation, is important for identifying potential life-threatening airway obstructions.
🚫 Stridor is only significant if it is present consistently and is definitely visible; it should not be confused with noises heard when the child is upset or feeding.

Q & A

What is the first main symptom to ask about when assessing a child's respiratory condition?
-The first main symptom to inquire about is whether the child has a cough or is experiencing difficulty breathing.
Why is it important to determine the duration of a child's cough?
-Knowing the duration of a child's cough is crucial as a chronic cough lasting more than 30 days may indicate tuberculosis, asthma, or whooping cough.
What is the significance of assessing fast breathing in a child with a cough?
-Fast breathing is a sign of pneumonia. It indicates that the child's lungs have become stiff, making it harder to breathe and causing an increase in the breathing rate as the body tries to compensate for lung stiffness and low oxygen levels.
How can one determine if a child's breathing rate is fast?
-Fast breathing is determined by counting the number of breaths the child takes in one minute and comparing it with age-specific cutoff rates.
What are the cutoff rates for fast breathing in children aged two months up to 12 months?
-For children aged two months up to 12 months, fast breathing is present if 50 breaths per minute or more are counted.
What are the cutoff rates for fast breathing in children aged 12 months up to five years?
-For children aged 12 months up to five years, fast breathing is indicated if 40 breaths per minute or more are counted.
Why is it necessary to observe a child's breathing when they are calm?
-Observing a child's breathing when they are calm ensures that the assessment is accurate and not influenced by temporary factors such as crying or agitation, which can alter the breathing pattern.
What is chest indrawing and why is it significant in assessing a child's respiratory condition?
-Chest indrawing occurs when the effort required to breathe in is much greater than normal, causing an inward movement of the lower chest wall. It is significant because it indicates severe respiratory distress and may be present in conditions like pneumonia.
How can one identify chest indrawing in a child?
-Chest indrawing can be identified by observing the inward movement of the lower chest wall when the child breathes in, which is more pronounced than the normal outward movement of the upper chest and abdomen.
What is stridor and how can it be detected?
-Stridor is a harsh noise made when a child is breathing in, which can indicate a life-threatening airway obstruction. It can be detected by listening closely to the child's breathing, especially by placing the ear near the child's mouth.
Why is it important to observe a child for stridor when they are calm?
-Observing a child for stridor when they are calm helps to ensure that the noise is not a temporary response to crying or upset but a consistent sign of respiratory distress.

Outlines

00:00

🩺 Assessing Respiratory Symptoms in Children

This paragraph focuses on the initial steps of assessing a child's health by inquiring about the presence of a cough or difficulty in breathing. It emphasizes the importance of identifying pneumonia among children with respiratory symptoms. The assessment includes determining the duration of the cough, as a chronic cough lasting over 30 days could indicate tuberculosis, asthma, or whooping cough. A crucial part of the assessment is to check for fast breathing, which is indicative of pneumonia. The paragraph provides guidelines on counting a child's breaths per minute, with specific rates for different age groups. It also demonstrates how to observe a child's breathing movements and instructs on how to count breaths correctly, ensuring the child is calm during the observation.

05:29

🚑 Recognizing Fast Breathing and Chest Indrawing

The second paragraph delves into the signs of fast breathing in a seven-month-old child, with the health worker counting 90 breaths per minute, indicating a respiratory issue. It explains chest indrawing, a condition where the effort to breathe in is significantly greater than normal, causing the lower chest wall to move inward during inhalation. The paragraph instructs on how to observe chest indrawing by watching the child's upper chest and abdomen move out while the lower chest moves in during inhalation. It also clarifies that chest indrawing is only significant if it's a constant and visible feature, especially when the child is at rest. The paragraph concludes with the importance of looking and listening for stridor, a harsh breathing sound, which may indicate a life-threatening airway obstruction.

10:30

🌡️ Evaluating Stridor and Other Breathing Noises

The final paragraph discusses the assessment of stridor, a high-pitched noise made during inhalation that can signal a serious airway obstruction. It advises clearing the nose if necessary to better hear this sound and to listen for stridor when the child is calm, as it may not be present during crying or agitation. The paragraph also mentions the possibility of hearing other breathing noises, such as wheezing, but clarifies that these are not stridor. The focus is on accurately identifying stridor as part of the overall assessment of a child's respiratory health.

Mindmap

Keywords

💡Pneumonia

Pneumonia is an infection that inflames the air sacs in one or both lungs. It is a serious condition that can cause difficulty in breathing and can be life-threatening if not treated promptly. In the context of the video, pneumonia is a potential diagnosis for a child presenting with a cough or difficulty in breathing. The script emphasizes the importance of identifying pneumonia among children with coughs or colds, as it requires specific medical intervention.

💡Severe Acute Respiratory Infection (SARI)

SARI refers to a group of infections that cause inflammation in the respiratory tract and can lead to severe illness. It is characterized by symptoms such as fever, cough, and difficulty breathing. The video script mentions SARI as a possible condition that could be causing a child's symptoms, highlighting the need for thorough assessment to differentiate it from other respiratory issues.

💡Chronic Cough

A chronic cough is a cough that lasts for more than 30 days. It can be indicative of underlying health conditions such as tuberculosis, asthma, or whooping cough. The script points out the importance of the duration of a child's cough as a diagnostic clue, with a chronic cough potentially signaling more serious health issues that require medical attention.

💡Fast Breathing

Fast breathing, or tachypnea, is an increased respiratory rate that can be a sign of pneumonia or other respiratory distress in children. The video script provides specific age-related cutoff rates for what constitutes fast breathing in children, which is crucial for healthcare workers to identify and respond to potential pneumonia cases. The script includes a demonstration of how to count a child's breaths to assess for fast breathing.

💡Breathing Rate

Breathing rate refers to the number of breaths taken per minute. It is a vital sign that can indicate the health of a child's respiratory system. In the video, assessing the breathing rate is a key step in diagnosing pneumonia, as children with pneumonia often have an increased breathing rate due to lung stiffness and the body's attempt to compensate for low oxygen levels.

💡Chest Indrawing

Chest indrawing, or retractions, is a visible inward movement of the chest wall during inhalation, which can be a sign of respiratory distress. The video script instructs viewers on how to observe for chest indrawing, emphasizing that it is significant only if it is present at rest and not just during agitation or feeding. This is an important clinical sign that can help in diagnosing conditions like pneumonia in children.

💡Stridor

Stridor is a high-pitched, harsh sound that occurs during inhalation and is often indicative of a partial airway obstruction. The video script describes how to look and listen for stridor, especially in a calm child, as its presence can signal a life-threatening condition requiring immediate medical intervention.

💡Asthma

Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to difficulty in breathing, wheezing, and coughing. The script mentions asthma as one of the possible causes of a chronic cough in children, emphasizing the need for healthcare workers to consider this diagnosis when assessing a child with respiratory symptoms.

💡Whooping Cough

Whooping cough, or pertussis, is a highly contagious respiratory infection that causes severe coughing fits and a characteristic 'whooping' sound as the patient tries to catch their breath. The video script includes whooping cough as a potential cause of a chronic cough in children, highlighting the importance of recognizing this condition in clinical assessments.

💡Tuberculosis

Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis, which primarily affects the lungs. It can cause a chronic cough, fever, and weight loss. The script mentions tuberculosis as a possible cause for a chronic cough lasting more than 30 days, indicating the need for healthcare workers to be aware of this serious condition when assessing children with prolonged respiratory symptoms.

💡Clinical Assessment

Clinical assessment refers to the process of evaluating a patient's health by observing, interviewing, and examining the patient to determine the presence or absence of disease. The video script outlines a systematic approach to assessing children with cough or difficulty breathing, emphasizing the importance of clinical assessment skills in identifying and managing pediatric respiratory conditions.

Highlights

Assessment begins with checking for general danger signs and asking about the first main symptom, such as cough or difficult breathing.

A child with a cough may have pneumonia or another severe acute respiratory infection.

Identifying pneumonia among children with coughs or colds is crucial.

The duration of a child's cough is important, with chronic coughs potentially indicating tuberculosis, asthma, or whooping cough.

Fast breathing is a sign of pneumonia and is assessed by counting breaths per minute.

Breathing rates vary with age, with specific cutoff rates for different age groups.

For children aged two months to 12 months, fast breathing is indicated by 50 breaths per minute or more.

For children aged 12 months to five years, fast breathing is indicated by 40 breaths per minute or more.

Demonstration of counting breaths on a seven-month-old child, highlighting the process and significance.

Chest indrawing occurs when the effort to breathe in is much greater than normal.

Chest indrawing is identified by the inward movement of the lower chest wall during inhalation.

Chest indrawing is only significant if it is present all the time and definitely visible.

Stridor is a harsh noise made during inhalation, indicating potential airway obstruction.

Stridor should be assessed when the child is calm to determine its significance.

Other noises during exhalation, such as wheezing, are not considered stridor.

The assessment for cough or difficult breathing includes looking for signs of stridor when the child is calm.