by Nicole Evans M.D.

Created on: April 26, 2009   Last Updated: December 12, 2009

An infant or young child with difficulty breathing may have an infectious or noninfectious cause. Every parent should be familiar with the  common causes of pediatric breathing difficulties discussed below.

Croup:

Croup is a viral infection of the upper respiratory tract. The most common infectious agent causing croup is the parainfluenza virus. Croup occurs most commonly in the fall and winter seasons. The most striking symptoms of croup are a barking cough and stridor. These symptoms are usually worse at night.

A child with croup may need to be admitted to the hospital if he or she has progressive or severe stridor at rest, respiratory distress, hypoxemia, cyanosis (blue coloring), pallor, high fever or suspected epiglottis.

Most children with croup do not require hospitalization and recover completely with time. Treatment for mild croup is mist therapy with a humidifier. A child with more severe symptoms of croup may require racemic epinephrine and/or dexamethasone. In the most severe croup cases a child may need to be admitted to the ICU.

Epiglottitis:

Epiglottitis is an acute, life-threatening infection of supraglottic tissues in the throat. The most common infectious agents in epiglottitis are Group A Strep, Strep pneumonia, and Staph aureus. H. influenza b was a very common cause of epiglottitis before the Hib vaccine.

Symptoms of epiglottitis include a hot potato voice, leaning forward and drooling, stridor, and tachycardia. A lateral neck x-ray may show the swollen epiglottic tissue. Direct visualization with laryngoscopy will reveal a big, cherry-red epiglottis.

Treatment for epiglottitis often requires endotracheal intubation, usually placed in the operating room, to support the airway. Antibiotic therapy of epiglottitis includes Ceftraixone for 7 to 10 days, as well as Rifampin for individuals who were in close contact with the sick child.

Foreign body inhalation:

Children ages 6 months to 3 years are most likely to inhale an object. Boys are two times more likely than girls to have a foreign body as the cause of their respiratory distress.

This diagnosis of inhaled foreign body is suggested if the child was left alone, has a sudden onset croupy cough with or without wheezing, can't speak, is coughing up blood, or is cyanotic (blue). However, if the object is stuck in the bronchi, the child may have a latent period with cough, recurrent lobar pneumonia, and/or intractable asthma.

Laryngoscopy or bronchoscopy, or sometimes chest x-ray, can assist

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