What is that hissing noise in the air? Plenty of wheezing and coughing ushering in upper respiratory season. With all this noise, I'm on the lookout for respiratory distress. As I start to see more and more sick kids, my office becomes a cacophony of coughing. While many of the coughs sound horrible, fortunately most of the children I will see do not have any real respiratory distress.
I will spend a lot of time this respiratory season talking to parents about respiratory distress and what to watch for. Just like so many things in parenting, observation is the key. Watching your child's breathing when they are coughing or even wheezing is the most important thing you can do. But knowing what is distress or shortness of breath really often means you need to know what to look for.
I just saw a precious little girl in the office, my first patient of the morning. She had a history of a few episodes of wheezing, and did have a nebulizer and medications at home. She had been well all summer and the mother hadn't thought about wheezing, but noted that her daughter started to cough over the weekend and had then gotten worse and had coughed all night, which made her come to the office bright and early the following am.
When I walked into the room I immediately could see that the little girl was in a bit of respiratory distress. Not only was she coughing (which every other patient seems to be doing), she was also retracting or pulling. She was still happy and playing but you could see that she was working to breath. Her tummy was moving in and out and you could see her ribs pulling in and out a bit. She was still well oxygenated and pink.
Her mother had not looked at her chest and had forgotten about her daughter's nebulizer (you know, out of sight out of mind), as she had not used it for 6 months and was not clued back into coughs and respiratory season.
A quick review and she remembered what we had discussed last winter and realized that she should have pulled out the nebulizer over the weekend. It is repetition that makes you remember the home wheezing action plan and if you only do it once a year it is easy to forget.
Any time your child is coughing, whether they are 2 days or 20 years old, you want to look at their color (pink, not blue) and at their chest. You want to see if they are using their ribs or tummy to breathe. The sound of the cough is not as important as LOOKING at their chests. Whether it is during the day or the middle of the night, take off their shirts, (turn on a light) and look. That is what your pediatrician is doing throughout the season.
Any type of retractions, pulling, or respiratory distress means a phone call and visit to the doctor or ER. Coughs are usually okay, but never respiratory distress.
That's your daily dose for today. We'll chat again tomorrow.