Editing Pediatric Nursing (section)

== Respiratory considerations ==

Respiratory failure is the most common pathway to cardiac arrest in children, so pediatric arrests are usually '''asphyxial''' rather than the sudden ventricular arrhythmias seen in adults. Anatomic reasons include:

* A proportionally large tongue and occiput, and a narrow, funnel-shaped airway. A small amount of edema markedly reduces the airway lumen because resistance rises steeply as radius falls.
* Short, horizontally oriented eustachian tubes, which predispose to otitis media.
* Fewer alveoli and less elastic recoil, so less respiratory reserve.
* Highly compliant chest wall, which produces '''retractions''' rather than effective ventilation when effort increases.
* Infants younger than about 4 to 6 months are largely obligate nose breathers, so nasal congestion alone can cause distress and feeding failure.
* Higher metabolic rate and oxygen consumption, so desaturation occurs quickly.

'''Signs of respiratory distress and impending failure.''' Nasal flaring, grunting, retractions (subcostal to intercostal to supraclavicular as severity increases), head bobbing, tachypnea, and stridor indicate distress. '''Bradycardia, a silent chest, decreased responsiveness, and a slowing respiratory rate in a child who was previously tachypneic are signs of impending arrest''', not improvement.