Pediatrics
Respiratory System
Paediatric respiratory disease for NEET-PG: croup, epiglottitis, bronchiolitis, pneumonia, foreign body and childhood asthma, mapped to NMC PE28 codes.
MedNext Academy | 3 min read
Respiratory System
Paediatric respiratory disease for NEET-PG: croup, epiglottitis, bronchiolitis, pneumonia, foreign body and childhood asthma, mapped to NMC PE28 codes.
This chapter covers paediatric respiratory disease from upper airway infections and croup through bronchiolitis, pneumonia, empyema, bronchiectasis and foreign body aspiration to childhood asthma with its function testing and delivery-device skills. It emphasises bedside severity assessment over reflex investigation.
High-yield: Respiratory System
- Green nasal discharge alone is not an indication for antibiotics; duration, worsening pattern, fever severity, facial swelling, ear pain and respiratory effort decide whether the diagnosis has changed.
- In croup, dexamethasone treats the inflammatory course while nebulised adrenaline buys time in moderate or severe obstruction and must always be followed by observation.
- Epiglottitis is managed by preserving spontaneous breathing until a controlled airway plan is ready, and inspecting the throat with a tongue depressor can precipitate complete obstruction.
- Bronchiolitis treatment is oxygen and hydration, not a package of bronchodilator, steroid, antibiotic and chest physiotherapy.
- Pneumonia severity is a bedside diagnosis, so a hypoxaemic child receives oxygen and antibiotics without waiting for the chest radiograph.
- Persistent fever after 48 to 72 hours of appropriate pneumonia therapy is not simply slow response; look for empyema, abscess, resistant organism, tuberculosis or a wrong diagnosis.
- Ultrasound decides whether a pleural effusion is simple, large or loculated more safely than repeated blind taps.
- Bronchiectasis care has two equal arms of treating infection and clearing mucus, and antibiotics alone without airway clearance give incomplete control.
- A toddler who suddenly coughs and chokes while eating and then develops a unilateral wheeze has a foreign body until proven otherwise, and a normal radiograph does not exclude it.
- Before increasing a controller dose in asthma, check inhaler technique, adherence, ongoing smoke exposure and rhinitis treatment.
- The most dangerous asthma signs are a silent chest, drowsiness, exhaustion, cyanosis or a normal-to-rising carbon dioxide in a distressed child, indicating life-threatening asthma.
- Peak expiratory flow action zones should use the child's personal best rather than a single predicted value, because the child is still growing.
- On a paediatric chest radiograph, a triangular right upper mediastinal thymic shadow in an infant is normal and must not be mistaken for a mass.
- Every asthma prescription has three parts: the medicine, the delivery device and demonstrated inhaler technique, and stepping up without watching device use is bad practice.
- Chest physiotherapy is for secretion clearance and cough effectiveness, not for every crackle, and routine percussion in bronchiolitis or empyema pain is not evidence-based.
Upper airway emergency contrasts
- **Croup:** Barking cough and stridor; dexamethasone plus nebulised adrenaline for moderate to severe obstruction, then observe.
- **Epiglottitis:** Toxic, drooling, tripod posture; preserve spontaneous breathing and do not examine the throat.
- **Bronchiolitis:** Treatment is oxygen and hydration, not routine bronchodilator, steroid or antibiotic.
- **Foreign body aspiration:** Sudden choking with unilateral wheeze; a normal radiograph does not exclude it.
NMC competencies in this chapter
- **PE28.4:** Croup: Acute Laryngotracheobronchitis
- **PE28.5:** Epiglottitis and Supraglottitis
- **PE28.6:** Bronchiolitis
- **PE28.7:** Community-Acquired Pneumonia
- **PE28.11:** Foreign Body Aspiration
- **PE28.12:** Childhood Asthma
- **PE28.16:** Pediatric Chest X-ray Interpretation
Frequently Asked Questions
How is croup treated?
Dexamethasone treats the underlying inflammatory course, and nebulised adrenaline is added in moderate or severe obstruction to buy time. Adrenaline is short-acting, so the child must be observed afterwards for return of obstruction.
Why must the throat not be examined in suspected epiglottitis?
Inspecting the throat with a tongue depressor can precipitate complete airway obstruction. Management preserves spontaneous breathing until a controlled airway plan and senior airway-capable help are ready.
What is the treatment of bronchiolitis?
Bronchiolitis is managed with oxygen and hydration. It is not treated with a routine package of bronchodilator, steroid, antibiotic and chest physiotherapy, and severe signs include apnoea, exhaustion, feeding under half normal and a silent chest.
What are the danger signs of life-threatening asthma?
A silent chest, drowsiness, exhaustion, cyanosis, poor speech or a normal-to-rising carbon dioxide in a distressed child indicate life-threatening asthma and require urgent escalation rather than routine outpatient review.
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