Pediatric Respiratory Assessment Part 4

Respiratory mechanics

·         Retractions

intercostal

subcostal

suprasternal

·         Grunting

·         Nasal flaring

·         Head bobbing

Retractions

Inward movement of the chest wall or tissues, neck or sternum during inspiration

Mechanical response to move air into noncompliant lungs by using chest muscles to overcome the airway resistance

Note:   Retractions occur during inspiratory phase.  When accompanied by stridor suggest upper airway obstruction.  When accompanied by grunting suggest decreased lung compliance

Location of Retractions

·         Subcoastal- of the abdomen, just below the rib cage

·         Substernal- of the abdomen just below the xyphoid

·         Intercoastal- between the ribs

·         Subclavicular- just above the collar bone

·         Suprasternal- in the chest, just above the sternum

·         Sternal- inward movement of the sternum

Nasal Flaring

·         Dilation of the nostrils with each inhalation

·         Maximizes air entry into the upper airway

·         Seen more frequently in infants and children

Head Bobbing

·         Caused by use of the neck muscles to assist breathing

·         Child lifts the chin and extends the neck during inspiration and allows the chin to fall during expiration

Seesaw Respirations

·         Paradoxical movement of the chest and abdomen during respirations

·         During inspiration the chest retracts and the abdomen expands; during expiration the chest expands and the abdomen retracts

·         Can quickly lead to respiratory fatigue and failure

Note:  Often observed in upper respiratory obstructions.  Also observe in severe lower airway obstructions, lung tissue disease, and disordered control of breathing.  They are also characteristic of infants with neuromuscular weakness. 

Source:

Pediatric Advanced Life Support Provider Manual by Leon, M.D. Chameides, Ricardo A., M.D. Samson, Stephen M., M.D. Schexnayder and Mary Fran, RN Hazinski (Oct 12, 2011)