Epidemiology and Etiology Choking is a leading cause of morbidity and mortality among children, especially those younger than 4 yr of age. Most victims of foreign body aspiration are older infants and toddlers ( Fig. 414.1 ); males have been found to be victims up to 1.7 times more likely than females. Studies show that children younger than 4 yr of age account for 61.7–70% of airway foreign…
The larynx functions as a breathing passage, a valve to protect the lungs, and the primary organ of communication; symptoms of laryngeal anomalies are those of airway obstruction, noisy breathing, difficulty feeding, and abnormalities of phonation (see Chapter 400 ). Obstructive congenital lesions of the upper airway produce turbulent airflow according to the laws of fluid dynamics. This rapid, turbulent airflow across a narrowed segment of…
Airway resistance is inversely proportional to the 4th power of the radius (see Chapter 400 ). Because the lumen of an infant's or child's airway is narrow, minor reductions in cross-sectional area as a result of mucosal edema or other inflammatory processes cause an exponential increase in airway resistance and a significant increase in the work of breathing. The larynx is composed of 4 major cartilages…
Anatomy The Waldeyer ring (the lymphoid tissue surrounding the opening of the oral and nasal cavities into the pharynx) comprises the palatine tonsils, the pharyngeal tonsil or adenoid, lymphoid tissue surrounding the eustachian tube orifice in the lateral walls of the nasopharynx, the lingual tonsil at the base of the tongue, and scattered lymphoid tissue throughout the remainder of the pharynx, particularly behind the posterior pharyngeal…
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Pharyngitis refers to inflammation of the pharynx, including erythema, edema, exudates, or an enanthem (ulcers, vesicles). Pharyngeal inflammation can be related to environmental exposures, such as tobacco smoke, air pollutants, and allergens; from contact with caustic substances, hot food, and liquids; and from infectious agents. The pharynx and mouth can be involved in various inflammatory conditions such as the periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA)…
Sinusitis is a common illness of childhood and adolescence. There are 2 common types of acute sinusitis—viral and bacterial—with significant acute and chronic morbidity as well as the potential for serious complications. Fungal sinusitis is rare in immunocompetent patients but can also occur. The common cold produces a viral, self-limited rhinosinusitis (see Chapter 407 ). Approximately 0.5–2% of viral upper respiratory tract infections in children and…
The common cold is an acute viral infection of the upper respiratory tract in which the symptoms of rhinorrhea and nasal obstruction are prominent. Systemic symptoms and signs such as headache, myalgia, and fever are absent or mild. The common cold is frequently referred to as infectious rhinitis but may also include self-limited involvement of the sinus mucosa and is more correctly termed rhinosinusitis. Etiology The…
Etiology Nasal polyps are benign pedunculated tumors formed from edematous, usually chronically inflamed nasal mucosa. They commonly arise from the ethmoidal sinus and occur in the middle meatus. Occasionally they appear within the maxillary antrum and can extend to the nasopharynx (antrochoanal polyp). It is estimated that between 1% and 4% of the population will develop nasal polyps at some point; the incidence of nasal polyps…
Tumors, septal perforations, and other acquired abnormalities of the nose and paranasal sinuses can manifest with epistaxis. Midface trauma with a nasal or facial fracture may also be accompanied by epistaxis. Trauma to the nose can cause a septal hematoma; if treatment is delayed, this can lead to necrosis of septal cartilage and a resultant saddle nose deformity. Other abnormalities that can cause a change in…
Normal Newborn Nose In contrast to children and adults who preferentially breathe through their nose unless nasal obstruction interferes, most newborn infants are obligate nasal breathers. Significant nasal obstruction presenting at birth, such as choanal atresia, may be a life-threatening situation for the infant unless an alternative to the nasal airway is established. Nasal congestion with obstruction is common in the 1st year of life and…
Background Infants commonly experience acute, self-resolving changes in their breathing, tone, mental status, and skin color. Usually these events are normal manifestations of developmental immaturity. Nonetheless, caregivers may worry that the acute event could have been life-threatening or is a sign of an undiagnosed medical problem and seek medical attention. In most cases, after a comprehensive history and physical examination, a clinician will determine the event…
Sudden infant death syndrome (SIDS) is defined as the sudden, unexpected death of an infant that is unexplained by a thorough postmortem examination, which includes a complete autopsy, investigation of the scene of death, and review of the medical history. An autopsy is essential to identify possible natural explanations for sudden unexpected death such as congenital anomalies or infection and to diagnose traumatic child abuse (…
Respiratory tract symptoms, including cough, wheeze, and stridor, occur frequently or persist for long periods in a substantial number of children; other children have persistent or recurring lung infiltrates with or without symptoms. Determining the cause of these chronic findings can be difficult because symptoms can be caused by a close succession of unrelated acute respiratory tract infections or by a single pathophysiologic process. Specific and…
History The history begins with a narrative provided by the parent/caretaker with input from the patient. It should include questions about respiratory symptoms (dyspnea, cough, pain, wheezing, snoring, apnea, cyanosis, exercise intolerance), as well as their chronicity, timing during day or night, and associations with activities including exercise or food intake. The respiratory system interacts with a number of other systems, and questions related to cardiac,…
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Inflammation of the peritoneal lining of the abdominal cavity can result from infectious, autoimmune, neoplastic, and chemical processes. Infectious peritonitis is usually defined as primary (spontaneous) or secondary. In primary peritonitis, the source of infection originates outside the abdomen and seeds the peritoneal cavity via hematogenous, lymphatic, or transmural spread. Secondary peritonitis arises from the abdominal cavity itself through extension from or rupture of an intraabdominal…
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Survival rates for pediatric liver transplantation are now >90% in the United States, in large part to refinements made in the critical care management of children with liver failure and advances in perioperative care and immunosuppression management. Protocols for immune suppression withdrawal enhancing tolerance have introduced the possibility of transplantation without the need for long-term immunosuppression. In the United States, a national allocation system matches donor…