Noisy breathing in a child while sleeping. Croup in children: symptoms and treatment. Measures for heavy breathing

What to do if your pediatrician finds that your breathing is hard small child? Is this symptom a cause for concern and could it indicate a more serious diagnosis such as bronchitis, pneumonia or even asthma? Should you worry if you yourself begin to notice that your child is breathing heavily and loudly? Let's listen to the recommendations of experts.

By itself noisy breathing is not a pathology and does not require treatment if the baby develops normally and feels well. This may be a structural feature of the nasopharynx or, more often, a reaction to too dusty and dry air in an apartment or garden. Children under one year old may breathe unevenly because their respiratory system is not yet fully developed. But if you notice that your child suddenly begins to breathe heavily, shortness of breath, coughing or wheezing appears, night snoring If it becomes difficult for him to breathe through his nose, be sure to consult a doctor and get an x-ray of his lungs.

The diagnosis of “hard breathing” can only be made by a doctor based on auscultation (listening) and is quite subjective. Fine healthy lungs and the airways work only on inhalation and relax on exhalation, which means that the doctor hears the inhalation well and almost does not hear the exhalation. If the exhalation becomes noisier, this may indicate an inflammatory process in the bronchi or the presence of mucus accumulations.

What does harsh breathing in children mean?

Parents often note such a sign as heavy breathing after suffering from an acute respiratory infection. If the child feels well, there is no fever, and the doctor does not note wheezing, this symptom is not a cause for concern. But often the cause of hard breathing can be something completely different:

1. If a child breathes noisily, this indicates an accumulation of mucus in the bronchi and respiratory tract, which must be removed so as not to provoke inflammatory processes. Mucus begins to accumulate if the air in the room is too dry, if the child does not walk outside much or drinks little. Abundant warm drink, regular ventilation, air humidification and frequent walks work wonders.
2. Hard breathing in a child may indicate progressive bronchitis if it is combined with a dry cough, wheezing and elevated temperature. This diagnosis should only be made by a doctor.
3. If hard breathing is combined with attacks of suffocation, shortness of breath and worsens during physical activity, this may indicate bronchial asthma, especially if there are people in the family suffering from this disease.
4. The child may have difficulty breathing after suffered trauma nose or adenoids. Be sure to consult an ENT doctor.
5. Nasal mucosa and respiratory tract may swell due to the presence of allergens in the child's environment, such as dust or mites living in feather pillows. Allergy tests will help determine the cause.

In any case, if you notice your child's breathing is harsh, contact a doctor you trust. A specialist will help you draw up full picture diseases and make the right decision.

Many people are interested in the causes of heavy breathing in children. Any, even minor, change in the child’s condition causes concern among parents. Babies breathe differently than adults: they sigh during sleep, the tummy and chest move more often, but this physiological norm. Any breathing disorder is called difficulty breathing, and it is this factor that is decisive when choosing treatment tactics. In this article we will talk about what disorders in the baby’s respiratory system you need to pay attention to and how to help if the child is breathing heavily.

Breathing process

Breathing is difficult physiological process. It includes two varieties: external and internal. Respiratory process divided into the act of inhalation and exhalation. Inhalation is the active part, during which the diaphragm and respiratory muscles contract chest, muscles of the anterior abdominal wall. At the same time, the ribs protrude forward, and movement outward of the chest and abdominal walls is felt. The passive part of the process is exhalation. The respiratory muscles and diaphragm relax, the ribs move down and inward. The physiological respiratory rate is directly dependent on the age of the child: the younger he is, the higher the frequency. With age, this figure approaches that of an adult.

It happens that Small child breathing heavily. Why is this happening?

Diagnostics

If the breathing process is complicated by symptoms such as confusion, increased chest movements, unusual sounds, it is necessary to pay attention to this and clarify the reasons. Sometimes such manifestations can be caused by nightmares or common cold, but it happens that heavy breathing indicates much more serious problems and requires immediate treatment. In most cases, heavy and noisy breathing occurs due to false or Viral Symptoms and treatment we will consider below.

Childhood infections

Sometimes this can be a manifestation of childhood infections such as measles, chickenpox, rubella, diphtheria, scarlet fever, and whooping cough. Inflammatory process the larynx and tracheal mucosa acts in such a way that the lumen narrows. The child begins to experience air deficiency when breathing. This is precisely the reason for the severe and deep breathing, the voice changes, becoming hoarse. A barking cough also appears. Defeat respiratory system always causes, but depending on the situation and the nature of the pathology, the treatment required is different. Doctors categorically prohibit self-prescription of inhalations for a child. Such self-medication can negatively affect the baby’s health and cause a crisis.

Allergy

Very common cause hard and heavy breathing becomes an allergy. In this situation, it is necessary to determine the type of allergen and try to exclude the child from contact with it. You should also consult your doctor about medications that can be used to relieve attacks. The risk of allergic reactions is reduced if you adjust your diet and include as much food as possible in your diet. more vitamins and minerals to strengthen the immune system.

Except painful conditions that the child is breathing heavily may be physiological feature body. This is typical for children under the age of one and a half years. In this case, the reason lies in the high elasticity of the tissues of the respiratory tract. If the child eats normally, sleeps soundly and grows well, there is no need to pay attention to these features. Upon reaching one and a half years will happen thickening of the cartilage of the larynx and heaviness breathing will pass by herself. But it’s still worth bringing this to the doctor’s attention at your next appointment to make sure there is no pathology.

Causes and treatments

So, the child is one year old and is breathing heavily, what should you do?

Naturally, the specialist selects treatment depending on the reasons that caused the breathing pathology. If the baby's condition does not cause serious concern, currently, you need to make an appointment with your pediatrician. If the baby’s condition rapidly deteriorates and he cannot breathe normally, then you should call ambulance. This must be done if hardness of breathing is accompanied by difficulty passing air, blueness of the nasolabial triangle, inability to make sounds, lethargy and drowsiness.

If difficulty breathing is caused by a cold or acute respiratory viral infection, it is usually accompanied by nasal congestion, cough, sore throat and fever. It is necessary to call a doctor so that he can confirm the diagnosis; before this, the child is given plenty of warm drinks and provided bed rest. The doctor will prescribe treatment, and the difficulty in breathing will disappear as treatment progresses and other symptoms of the disease disappear.

Bronchiolitis

It happens that a child breathes heavily in his sleep.

Another reason may be a disease such as bronchiolitis. It has viral nature and affects the bronchi. Most often occurs in infants of the first year of life. The condition is accompanied by a persistent, prolonged cough, which not only makes breathing difficult, but makes this process very problematic. With this pathology, the child does not breathe, but frequent and deep sighs. At the same time, the appetite decreases, the baby is capricious and sleeps poorly. It is necessary to call a doctor who decides whether hospitalization is necessary. When the disease is cured, breathing returns to normal.

If a child has asthma, then his breathing will be difficult, he coughs and chokes at the slightest physical exertion. As a rule, the child's closest relatives have asthma or allergies. In this case, only a doctor can prescribe effective and, most importantly, appropriate therapy for the condition. With this disease, self-medication is especially dangerous.

Breathing difficulties may occur with croup. In addition, the condition is accompanied barking cough, hoarse voice and fever. Breathing worsens at night. It is necessary to call an ambulance, and before it arrives, try to alleviate the child’s condition. To do this you need to pour hot water and close the door tightly, then bring the child into the bathroom and let him breathe warm, humidified air. This helps to expand the airway lumen. If this does not have a beneficial effect, you can take the child outside and let him breathe in the fresh night air.

Pneumonia

Another common cause of heavy breathing is pneumonia. In this case, the child very often sighs hoarsely, coughs heavily, and the temperature can rise above 38 degrees. As you inhale, you can notice how the skin retracts into the intercostal spaces. Urgent hospitalization is required here; treatment of pneumonia at home can lead to serious complications.

This is what harsh breathing in a child means.

All listed reasons are pathological conditions that require drug treatment, but other circumstances may also occur in which breathing will be difficult. For example, the impact may cause the baby to become harsh, intermittent, and wheezing. In this condition, emergency assistance from a specialist is required.

Adenoiditis

There may also be diseases that interfere normal breathing, in which it is necessary surgical intervention. This type of pathology includes adenoiditis. How larger size adenoids, the more they interfere with free breathing. With this disease, the child's sleep is accompanied by snoring and hoarse sighs. The baby breathes through his mouth all the time, due to the fact that his nose is stuffy, in the morning, when he wakes up, he looks sleep-deprived and irritated, and often suffers from colds.

In this situation, it is necessary to consult an ENT doctor, who will prescribe treatment. If the child’s condition is critical, then surgery to remove the adenoids is prescribed. In addition to all this, this condition can occur due to basic dry air in the room or inhalation of smoke from cigarettes. When a child is breathing heavily, how can you help him? More on this later.

How to alleviate the child's condition?

There are ways that can alleviate the child’s condition and help prevent drying out of the larynx and relieve spasms:

• humidification of indoor air using special devices;
• inhalation of warm, humidified air;
• inhalation with mineral water, soda or saline solution.

For inhalation you can use aerosol and steam inhalers, in a hospital setting - steam-oxygen tents. We remind you once again that inhalations can only be done after consulting a doctor.

Croup in children: symptoms and treatment

Croup is characterized by a triad of symptoms:

• barking paroxysmal cough;
• stridor (noisy breathing), especially with crying and excitement;
• hoarseness of voice.

In addition, there is an appearance secondary signs illness - severe anxiety, palpitations, nausea, hyperthermia.

When increasing respiratory failure all signs worsen, the child’s skin becomes gray or bluish in color, salivation intensifies, wheezing is heard already in calmness, anxiety is replaced by lethargy.

Children with this diagnosis require hospitalization. The first thing doctors should do is restore the airway. To do this, it is important to reduce swelling and also free the lumen from accumulated mucus.

Drug therapy is prescribed:

• Glucocorticoids are required to reduce laryngeal edema (through a nebulizer, for example).
• Drugs that relieve spasms of the respiratory tract (Salbutamol, Atroventa, Baralgina).
• Inhalations with Ambroxol are performed to remove sputum.
• If necessary, use antihistamines.

IN difficult cases tracheal intubation or tracheotomy with artificial ventilation lungs.

If a child has difficulty breathing, now we know what to do.

A child's breathing in the first months of life is often noisy. A breathing noise (called stridor) may be heard constantly or intermittently. In some cases, it occurs against the background of certain conditions, for example, physical activity, emotional excitement(crying), acute viral infection, allergic reaction, etc. Sometimes stridor occurs for no apparent reason.

The child is not bothered by noise when breathing. Indeed, stridor itself does not cause harm. It is also not a symptom specific to any one disease, and does not even reflect the severity of the patient's condition. In this regard, doctors pay little attention to it. When, apart from noisy breathing, there is no other pathological symptoms, the child is usually considered healthy and the stridor is benign.

In some cases, breathing noise is noticeable from birth or appears in the first days (weeks) of life. Then it is called innate. If there is no clear cause for the noise in medical documents The diagnosis is recorded: “congenital stridor”. The legality of this formulation is highly questionable.

Background

Because murmurs can also be benign (i.e., disappear without treatment) in various other conditions, by the mid-20th century the term laryngomalacia began to be widely used instead of the term “benign congenital stridor.” It is still used in medical literature.

Causes

Short-term stridor (up to several weeks) can be caused by an inflammatory disease or an allergic reaction. In this case, the sound is produced by edematous folds of the mucous membrane or secretions in the respiratory tract. Both pathological conditions are quite obvious due to symptoms other than noisy breathing. Stridor is not presented as a separate diagnosis.

Laryngomalacia, according to modern research, is the cause of noisy breathing in children of the first year of life in more than 70% of cases. Stridor with it is unstable. It may get worse or worse during sleep. Often the severity of the noise is influenced by the position (it is quieter in the prone position) and the activity of the child. The noise is heard more during inhalation, since exhalation with laryngomalacia occurs in the usual way.

The stability of the walls of the entrance to the larynx is ensured by both the supporting function of cartilage and muscle tension. Therefore, each child has an individual character of stridor.

Diagnosis and determination of the severity of laryngomalacia

If laryngomalacia is suspected (based on the nature of the noise and radiological data), an endoscopic examination (fnbrol-rnngoscopy) is performed. It does not require anesthesia, is not painful and can be performed from 1-2 months of age. Endoscopic signs of laryngomalacia are very specific, and the diagnosis is based on them even if there is a discrepancy with clinical data (for example, stridor may be absent).

In addition to establishing the fact of laryngomalacia, endoscopic examination allows one to evaluate the shape of the larynx and the degree of its closure during inspiration. At the present stage, the study is accompanied by video recording on DVD. This shortens its duration (no more than two minutes), allows you to review the recording in slow motion and take still pictures. Such data are necessary to decide the issue of surgical correction of the larynx and choose a specific surgical technique.

The next stage of the examination is to determine the degree of compensation of the defect. On severe course indicates the presence of constant noticeably difficult breathing - shortness of breath, but it occurs in isolated cases. The endoscopic picture does not reflect this side of the problem. Determine the level of obstruction to the air flow (function external respiration) is very difficult for children in the first months and years of life. This method not introduced into clinical practice in St. Petersburg. Therefore, the degree of blood saturation with oxygen and carbon dioxide is determined. Research this total indicator respiratory functions is available in various diagnostic centers in our city. The automatic analyzer provides data on the partial pressure of blood gases.

Normal indicators for children: carbon dioxide not higher than 40 mm Hg. Art., oxygen not lower than 80 mm Hg. Art. According to our data, 99% of children with laryngomalacia are in a state of chronic hypoxia. In all examined children under the age of 1 year, the oxygen level varied from 46 to 80 mm Hg. Art., whereas healthy children in the same laboratory the result was 94-97 mmHg. Art. As mentioned above, time in this situation works on the child’s side - the larynx expands and thickens with age. However, compensation occurs slowly, the indicator increases by an average of 4 mm Hg. Art. per month. The central region is most sensitive to this pathological condition. nervous system(especially the brain), which should develop rapidly during this period.

Level carbon dioxide in the blood was elevated in only two examined children. This explains the absence in most cases of such clinical symptom, like cyanosis - a bluish tint to the skin. The degree of hypoxia is an important factor in determining the need and timing of surgical intervention.

Another consequence of the collapse of the laryngeal opening during inspiration is episodes of obstructive sleep apnea. For some time, the entrance to the larynx remains completely closed, regardless of breathing movements. Such episodes occur no more often than 5% of cases of laryngomalacia, but they are very dangerous. The presence of apnea can be noticed in those children whose noise persists during sleep. It usually stops suddenly and reappears 10-25 seconds after a loud inhalation.

The next stage of examining the child is to identify symptoms of the disease from systems other than the respiratory system. This is, first of all, the digestive tract. The filling of the lungs with air occurs due to muscular effort, expanding the chest and lowering the diaphragm, which separates chest cavity from the abdominal. The pressure in the chest becomes below atmospheric pressure, and air rushes into the lungs. The presence of an obstruction in the larynx forces the child to make additional efforts to get the right amount of air. The pressure in the chest becomes too low. Because of this, food from the stomach is thrown back into the esophagus and higher (reflux). About 70% of children with laryngomalacia suffer from frequent, profuse regurgitation. The connection between laryngomalacia and reflux is demonstrated by the disappearance or significant reduction in the severity of regurgitation after surgery on the larynx.

The combination of deformation of the larynx with improper movement of food (up the pharynx) leads in some children to the reflux of food into the larynx and lower respiratory tract (aspiration). About 5% of children with laryngomalacia choke and cough when feeding. This can lead to severe pneumonia.

The combination of frequent regurgitation and low levels of oxygen in the blood means that about 7% of children with laryngomalacia grow slowly, gain weight and develop poorly.

The effect of laryngomalacia on the cardiovascular system consists of two factors. Firstly, low pressure in the chest leads to stagnation of blood in the vessels located there. The blood supply to the lungs changes and, while compensation is achieved, it grows along the lower respiratory tract. connective tissue. This is not fatal, but in the future it gives rise to frequent and prolonged bronchitis and pneumonia. Secondly, some children experience retraction of the sternum during inspiration. With age, this leads to the formation of a funnel-shaped chest and has a negative reflex effect on the functioning of the heart and bronchi.

A severe complication of laryngomalacia is a narrowing of the lumen of the larynx (larynx stenosis) due to an overlapping viral infection or an allergic reaction. Adding swelling to existing collapse can narrow the larynx so much that the child begins to choke. Infection and allergies lead to stenosis in children with a normal larynx, but a child with laryngomalacia reacts to them more often and more severely. In this case, it is important to be especially careful about this method of restoring breathing, such as intubation (insertion of a tube through the nose or mouth to the trachea). Carelessness during intervention or prolonged exposure of the tube can lead to severe deformation of the larynx with scarring.

Thus, the severity of laryngomalacia is determined not by the volume or duration of stridor, but by the presence (and severity) of all of the above pathological conditions. Each child has his own weak spots, especially in the first years of life, and the set of symptoms of laryngomalacia is also individual. The proportion of cases of laryngomalacia for which surgical treatment is indicated is at least 10-20%, depending on the severity of the criteria. Stridor can be very quiet during severe hypoxia and very loud when it is almost completely compensated. It depends not on the degree of collapse of the larynx, but on the severity of vibration of its individual structures.

Treatment of laryngomalacia

The operation is indicated if the child has:

Clear signs of constant shortness of breath;
- severe hypoxia;
- frequent excessive regurgitation;
- delays in physical and/or psychomotor development;
- frequent choking, episodes of pneumonia;
- more than one episode of laryngeal stenosis in the first year of life;
- episodes of obstructive sleep apnea.

Severe deformation of the laryngeal vestibule, as determined by fibrolaryngoscopy, is only an additional indication for surgery. The main indications are considered comprehensively, taking into account the severity of each pathological condition.

Surgery laryngomalacia is called supraglottoplasty. This is a variant of plastic reconstruction of the upper larynx. The only negative side of this tactic is the need to use anesthesia.

There are many more positive qualities. The operation is performed completely endoscopically without the use of external access, drainage, tracheotomy, etc. Despite the complexity of the operation for the surgeon, its volume is very small: most often, excess tissue that sinks into the larynx during inspiration is removed. The removed pieces of tissue, taken together, are usually placed on an adult's nail. On modern stage intervention is performed surgical laser, which virtually eliminates the possibility of bleeding. As a result, the patient tolerates the operation easily and immediately after it is sent to the ward (where one of the relatives may be). A awakened baby, as a rule, behaves normally: eats, drinks, babbles, etc. The effectiveness of the operation depends on the age of the child. Performing an intervention before the age of 6 months is associated with great difficulties for the surgeon due to the small size of the baby’s pharynx and larynx. The amount of intervention has to be limited to avoid complications, so that usually only a partial effect is achieved.

Between the ages of 7 and 12 months, the full effect is achieved in 95% of operations. This means an almost immediate disappearance of existing symptoms: stridor, shortness of breath, cyanosis, profuse regurgitation, hypoxia, etc. The older the patient, the higher the proportion of operations with full effectiveness, in adolescence it reaches almost 100%.

The only relative contraindication to surgery is the child’s large number external anomalies and microanomalies or malformations various organs. These children are at risk of a nonspecific laryngeal reaction to the intervention. At the site of the removed tissue, persistent swelling develops, which also interferes with breathing. The overall incidence of this complication in supraglottogastitis (for all children with laryngomalacia) is about 1%. Careful selection of patients for surgery allows us to minimize the risk for each individual baby.

Currently surgical treatment birth defects development of the larynx, harmful to the health of the child, is financed from the budget of St. Petersburg. This saves parents from serious costs. On the other hand, experience of such treatment in Russia currently exists only at the department and clinic of otorhinolaryngology of St. Petersburg State Pediatric Medical Academy. At the same time in European countries and the USA, such patients are operated on in almost any large hospital.

In the absence of indications for surgical treatment or when the operation is postponed to an older age (in order to increase its effectiveness), observational and preventive tactics are chosen. Monitoring of the child's growth, development and morbidity continues. This is necessary to correct the indications for the operation and clarify the timing of its implementation.

Prevention of complications of laryngomalacia

To improve the development of the child and prevent aspiration, you need to fight regurgitation: follow the correct diet, keep the baby in vertical position after feeding. Drug treatment may be prescribed.

Currently there is no data on increased risk complications during vaccination in such patients. Therefore, the usual vaccination schedule is used.

The course of laryngomalacia in older children

IN adolescence the collapse of the entrance to the larynx during inspiration may again become relevant, as it interferes with physical activity. The child may have difficulty running and performing other sports exercises due to shortness of breath. In the future, this may limit the choice of profession (while not being a contraindication to conscription into the army). At this age, laryngomalacia can still be diagnosed by residual deformation of the larynx. Surgical treatment improves the situation in all patients.

Knowledge of the presence of laryngomalacia is also useful in adulthood. It is a factor predisposing to chronic laryngitis and tumors of the larynx. This increases the alertness of therapists and ENT doctors.

Medical genetic counseling

When the airways are normal, the child breathes silently and effortlessly. When their patency is impaired, a high-pitched sound may appear when breathing, as air passes through the narrowed breathing tubes with effort. These are the sounds that occur when a child inhales and exhales through narrowed airways. Airway obstruction can occur due to swelling caused by infection, foreign body, inflammation and spasm of the bronchial muscles in asthma. Sometimes a rough wheeze is heard only when inhaling: this may be a symptom of croup. This wheezing is called stridor (see Help for croup).

URGENT CARE

Call emergency services for your child if wheezing is accompanied by:

• difficulty breathing
• around the child's lips
• unusual drowsiness, lethargy
• inability to speak or produce
• normal sounds

ATTENTION!

Wheezing in a child may appear suddenly when the respiratory tract gets foreign body. Minor wheezing may be accompanied by ARVI. If you experience wheezing when breathing, consult a doctor immediately.