Dr David Lowinger MBBS FRACS Ear Nose & Throat Specialist Surgeon
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Children

Newborn Breathing/Complex Airway Care

In infants, the airways and nasal passages are very small and narrow and are filled with amniotic fluid and mucous. Your baby will take some time to clear the amniotic fluid and mucous and makes adjustments to breathe on its own. During this process they may cough, produce noises, and also develop breathing difficulties. The normal breathing in children is affected by posture, sleep state, and gestational age. Infants' normal breathing rate is 40 breaths per min.

Airway is a tube that allows air to pass in and out of the lungs through tiny tubes. It is located at the voice box (larynx). Proper functioning of brain, lungs, respiratory muscles, and airway are necessary for proper breathing process. Any problems in these body parts may lead to breathing difficulties.

Causes

Some of the causes of breathing problems in children are due to incident of a trauma, holes in the heart, blockage of heart valves, infection of the lungs (pneumonia), cystic fibrosis (mucous in the lungs and digestive tract), infection of the airway, and airway obstruction due to foreign bodies.

Other causes include blockage of the larynx (voice box), nasal passages, trachea (wind pipe), or throat, enlarged tonsils and adenoids, retropharyngeal abscess (collection of pus behind the pharynx), laryngomalacia (partial collapse of the larynx), and sleep apnoea. In some children, large doses of pain medications given to the mother will also lead to breathing problems.

Symptoms

If your child start breathing faster than normal, produces various noise while asleep, ribs will become noticed during each breath, stomach will stick to the muscles, nostrils will flare out then you should visit your pediatrician immediately.

Diagnosis

Your pediatrician performs various diagnostic tests to detect airway problems. Some of the tests done are tracheoscopy (to examine trachea using tracheotomy tube), stroboscopy (to examine vocal cords abnormalities using pulsating light), endoscopic evaluation of swallowing to look for the passage of liquids or foods, laryngoscopy (to examine larynx and vocal cords), and bronchoscopy (to examine trachea and lung passages).

Airway care

  • Home care

    If your baby has excess mucous which has blocked the sinuses, then use one or two drops of saline nose drops in each of nostril to clear the blockage and release the congestion.

    Another device that will help to release the congestion is the blue bulb syringe. In this procedure, squeeze the bulb to create vacuum and stick it into the baby's nostril and release the bulb. The bulb helps to clear the excess mucous and lessen the breathing noise. Repeat this four times a day, before feeding and before going to bed

Surgical Options

Surgery is considered to be the last remedy if the other treatments do not work. Some of the surgeries include

  • Laryngotracheoplasty - It is the surgical procedure performed in infants who have narrow trachea. The narrowed trachea is reconstructed or widened using a cartilage, which is taken from the child's ribs or ear
  • Adenotonsillectomy - It is done to remove the enlarged tonsil and adenoids glands that causes sleep apnoea in children
  • Partial cricotracheal resection - In this procedure the narrowed part of the airway located below the voice box is removed and the trachea and larynx is sewed back together
  • Tracheotomy - Tracheostomy is a procedure that creates a surgical airway in the neck (trachea) to bypass the normal airway. It is done in children whose trachea is blocked due to congenital anomalies such as hypoplasia and vascular web or airway blockage due to foreign bodies
  • Supraglottoplasty - It is done in children whose larynx is obstructed due to a condition known as laryngomalacia. This procedure uses laser or surgical instrument to remove the tissue that has blocked the larynx
  • Laryngotracheal reconstruction - It is done in two procedures, single stage repair and double stage repair. In single stage, the narrowed trachea is opened by removing the scarred portion of the larynx and using grafts to widen the airway. The double stage procedure is the same of single stage, but in this case a breathing tube is left in the airway
  • Removal of foreign bodies - Foreign bodies can be coins, small toys, peas, beans, nuts, or any tiny objects. When your child swallows any of these, surgical removal of foreign bodies will help your child breathe easier
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Royal Australasian College of Surgeons The Australian Society Of Otolaryngology Head And Neck Surgery Australian New Zealand Society of Paediatric Otorhinolaryngology (ANZSPO) The University of New South Wales The University of Sydney Harvard Medical School

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