Breathing difficulty is an emergency

By Agnes Kyotalengerire

Four-year-old Pearl Businge tosses in bed as her mother, Noella Barungi, watches in fear. “My baby was fi ne until two days ago when she ran short of breath after developing a cough and fever. She was admitted and put on oxygen.

Like Businge, many children suffer breathing diffi culties. Dr. Thereza Piloya, a paediatrician at Mulago Hospital, says breathing diffi culty ranges from running short of breath, being unable to take a deep breath and gasp for air.

Cause
Piloya says the commonest cause of breathing difficulty in children is respiratory infections like pneumonia, whooping cough, infl ammation of the trachea and larynges (a structure that contains the vocal cords).

Flu can also cause breathing diffi culty. When a viral infection spreads to the lungs, it causes bronchitis (inflammation of the main air passages to the lungs).

Piloya says acute asthma, also known as obstructive airway disease, can also trigger breathing problems, especially in children under fi ve years.

Foreign bodies in the nasal passage, according to Dr. Arnold Nambassi, an ear, nose and throat specialist at Mulago Hospital, can cause breathing problems. The common foreign bodies are beans, groundnuts and popcorns.

Dr. Vicky Nakibuuka, a paediatrician at Nsambya Hospital, says nasal congestions are secondary to allergic rhinitis and both are on the increase. Allergic rhinitis is a collection of symptoms, mostly in the nose and eyes, which occur when you
breathe in something you are allergic to.

These cause breathing difficulty, especially in the morning and evening. Piloya says other causes include metabolic problems like heart, kidney and liver failure.

Some babies are born with lung abnormalities, while premature babies may not be able to breathe properly due to immature lungs. This normally presents at birth, but the baby stabilizes after being put on oxygen, she says.

Symptoms
Hellen Aanyu, a paediatrician at Mulago Hospital, says a child with breathing diffi culty may wheeze, gurgle or let out a whistle-like sound as a result of the airway being narrow. In addition, there is straining of the muscles; the lower chest wall moves in an unusual way, the child breathes faster and may even fail to reastfeed.

The lips and palms may also turn blue and become sweaty because oxygen does not reach the brain. In addition, the child may appear weak and agitated.

Prevalence
Breathing difficulty is a common medical emergency, which when not managed promptly is fatal. Piloya says during the rainy season, Mulago admits between 10 to 20 children daily with pneumonia. And in low seasons about fi ve to 10 children are admitted.

According to Nambassi, about two to four children with breathing diffi culty, resulting from foreign bodies in the airway are registered daily at Mulago.

First aid and treatment
When a child gets breathing difficulty, the first step is to open the mouth and check the airway for any foreign bodies. Thereafter, check for any chest movement. Put the ear against the nose or mouth, or touch the mouth to check for breathing. If there is no breathing, give a mouth-to-mouth resuscitation.

Nakibuuka says treatment and the cost basically depend on the cause. For bacterial infections in the respiratory airway, a child is given antibiotics.

Nasal drops are also given to clear congestion in case of a cold.

Desist from
l Giving food or a drink.

l Moving the child if there has been a chest or airway injury, unless it is absolutely necessary.

Placing a pillow under the child’s head as this can close the airway.

Waiting to see if the child’s condition improves before getting medical help. Get help immediately.

Prevention
If the child is asthmatic or has allergies, eliminate allergy triggers.

Discourage smoking in the house and keep the children away from second-hand smoke.

Do not cook in the house.

Ensure the child obtains the pneumococcal and whooping cough vaccines.