Chart — Pediatrics
Pediatric Respiratory Disorder Comparison
A side-by-side comparison of four high-yield pediatric respiratory disorders — croup, epiglottitis, bronchiolitis, and asthma — across hallmark findings, airway risk, and primary nursing priorities for NCLEX and clinical practice.
Educational use only. Pediatric respiratory emergencies require immediate clinical assessment and individualized management. Always follow current PALS guidelines and institutional protocols. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Disorder Comparison
| Feature | Croup | Epiglottitis | Bronchiolitis | Asthma |
|---|---|---|---|---|
| Typical age | 6 mo–3 yr | 2–7 yr (any age) | <2 yr (infant peak) | Any age |
| Cause | Parainfluenza (viral) | Hib bacteria (bacterial) | RSV (viral) | Chronic inflammation; triggers: allergens, URI, exercise |
| Onset | Gradual (1–2 days) | Sudden (hours) | Gradual (URI prodrome) | Trigger-dependent; can be sudden |
| Location | Subglottic (upper airway) | Supraglottic (epiglottis) | Bronchioles (lower airway) | Bronchi/bronchioles (lower airway) |
| Hallmark cough | Barky, seal-like cough | Absent or minimal | Wet, productive cough | Dry, nocturnal cough |
| Voice / cry | Hoarse | Muffled "hot potato" voice | Normal | Normal (unless severe) |
| Key findings | Inspiratory stridor; worse at night; low-grade fever | Drooling; tripod position; high fever; toxic appearance | Expiratory wheeze; poor feeding; crackles; tachypnea | Expiratory wheeze; dyspnea; accessory muscle use; silent chest = severe |
| X-ray finding | Steeple sign (AP neck) | Thumbprint sign (lateral neck) | Hyperinflation; peribronchial cuffing | Hyperinflation; flattened diaphragm |
| Airway risk | Moderate; rarely complete | CRITICAL — complete obstruction risk | Lower; apnea risk in infants | Variable; silent chest = severe |
Nursing Priorities Comparison
| Disorder | First Priority | Key Intervention | Critical DON'T |
|---|---|---|---|
| Croup | Keep calm; minimize agitation | Racemic epi + dexamethasone; keep parent at bedside; watch for rebound | Never examine throat with tongue blade |
| Epiglottitis | Airway emergency — notify provider, anesthesia, OR immediately | Allow position of comfort (tripod); O₂ without disturbing; prepare for intubation; IV antibiotics after airway secured | Never examine throat; never lay supine; never agitate; never do IV before airway support is ready |
| Bronchiolitis | Supportive care; nasal suction; oxygen | Bulb suction; O₂ for SpO₂ <90–95%; small frequent feeds; HFNC if moderate-severe; contact precautions | No routine bronchodilators or steroids (AAP guideline) |
| Asthma | High-Fowler's; O₂; albuterol (SABA) | Albuterol → ipratropium → systemic steroids → magnesium; peak flow monitoring; asthma action plan | Silent chest = impending arrest — escalate immediately |
NCLEX Pearls
- Barky cough + hoarse + stridor = croup; drooling + muffled voice + tripod + fever = epiglottitis
- Epiglottitis: NEVER use tongue depressor — can trigger complete airway obstruction
- Bronchiolitis: supportive care only — no antibiotics (it's viral), no routine bronchodilators
- Silent chest in asthma = severe obstruction, no air movement — impending arrest, escalate NOW
- Racemic epinephrine rebound: symptoms can return 2–4 hours after administration — observe child
- In epiglottitis, Hib vaccine has nearly eliminated the disease — but it still occurs in unvaccinated individuals
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with PALS / AAP Pediatric Respiratory Guidelines. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →