Reference — Pediatrics
Common Pediatric Respiratory Disorders
A quick reference comparing the four most commonly tested pediatric respiratory disorders: croup, epiglottitis, bronchiolitis, and asthma. Each entry includes hallmark clinical findings, airway risk level, and primary nursing priorities for NCLEX and clinical practice.
Educational use only. Pediatric respiratory disorders vary in severity and require individualized clinical assessment. Always follow current PALS guidelines, institutional protocols, and provider orders. 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.
At-a-Glance Comparison
| Disorder | Age / Cause | Hallmark Findings | Airway Risk |
|---|---|---|---|
| Croup | 6 mo–3 yr; Parainfluenza virus | Barky seal-like cough; inspiratory stridor; hoarse voice; worse at night | Moderate; rarely complete obstruction |
| Epiglottitis | 2–7 yr (any age); Hib bacteria | Tripod position; drooling; muffled "hot potato" voice; high fever; sudden onset | CRITICAL — can progress to complete obstruction in minutes |
| Bronchiolitis | <2 yr (infant peak); RSV | Expiratory wheeze; URI prodrome; poor feeding; tachypnea; nasal flaring; crackles | Lower airway; apnea risk in young infants |
| Asthma | Any age; allergens, URI, exercise triggers | Expiratory wheeze; dyspnea; cough (nocturnal); accessory muscle use; silent chest = severe | Variable; silent chest = life-threatening |
Croup — Key Points
- Subglottic (upper airway) inflammation narrows the airway below the vocal cords
- "Steeple sign" on AP neck X-ray (subglottic narrowing — not routinely needed if presentation is classic)
- Symptoms worsen with agitation — keep child calm and parent at bedside
- Racemic epinephrine: Nebulized; reduces edema; observe for rebound symptoms 2–4 hours after administration
- Dexamethasone: Single oral/IM dose reduces edema and hospitalization; onset 6–12 hours
- Never use tongue depressor to visualize airway — can precipitate spasm
Epiglottitis — Key Points
- Bacterial cellulitis of the supraglottic structures (epiglottis, aryepiglottic folds)
- "Thumbprint sign" on lateral neck X-ray — enlarged epiglottis (do not delay airway management for X-ray)
- 4 Ds: Dysphagia, Dysphonia (muffled voice), Drooling, Distress (toxic appearance)
- Do NOT: use tongue blade, attempt oral exam, lay child supine, insert IV without airway support, agitate child
- Allow position of comfort (sitting forward, tripod); do not separate from parent
- Once airway secured: IV antibiotics (ceftriaxone); blood cultures; supportive care
- Prevention: Hib vaccine — dramatically reduced incidence
Bronchiolitis — Key Points
- RSV causes 75% of cases; peak season November–March
- Inflammation of bronchioles with edema, mucus, and bronchospasm → air trapping
- Management is supportive: nasal suction, oxygen (SpO₂ <90–95%), hydration, positioning
- Bronchodilators and steroids are NOT recommended by AAP for routine bronchiolitis
- Apnea is a risk in young infants (<2 months) and premature infants — monitor closely
- High-flow nasal cannula (HFNC) effective for moderate-severe respiratory distress
- RSV immunoprophylaxis (AAP/CDC ACIP, since 2023): a single dose of a long-acting monoclonal antibody — nirsevimab (Beyfortus) or clesrovimab (Enflonsia) — for all infants <8 mo born during or entering their first RSV season, unless the mother received the maternal RSV vaccine (Abrysvo) at 32–36 wk (either pathway protects the infant; most infants do not need both). Palivizumab (Synagis) is no longer recommended and has been discontinued (unavailable as of Dec 31, 2025)
- Infection control: contact precautions for RSV; meticulous hand hygiene
Asthma — Key Points
- Chronic inflammatory disease with reversible bronchospasm (unlike COPD)
- Peak flow monitoring: green (≥80%), yellow (50–80%), red (<50%) — action plan based on zones
- Acute exacerbation treatment: SABA (albuterol) → ipratropium → systemic steroids → magnesium sulfate
- Silent chest = severely reduced airflow — impending respiratory arrest; escalate immediately
- Controller medications (ICS, leukotriene modifiers) used daily for persistent asthma — not for acute relief
- MDI + spacer technique: coordinate actuation with breath; 3–5 second breath-hold; spacer required for children who cannot coordinate
- Triggers to avoid: allergens (pollen, dust mites, pet dander), tobacco smoke, exercise (use pre-treatment with SABA), viral URI
- Asthma action plan: written plan with green/yellow/red zones and family-specific instructions for each zone
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Pediatrics (AAP) · CDC / ACIP (immunization schedule). 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 →