• Are irregular 
• Range from 30-70 breaths per minute
• Become more rapid as gestation advances

• Via the placenta.
• Movement in/out of the potential air spaces conditions the resp. muscles and stimulates lung development.

• At birth.
• The lungs take on the role of ventilation and oxygenation.
• The fluid in the lung moves into the tissues surrounding the alveoli
• The fluid is absorbed into the lymphatic system.
• Gas exchange occurs through diffusion across the alveolar-pulmonary capillary membranes.

• The thorax is the bony cage that surrounds the heart and lungs.
• Composed of the manubrium, sternum, xiphoid process, & ribs.

• Is roughly triangular and attaches to the first and second ribs. 
• It provides a place of attachment for the sternocleidomastoid and pectoralis major muscles.

• The small, thin, cartilaginous end of the sternum
• Varies greatly in shape and prominence in infants and children because of the influence of heredity, intrauterine environment, and nutrition. 

• "Pigeon Breast"
• The abnormal protrusion of the xiphoid process and sternum

• "Funnel Chest"
• The abnormal depression of the sternum

• 12 pairs in all
• First 7 pairs attach anteriorly via their corresponding costal cartilages to the sternum.
• 8-10 attach to the costal cartilage on the rib above them.
• 11-12 do not attach anteriorly.
• All 12 pairs attach posteriorly to the thoracic vertebrae.

• 11 anteriorly and posteriorly
• 8 thoracic mucles
• All help to increase the volume of the rib cage with inspiration and decrease the thoracic volume with expiration.

• Right mainstem bronchus is shorter and more vertical than the left
• More susceptible to aspiration of foreign bodies in the young child

Termination of the Respiratory Tract

• Terminates with the alveolar ducts, alveolar sacs, and alveoli where gas exchange takes place.

• Branch from the aorta and supply blood to the lung parenchyma.
• Blood supply is returned primarily by the pulmonary veins.

Apex; which extend above the clavicals

examined for the presence of rhinitis, any nasal secretions, polyps, or nasal obstruction.

Observe for postnasal drip and tonsillar size.

• Normal =1 : 2
• Infant<2yoa=1 : 1 (barrel chest)
• >6 yoa=1 : 1.36

**barrel chest also seen w/ CF

• Rapid breathing followed by periods of apnea, cessation of breathing. 
• Normal first few hours of life in healthy full term NB. 
• More common in preterm but episodes of apnea should improve as approach term age.

"Seesaw breathing"

Often seen in newborns and infants because they use abdominal muscles more than intercostal muscles.

• Characterized by cycles of increasing and decreasing tidal volume separated by apnea.
• Occurs  with CHF and increased ICP.

• High pitched, loud, inspiratory sound produced by upper airway obstruction.
• Causes: Edema status post intubation; subglottic stenosis, laryngotracheobronchitis; foreign body aspiration.

• A rough, snorting sound that can be present on inspiration or expiration. 
• Present during sleep in healthy children who have an upper respiratory infection, respiratory distress, chest pain.
• Often heard in the presence of Nasal polyps, T&A hypertrophy, congenital facial anomolies.

Mild nasal flaring in newborns is normal because they are preferential nose breathers in the first month of life.

Increased flaring is a sign of resp distress

A sign of respiratory distress

Due to the contraction of the scalene and sternocleidomastoid muscles.

Infant=1:2 seconds

Newborn=variable

Restrictive diseases=1:1

Upper airway obstruction=2:2 or 4:2

If you hear voice sounds or cry loud and clear=Bronchophony

Speak word "ee" & sounds like "ay"=egophony.

• Soft sound heard over entire surface of lungs 
• Inspiration louder, longer, higher pitched than experation
• Insp>Exp

• Loud, high pitched sounds heard over intrascapular area
• Inspiration =Experation

• "Tubular"
• Very loud over trachea near suprasternal notch
• Inspiration <Expiration

• Thoracic expansion
• Note symmetry of the chest excution on inspiration done anteriorly and posteriorly
• Could indicate diphragmatic hernia; pneumothorax, mass, foreign body, abnormal chest wall shape

• Pneumothorax or Pleural Effusion
• Occurs when there is a difference in volume or pressure between the two sides of the chest

• Palpation portion of exam
• Increased or decreased fremitis could indication consolidation or pneumothorax

• Inflammatory obstruction of the small airways
• Caused by edema, mucus plugging
• Occurs during 1st 2 years of life, peaking at 6 mos
• 50% Caused by RSV

• Obstructive inflammatory porcess of airway that is supraglottic
• Abrupt onset of high fever, sore throat, drooling, dysphagia, dyspnes, increasing airway obstruction
• Occurs between 2-7 yoa
• Bacterial, decreased incidence due to Flu vaccine

• Inflammatory process initiated by irritability/hyperreactivity of airway to variety of stimuli, obstruction/bronchoconstriction
• Inflammation plays KEY role in factors leading to cough, wheezing, tachypnea, dyspnea with prolonged expiration

• Acute upper airway obstruction; inflammation, edema of airway
• Leads to hoarse, barking cough, intermittent stridor, respiratory distres occurs in some cases, which is worse at night
• Most common between 3 mos-5 yoa
• 75% is parainfluenza virus etiology

• Inherited Autosomal recessive trait
• Causing multisystem disorder in children
• Characterized by obstruction, infection of airways caused by dysfunction of epithelial surface leading to thick, retained secretions
• 1:4 Births, caucasian.

• Lodging of object into larynx, trachea, bronchi with degree of obstruction
• Hot dogs/bread most common causes of fatal aspiration
• Possibility of foreign body must be considered in infants and young kids with acute respiratory distress regardless of history.

• A passive transfer/reflux of gastric contents across lower esophageal sphincter, which may lead to tissue damage causing GERD
• May be associated with respiratory conditions such as bronchospasm, pneumonia.

• "Floppy airway"
• Congenital deformity of larynx or trachea 
• Harsh noise, stridor on inspiration cuased by airway collapse
• Onset early in neonatal period
• Dx with laryngoscopy

• Inflammation of parenchyma of lungs
• Primary condition or may manifest from another illness
• Etiology: Viral microorganisms (RSV, paraflu, adeno)
• Bacterial less common but can be mycoplasma pneumoniae 70% of all pneumonias 9-15 yoa

• A condition related to developmental delay of maturation of lungs
• Deficient production of surfactant
• Inadequate pulmonary perfusion and ventilation develop resulting in long term respiratory complications.