Causes of acute respiratory distress in children

Respiratory tract

Infection

Uvulitis

Epiglottitis*

Retropharyngeal abscess

Peritonsillar abscess

Croup

Tracheitis

Bronchiolitis

Pneumonia^¶

Asthma

Anaphylaxis*

Foreign body (upper airway*, lower airway, esophagus)

Airway anomalies (eg, laryngomalacia, laryngospasm, tracheoesophageal fistula, tracheal stenosis, tracheal ring or sling)

Biologic or chemical weapons* (eg, anthrax, tularemia, phosgene, nitrogen mustard, nerve agents, ricin)

Chest wall trauma or abnormalities (eg, flail chest*, open pneumothorax*, thoracic dystrophy)

Thoracic cavity trauma or conditions (eg, pneumothorax*, hemothorax*, pleural effusion, empyema, mediastinal mass)

Pulmonary trauma or conditions (contusion, embolism, hemorrhage)

Smoke inhalation*

Chemical agent exposures* (eg, phosgene, chlorine, cyanide)

Submersion injury (near-drowning)*

Cardiovascular

Congenital heart disease*

Acute decompensated heart failure*

Myocarditis*

Pericarditis

Arrhythmia*

Shock*

Cardiac tamponade*

Myocardial infarction*

Nervous system

Depressed ventilation* (eg, ingestion, CNS trauma, seizures, or CNS infection)

Hypotonia* (conditions causing poor airway or respiratory muscle tone and ineffective respiratory effort)

Pulmonary aspiration due to loss of airway protective reflexes

Gastrointestinal

Hypoventilation due to abdominal pain or distention (eg, intraabdominal trauma, small bowel obstruction, bowel perforation)

Gastroesophageal reflux with pulmonary aspiration

Metabolic and endocrine diseases

Metabolic acidosis (eg, diabetic ketoacidosis, severe dehydration, sepsis, toxic ingestions, inborn errors of metabolism)

Hyperthyroidism

Hypothyroidism

Hyperammonemia

Hypocalcemia (laryngospasm)

Hematologic

Decreased O₂ carrying capacity (eg, acute severe anemia from blood loss or hemolysis, hemoglobin variants, methemoglobinemia, or carbon monoxide poisoning)

Acute chest syndrome (patients with sickle cell disease)*

CNS: central nervous system; O₂: oxygen.
*Condition that can be immediately life threatening.
^¶Pneumonia may be caused by a variety of bacterial and viral pathogens. COVID-19 should also be considered in acutely ill children presenting with pneumonia in regions with a high prevalence although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rarely causes serious illness in the pediatric age group. Refer to UpToDate topics on COVID-19 infection in children.

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Causes of acute respiratory distress in children