Care of Child with Breathing Problem

EMERGENCY DEPARTMENT PATIENT INFORMATION FOR YOUR CARE

Care of the Child with a Breathing Problem (General instructions, Pneumonia, Bronchitis, Croup, Bronchiolitis, Asthma) □ General Instructions 1. If anyone around the child smokes, stop. Exposure to smoke makes the child more likely to get a lung infection, and makes infections last longer when they do occur. 2. You should give the child medication as it was prescribed until all of it is gone, even if they are feeling better. 3. You may give the child acetaminophen (Tylenol, Tempra) or ibuprofen (Motrin, Advil) for fever or body aches, unless you have been told not to (e.g. if they have stomach ulcers, or if they have asthma and these medicines aggravate their symptoms). a. acetaminophen ______mg every 4 hours b. ibuprofen ______mg every 8 hours 4. Make sure the child drinks plenty of fluids. This helps to loosen secretions in the throat and lungs and makes them easier to cough out. 5. Return to the ER immediately (call 911) if the child: a. Develops severe difficulty breathing (you may notice indentations between the child’s ribs or at the breastbone when they breathe in) b. Has difficulty or severe pain when swallowing (you may notice excessive drooling) c. Experiences swelling of the mouth or tongue d. Develops bluish discoloration of the lips or tongue e. Becomes confused, unusually difficult to waken, or behaves abnormally 6. Bring the child to their primary care provider or return to the ED if: a. Their cough or other symptoms are becoming worse b. They develop a new fever, or if they already had one, it is not going away c. You don’t think they are better after 2-3 days d. They are unable to take their medication 7. The child may return to school when they no longer have a fever and are feeling better. □ Pneumonia 1. Some pneumonias are caused by viruses, and some are caused by bacteria. Since we often can’t tell these apart by looking at the child or the X-ray, most children will be given an antibiotic. 2. You should give the child their antibiotic as it was prescribed until all of it is gone, even if they are feeling better. 3. Try to avoid the use of cough suppressants (e.g. DM, dextromethorphan). Coughing is the body’s way of clearing the secretions and infection. 4. Usually the child will begin to feel better after 2 to 3 days of antibiotics. You should encourage them to get extra rest until they are feeling better.

These instructions are not intended to be all-inclusive, and may not cover all possibilities. If a new problem develops, or if you have any further concerns or questions please contact your primary care provider, Telehealth Ontario at (866) 797-0000, or return to the ER.

Royal Victoria Hospital of Barrie, 201 Georgian Drive, Barrie, Ontario L4M 6M2 (705) 728-9802 www.rvh.on.ca Rev 10/07 D:\Docs\2017-12-15\0cc5ba8775a68f0ab746ec499e017bad.doc EMERGENCY DEPARTMENT PATIENT INFORMATION FOR YOUR CARE

□ Bronchitis 1. Read the instructions above under “General Instructions”. 2. Most cases of bronchitis are caused by viral infection, and so do not respond to antibiotics. 3. Under certain circumstances, your doctor may prescribe the child with an antibiotic. If so, you should give them the antibiotic as it was prescribed until all of it is gone, even if they are feeling better. 4. You may try giving the child over-the-counter cough medication, but should be aware of the fact that these medications do not make the cough go away faster, and can cause drowsiness and other side effects. Make sure you check with the pharmacist if the child takes any other prescribed medicines or has other medical problems (e.g. kidney disease).

□ Croup 1. Read the instructions above under “General Instructions”. 2. Croup is an infection of the larynx (voice box), trachea (windpipe) and upper airway caused by a virus. The infection causes swelling which narrows the airway slightly. 3. This narrowing of the airway is the cause of the barky cough, hoarse voice, and noisy breathing that is seen with croup. 4. Patients with croup are usually treated with a steroid medication (dexamethasone) in the ER to reduce the swelling, and improve the symptoms. This medication only needs to be given once since it lasts a long time. 5. In addition to the General Instructions above: a. Try to keep the child’s bedroom slightly cooler than normal. The child doesn’t need to be cool, just the air they breathe. This can be accomplished by using a cool mist humidifier, or opening the window slightly. b. If the child awakens and is breathing noisily, you may try helping them at home if they are not too distressed. Sitting in the bathroom with the shower on to make steam, or taking the child outside to breathe the cool air may both be helpful. c. If the child is not improving quickly at home with your treatment, come to the ER. □ Bronchiolitis 1. Read the instructions above under “General Instructions”. 2. Bronchiolitis is an infection of the small, distal airways that is caused by a virus. The infection causes swelling which narrows the airways slightly. 3. This narrowing of the airways is the cause of the cough and wheezing. 4. Patients with bronchiolitis are sometimes treated with a bronchodilator medication (Ventolin) to reduce the airway swelling, and improve the symptoms. If your child has been prescribed this medicine, it should be used as directed. 5. Getting bronchiolitis does not necessarily mean that your child will develop asthma later in life, but they are at higher risk than children that never had bronchiolitis.

Royal Victoria Hospital of Barrie, 201 Georgian Drive, Barrie, Ontario L4M 6M2 (705) 728-9802 www.rvh.on.ca Rev 10/07 D:\Docs\2017-12-15\0cc5ba8775a68f0ab746ec499e017bad.doc EMERGENCY DEPARTMENT PATIENT INFORMATION FOR YOUR CARE

□ Asthma 1. Read the instructions above under “General Instructions”. 2. Most asthma exacerbations are caused by viral infection or allergies, and so do not respond to antibiotics. Your child may get antibiotics if your doctor thinks they would be helpful. 3. Your child may be prescribed a steroid medication (prednisone) to help reduce the inflammation in your lungs. There are many side effects associated with steroid use, but most of them only occur if steroids are taken for a long time. If the child develops sudden hip or leg pain while on the prednisone, stop the medicine and see your doctor. 4. Your child should take their puffers as directed by their doctor, or according to their Asthma Action Plan. In general, there are two kinds of puffers: relievers (e.g. Ventolin, salbutamol, Bricanyl, which are usually blue in colour) and preventers (e.g. QVAR, Flovent, Advair). 5. If the child is short of breath, wheezing, or coughing, they should use the reliever puffer. 6. The preventer puffers should only be used regularly as prescribed, and not taken extra times if the child is not feeling well. 7. All patients should take their puffers using an Aerochamber or other spacer device. These are not just for kids; they help get more of the puff into your lungs where it can do its job. 8. You should make an appointment to see your child’s regular doctor to review their overall asthma management plan. If you don’t have a family doctor, any other doctor (e.g. ER or walk-in clinic) can refer you to the Asthma Clinic at RVH.

Royal Victoria Hospital of Barrie, 201 Georgian Drive, Barrie, Ontario L4M 6M2 (705) 728-9802 www.rvh.on.ca Rev 10/07 D:\Docs\2017-12-15\0cc5ba8775a68f0ab746ec499e017bad.doc