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LEARNING OBJECTIVES
Upon completion of this chapter, the reader will be able to:
Identify signs and symptoms of respiratory distress.
Understand normal development changes in blood pressure and heart rate.
Discuss radiologic consideration in cardiovascular problems.
Describe functional limitations in children with asthma.
Understand steps of airway clearance.
Discuss progression of rehabilitation for children with cardiovascular dysfunction.
Explain the effects of COVID-19 in children.
Discuss manual therapy techniques to improve lung function.
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Case Study
A 7-year-old boy complains of a 3-month history of a nonproductive cough that is worse at night and with exercise. He does not have fevers or other symptoms to suggest infection. He is normotensive, and his lungs are clear to auscultation bilaterally, except for an occasional expiratory wheeze on forced expiration. A chest radiograph is read as normal.
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Children with cardiopulmonary dysfunction can have a combination of impairments and decreased function including decreased proximal upper-limb strength, limited endurance capacity, limited active range of motion, inability to ambulate independently, dependent for transfers, and developmental delay. They may also have activity and exercise limitations, excess loss of salts/electrolytes from sweating, and shortness of breath.
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As a physical therapist with direct access, it is important to recognize signs of cardiopulmonary dysfunction (Table 16-1).
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PHYSICAL THERAPY ASSESSMENTS
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If the child has a history of cardiopulmonary issues, the physical therapist should assess the child’s vital signs including heart rate, blood pressure, temperature, and oxygen saturation levels (pulse oximetry); capillary refill time; height; and weight. Assessments of functional limitations of decreased activity level and exercise tolerance are key assessments. Disabling dyspnea can cause malnutrition and fatigue and limit functional ability when performing simple tasks. Lung function or pulmonary function tests include spirometry, body plethysmography, and peak expiratory flow. It is important to determine and document if the infant or child has any unrepaired heart defects or cardiopulmonary pathology, precautions, or contraindications. Indications should include if the child requires oxygen or ventilator support, and the child’s aerobic capacity and endurance should be noted, including any shortness of breath observed.
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Heart Rate Values in Children
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Resting heart rate values in children are listed in Table 16-2.
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