Respiratory Assessment

in Pediatric Sleep
The Sights and Sounds of Abnormal Breathing and
Accessory Muscle Use

Breathing Sounds

Snoring
Stridor
Gasping/Grunting
Wheezing

Abnormal Use of Accessory Muscles

Tracheal Tug
Sternal/Substernal Retractions
Suprasternal Retractions

Assessment Objectives

Stridor

Click to hear a sample

of Stridor!

Click the images below to see

and hear examples of Stridor!

Low or high pitched

sound heard in upper
airway

Indicates
narrowed/obstructed
upper airway

Grunting

Click to hear a sample

of Grunting!

Indicates a respiratory
emergency

Will usually grunt with

every breath

Attempting to maintain FRC

(Keep Lungs inflated)

Wheezing

Click the image to see and hear an

example of Wheezing!

Click the box to hear an

example of Wheezing!

Not all that wheezes is

asthma

More common during

expiration

Inspiratory & expiratory

wheeze indicates severe
obstruction

Normal Breathing
3

1. The pressure inside your lung

pushes outward
2. When you breathe-in, pressure is
applied inward

3. With normal breathing, both

pressures are equal, resulting in no
retractions

Accessory Muscle Use-Retractions

Increased Work of Breathing

Because the patient is breathing
harder, the tissue appears to suckinwards. This phenomenon is referred
to as retraction.

Accessory Muscle Use-Retractions

Substernal Retractions

Click the image to see a sample of

substernal retractions!

Located below the

sternum (see graphic)

Indicates mild-tomoderate breathing

difficulty

Can be an early indicator

of pending respiratory
distress syndrome

Intercostal Retractions

Click the image to see a sample of

intercostal retractions!

Occurs between the ribs

(see graphic)

Indicates mild-tomoderate breathing

difficulty

Suprasternal Retractions

Occurs above the clavicles

or above the sternum
(commonly referred to as
Tracheal Tug)

Indicates an obstruction
of the upper airway

Commonly seen in Croup

Click the image to see a sample of
Suprasternal retraction (Tracheal Tug)!

Respiratory Assessment
in Pediatric Sleep
The Sights and Sounds of Abnormal Breathing and
Accessory Muscle Use