Pharmacological management will be determined by the underlying cause and how actively the child is to be managed:
Antibiotics may be used to treat pneumonia if in line with the goals of care and stage of the disease.
Bronchodilators and oxygen therapy may be helpful if there are signs of bronchospasm.
Saline nebulisers can be helpful to loosen secretions and to moisten the airways.
Nebulisers with adrenaline
If there is an upper airway obstruction or stridor, consider nebulisation with adrenaline or give high dose intravenous dexamethasone over 2 minutes.
Diuretics may be beneficial in children with fluid retention and shortness of breath associated with pulmonary oedema or congestive heart failure.
Anxiolytics e.g. diazepam or lorazepam (benzodiazepines) can help assist when there is an associated anxiety component to the shortness of breath.
Use morphine if the shortness of breath is severe as this helps reduce anxiety and pain. If the child is not already on an opioid, give morphine at a third of the normal starting dose. If the child is already on morphine, increase the dose by a half.
Combination of morphine and midazolam
Sudden and severe shortness of breath in terminal care must be managed quickly with a combination of morphine and midazolam which can be given buccally (by mouth) or rectally.
Likely causes are a pneumothorax or pleural effusion. Treat any specific cause if appropriate.
If a child is short of breath but not hypoxic, oxygen therapy is not likely to relieve the shortness of breath. However, it may provide reassurance to the parents and some comfort to the child as long as the child is not distressed by the nasal cannula or an oxygen mask.
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