GRUNTING RESPIRATIONS IN INFANTS AND CHILDREN

Grunting respirations are recognized as a sign of serious illness in i nfants and children, but have not been well studied beyond the newborn period, We present three illustrative cases and the results of a desc riptive study which elucidates the causes of grunting in infants and c hildren and suggests guidelines for assessing pediatric patients with this symptom, All patients between one month and 18 years of age who p resented to the Emergency Department (ED) of The Children's Hospital o f Denver during the last five months of 1992 with grunting respiration s were prospectively identified, and their charts were retrospectively reviewed. The 51 pediatric patients with grunting respirations (0.3% of all patients seen in the ED) fell into three groups based upon mode of presentation: 1) 55% presented with predominately respiratory sign s and symptoms, and each one had a respiratory or cardiac condition; 2 ) 25% presented with high fever (greater than 385 degrees C) but witho ut respiratory signs and symptoms, and dr had an infectious cause (thr ee fourths of them had an invasive bacterial disease); 3) 20% presente d with neither fever nor respiratory signs or symptoms and had one of a variety of conditions which appeared to cause pain, Presenting sympt oms can guide the selection of tests used to evaluate the infant or ch ild with grunting respirations, Guidelines for evaluation are provided in this report.