How to assess a child in respiratory distress
Other platforms explain it with text and video. In Making Synapses you practice it on the patient.
Children compensate well and then tire quickly. Look before you touch.
Step by step
Appearance
Alert, interacting, or drowsy and floppy (urgent). [1]
Work of breathing
Fast breathing, nasal flaring, retractions, head bobbing, grunting. [1]
Sounds
Stridor (upper airway), wheeze (lower), crackles. [1]
Color and saturation
Pale or blue; saturation below about 92% needs oxygen. [1]
Position
Sitting forward, drooling: do not upset the child (epiglottitis). [1]
Act
Oxygen as tolerated, keep the child with the parent, call for help. [1]
Common errors
- Laying a struggling child flat.
- Checking the throat in suspected epiglottitis.
- Missing tiring (slowing breathing).
Practice it in Making Synapses
In Making Synapses you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
Making Synapses cases that train this skill
- Acute asthma attack
- Bronchiolitis in an infant
- Croup
- Pepper spray exposure
- Atopic dermatitis
- Cushing syndrome
14 Making Synapses cases train this skill: open the case library
Sources
- NASEMSO National Model EMS Clinical Guidelines
- NCCPA PANCE Content Blueprint
- Stanford Medicine 25 (bedside exam)
- Open RN, Nursing Skills 2e (Chippewa Valley Technical College) (CC BY 4.0)
Steps adapted from Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. Facts and steps also follow NCCPA PANCE Content Blueprint; Stanford Medicine 25 (bedside exam). Making Synapses is not affiliated with these organizations. Updated: 2026-10-11.