Summer 2000 ~ Newsletter
How To Tell When Your Child Is Sick
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Recognizing Respiratory Illness
by LaCrecia J. Britton, CRNP
A respiratory illness in patients with Cystic Fibrosis is commonly called a "CF Exacerbation." This type of illness can be very difficult to recognize because it tends to happen gradually. Therefore, a person with CF may not realize that are sick until they have caused serious damage to their lungs.
The CF Foundation has developed a list of signs and symptoms of an exacerbation. The are as follows:
Increased cough
Increased sputum production
Fever of 100.5 or greater
Weight loss
Missed school or work
Increased work of breathing
Inability to exercise, walk stairs, etc. without coughing or increased work of breathing
However, this list doesn't help the parent of the child who hides symptoms, or the child who pretends to be sick. It also doesn't help the patient who doesn't notice subtle changes in their health. Therefore this article will discuss more practical ways of identifying illness earlier.
The best assessment of one's respiratory status is the respiratory rate. This is easy for a parent to do; simply count how many times in one minute your child breathes. If you are an adult patient, find a friend who will occasionally count your respiratory rate. Normal respiratory rates range from 30 in infants to 16 in adults. People with CF tend to have a higher resting respiratory rate, so count the rate on a couple of good days and decide the average rate for you or your child. If you or your child's respiratory rate is 10 to 20 breaths higher than your usual rate, it can be a strong indicator of illness.
The second best assessment is cough. Even small increases in cough which last for a week are an indication of illness. Coughing in the middle of the night is a definite sign of illness. A wet cough (a cough in which you can hear mucus move) is also a sign of illness if your cough does not usually sound this way.
Some adolescents will attempt to suppress their cough and parents may not notice the increase. A suppressed cough is difficult to describe but usually is similar to a short strained bark. The shoulders are usually forced downward in this type of cough.
Thirdly, changes in sputum may also indicate illness. An increase in the amount of sputum and in the thickness of mucus are two signs of illness. Sputum which changes color form clear to yellow, yellow to green, or green to brown also indicates illness. Blood in the sputum is another worrisome symptom. Most people only have streaks or small clots in their sputum. Blood in the sputum is almost always a sign that the person with CF needs IV antibiotics. The exception to this is the person who bleeds on a daily basis and this person has to depend on other symptoms when they are sick. If you or your child coughs up more than three tablespoons of blood, a doctor should be notified immediately.
Work of breathing is also an important assessment. In infants and young children, increased work of breathing can be seen as an in and out movement of the sides of the nose, and as a sinking in motion of the spaces between the ribs. Older children, adolescents, and adults tend to use the muscles in their shoulders and neck. It is much harder to notice that these muscles are being used because the motions are so small. Watch this area closely if you are concerned about illness.
Finally, changes in the usual energy level can indicate illness. As mentioned above, if usual activity causes cough or increased work of breathing, this is definitely a sign of illness.
Any time you have questions about your CF or your child's CF, call a member of your health care team. Sometimes an early illness can be managed over the phone or with outpatient treatment.