Boys have an abdominal type of breathing during the period. Features of the structure of the respiratory system in children

In children, it occurs at the 3-4th week of gestation. The respiratory organs are formed from the rudiments of the anterior intestine of the embryo: first - the trachea, bronchi, acini (functional units of the lungs), in parallel with which the cartilaginous frame of the trachea and bronchi is formed, then the circulatory and nervous systems of the lungs. By birth, the vessels of the lungs are already formed, the airways are quite developed, but filled with fluid, the secret of the cells of the respiratory tract. After birth, with a cry and the first breath of the child, this liquid is absorbed and coughed up.

The surfactant system is of particular importance. Surfactant - a surfactant that is synthesized at the end of pregnancy, helps to straighten the lungs during the first breath. With the onset of breathing, immediately in the nose, the inhaled air is cleaned of dust, microbial agents due to biologically active substances, mucus, bactericidal substances, secretory immunoglobulin A.

The respiratory tract of a child adapts with age to the conditions in which he must live. The nose of a newborn is relatively small, its cavities are poorly developed, the nasal passages are narrow, the lower nasal passage is not yet formed. The cartilaginous skeleton of the nose is very soft. The nasal mucosa is richly vascularized with blood and lymphatic vessels. Approximately by the age of four, the lower nasal passage is formed. The cavernous (cavernous) tissue of the child's nose gradually develops. Therefore, nosebleeds are very rare in children under one year old. It is almost impossible for them to breathe through the mouth, since the oral cavity is occupied by a relatively large tongue, which pushes the epiglottis backwards. Therefore, in acute rhinitis, when breathing through the nose is sharply difficult, the pathological process quickly descends into the bronchi and lungs.

The development of the paranasal sinuses also occurs after a year, therefore, in children of the first year of life, their inflammatory changes are rare. Thus, the smaller the child, the more adapted his nose to warming, moisturizing and purifying the air.

The pharynx of a newborn baby is small and narrow. The pharyngeal ring of the tonsils is under development. Therefore, the palatine tonsils do not extend beyond the edges of the arches of the palate. At the beginning of the second year of life, the lymphoid tissue develops intensively, and the palatine tonsils begin to extend beyond the edges of the arches. By the age of four, the tonsils are well developed, under adverse conditions (infection of the ENT organs), their hypertrophy may appear.

The physiological role of the tonsils and the entire pharyngeal ring is the filtration and sedimentation of microorganisms from the environment. With prolonged contact with a microbial agent, a sudden cooling of the child, the protective function of the tonsils weakens, they become infected, their acute or chronic inflammation develops with a corresponding clinical picture.

An increase in the nasopharyngeal tonsils is most often associated with chronic inflammation, against which there is a violation of breathing, allergization and intoxication of the body. Hypertrophy of the palatine tonsils leads to violations of the neurological status of children, they become inattentive, do not study well at school. With hypertrophy of the tonsils in children, a pseudo-compensatory malocclusion is formed.

The most common diseases of the upper respiratory tract in children are acute rhinitis and tonsillitis.

The larynx of a newborn has a funnel-shaped structure, with soft cartilage. The glottis of the larynx is located at the level of the IV cervical vertebra, and in an adult at the level of the VII cervical vertebra. The larynx is relatively narrow, the mucous membrane covering it has well-developed blood and lymphatic vessels. Its elastic tissue is poorly developed. Sex differences In the structure of the larynx appear by puberty. In boys, the larynx in place of the thyroid cartilage is sharpened, and by the age of 13 it already looks like the larynx of an adult male. And in girls, by the age of 7-10, the structure of the larynx becomes similar to the structure of an adult woman.

Up to 6-7 years, the glottis remains narrow. From the age of 12, the vocal cords in boys become longer than in girls. Due to the narrowness of the structure of the larynx, the good development of the submucosal layer in young children, its lesions (laryngitis) are frequent, they are often accompanied by a narrowing (stenosis) of the glottis, a picture of croup with difficulty breathing often develops.

The trachea is already formed by the birth of the child. The upper edge of the ce in newborns is located at the level of the IV cervical vertebra (in an adult at the level of the VII cervical vertebra).

The bifurcation of the trachea lies higher than in an adult. The mucous membrane of the trachea is delicate, richly vascularized. Its elastic tissue is poorly developed. The cartilaginous skeleton in children is soft, the lumen of the trachea narrows easily. In children with age, the trachea gradually grows in length and width, but the overall growth of the body overtakes the growth of the trachea.

In the process of physiological respiration, the lumen of the trachea changes; during coughing, it decreases by approximately 1/3 of its transverse and longitudinal size. The mucous membrane of the trachea contains many secreting glands. Their secret covers the surface of the trachea with a layer 5 microns thick, the speed of mucus movement from the inside outward (10-15 mm / min) is provided by the ciliated epithelium.

In children, diseases of the trachea such as tracheitis are often noted, in combination with damage to the larynx (laryngotracheitis) or bronchi (tracheobronchitis).

The bronchi are formed by the birth of the child. Their mucous membrane is richly supplied with blood vessels, covered with a layer of mucus, which moves from the inside outward at a speed of 0.25 - 1 cm / min. The right bronchus is, as it were, a continuation of the trachea, it is wider than the left. In children, unlike adults, the elastic and muscle fibers of the bronchi are poorly developed. Only with age increase the length and width of the lumen of the bronchi. By the age of 12-13, the length and lumen of the main bronchi doubles compared to the newborn. With age, the ability of the bronchi to resist collapse also increases. The most common pathology in children is acute bronchitis, which occurs against the background of acute respiratory diseases. Relatively often, children develop bronchiolitis, which is facilitated by the narrowness of the bronchi. Approximately by the age of one year, bronchial asthma can form. Initially, it occurs against the background of acute bronchitis with a syndrome of complete or partial obstruction, bronchiolitis. Then the allergic component is included.

The narrowness of the bronchioles also explains the frequent occurrence of lung atelectasis in young children.

In a newborn child, the mass of the lungs is small and is approximately 50-60 g, this is 1/50 of its mass. In the future, the mass of the lungs increases by 20 times. In newborns, the lung tissue is well vascularized, it has a lot of loose connective tissue, and the elastic tissue of the lungs is less developed. Therefore, in children with lung diseases, emphysema is often noted. The acinus, which is the functional respiratory unit of the lungs, is also underdeveloped. The alveoli of the lungs begin to develop only from the 4-6th week of a child's life, their formation occurs up to 8 years. After 8 years, the lungs increase due to the linear size of the alveoli.

In parallel with the increase in the number of alveoli up to 8 years, the respiratory surface of the lungs increases.

In the development of the lungs, 4 periods can be distinguished:

I period - from birth to 2 years; intensive growth of the alveoli of the lungs;

II period - from 2 to 5 years; intensive development of elastic tissue, significant growth of bronchi with peribronchial inclusions of lymphoid tissue;

III period - from 5 to 7 years; final maturation of the acinus;

IV period - from 7 to 12 years; further increase in lung mass due to the maturation of lung tissue.

The right lung consists of three lobes: upper, middle and lower, and the left lung consists of two: upper and lower. At the birth of a child, the upper lobe of the left lung is worse developed. By 2 years, the sizes of individual lobes correspond to each other, as in adults.

In addition to the lobar in the lungs, there is also a segmental division corresponding to the division of the bronchi. There are 10 segments in the right lung, 9 in the left.

In children, due to the peculiarities of aeration, drainage function and secretion evacuation from the lungs, the inflammatory process is more often localized in the lower lobe (in the basal-apical segment - the 6th segment). It is in it that conditions are created for poor drainage in the supine position in infants. Another site of pure localization of inflammation in children is the 2nd segment of the upper lobe and the basal-posterior (10th) segment of the lower lobe. Here so-called paravertebral pneumonias develop. Often the middle lobe is also affected. Some segments of the lung: mid-lateral (4th) and mid-lower (5th) - are located in the region of the bronchopulmonary lymph nodes. Therefore, during inflammation of the latter, the bronchi of these segments are compressed, causing a significant shutdown of the respiratory surface and the development of severe lung failure.

Functional features of breathing in children

The mechanism of the first breath in a newborn is explained by the fact that at the time of birth, the umbilical circulation stops. The partial pressure of oxygen (pO 2) decreases, the pressure of carbon dioxide increases (pCO 2), and the acidity of the blood (pH) decreases. There is an impulse from the peripheral receptors of the carotid artery and aorta to the respiratory center of the CNS. Along with this, impulses from skin receptors go to the respiratory center, as the conditions for the child's stay in the environment change. It enters colder air with less moisture. These influences also irritate the respiratory center, and the child takes the first breath. Peripheral regulators of respiration are hema- and baroreceptors of the carotid and aortic formations.

The formation of breathing occurs gradually. In children in the first year of life, respiratory arrhythmia is often recorded. Premature babies often have apnea (cessation of breathing).

Oxygen reserves in the body are limited, they are enough for 5-6 minutes. Therefore, a person must maintain this reserve with constant breathing. From a functional point of view, two parts of the respiratory system are distinguished: conductive (bronchi, bronchioles, alveoli) and respiratory (acini with adducting bronchioles), where gas exchange takes place between atmospheric air and the blood of the capillaries of the lungs. Diffusion of atmospheric gases occurs through the alveolar-capillary membrane due to the difference in pressure of gases (oxygen) in the inhaled air and venous blood flowing through the lungs through the pulmonary artery from the right ventricle of the heart.

The pressure difference between alveolar oxygen and venous blood oxygen is 50 mm Hg. Art., which ensures the passage of oxygen from the alveoli through the alveolar-capillary membrane into the blood. At this time, carbon dioxide, which is also in the blood under high pressure, passes from the blood at this time. Children have significant differences in external respiration compared with adults due to the continued development of respiratory acini of the lungs after birth. In addition, children have numerous anastomoses between the bronchiolar and pulmonary arteries and capillaries, which is the main reason for shunting (connection) of blood that bypasses the alveoli.

There are a number of indicators of external respiration that characterize its function: 1) pulmonary ventilation; 2) lung volume; 3) mechanics of breathing; 4) pulmonary gas exchange; 5) gas composition of arterial blood. The calculation and evaluation of these indicators is carried out in order to determine the functional state of the respiratory organs and reserve capabilities in children of different ages.

Respiratory examination

This is a medical procedure, and nursing staff should be able to prepare for this study.

It is necessary to find out the timing of the onset of the disease, the main complaints and symptoms, whether the child took any drugs and how they affected the dynamics of clinical symptoms, what complaints are there today. This information should be obtained from the mother or caregiver.

In children, most lung diseases begin with a runny nose. In this case, in the diagnosis it is necessary to clarify the nature of the discharge. The second leading symptom of damage to the respiratory system is a cough, the nature of which is used to judge the presence of a particular disease. The third symptom is shortness of breath. In young children with shortness of breath, nodding movements of the head, swelling of the wings of the nose are visible. In older children, one can notice the retraction of the compliant places of the chest, the retraction of the abdomen, a forced position (sitting with support from the hands - with bronchial asthma).

The doctor examines the nose, mouth, pharynx and tonsils of the child, differentiates the existing cough. Croup in a child is accompanied by stenosis of the larynx. There are true (diphtheria) croup, when the narrowing of the larynx occurs due to diphtheria films, and false croup (subglottic laryngitis), which occurs due to spasm and edema against the background of an acute inflammatory disease of the larynx. True croup develops gradually, in days, false croup - unexpectedly, more often at night. The voice with croup may reach aphonia, with sharp breaks of sonorous notes.

Cough with whooping cough in the form of a paroxysm (paroxysmal) with reprises (long high breath) is accompanied by reddening of the face and vomiting.

A bitonic cough (rough basic tone and musical second tone) is noted with an increase in bifurcation lymph nodes, tumors in this place. A painful dry cough is observed with pharyngitis and nasopharyngitis.

It is important to know the dynamics of cough changes, whether the cough bothered you before, what happened to the child and how the process ended in the lungs, whether the child had contact with a patient with tuberculosis.

When examining a child, the presence of cyanosis is determined, and if it is present, its character. Pay attention to increased cyanosis, especially around the mouth and eyes, when crying, physical activity of the child. In children under 2-3 months of age, on examination, there may be foamy discharge from the mouth.

Pay attention to the shape of the chest and the type of breathing. The abdominal type of breathing remains in boys and in adulthood. In girls, from the age of 5-6, a chest type of breathing appears.

Count the number of breaths per minute. It depends on the age of the child. In young children, the number of breaths is counted at rest when they are sleeping.

According to the frequency of breathing, its ratio with the pulse, the presence or absence of respiratory failure is judged. By the nature of shortness of breath, one or another lesion of the respiratory system is judged. Shortness of breath is inspiratory when the passage of air in the upper respiratory tract is difficult (croup, foreign body, cysts and tumors of the trachea, congenital narrowing of the larynx, trachea, bronchi, retropharyngeal abscess, etc.). When a child inhales, there is a retraction of the epigastric region, intercostal spaces, subclavian space, jugular fossa, tension m. sternocleidomastoideus and other accessory muscles.

Shortness of breath can also be expiratory, when the chest is swollen, almost does not participate in breathing, and the stomach, on the contrary, actively participates in the act of breathing. In this case, the exhalation is longer than the inhalation.

However, there is also mixed shortness of breath - expiratory-inspiratory, when the muscles of the abdomen and chest take part in the act of breathing.

Tire's shortness of breath (expiratory shortness of breath) may also be observed, which occurs as a result of compression of the lung root by enlarged lymph nodes, infiltrates, the lower part of the trachea and bronchi; the breath is free.

Shortness of breath is often observed in newborns with respiratory distress syndrome.

Palpation of the chest in a child is carried out with both hands to determine its soreness, resistance (elasticity), elasticity. The thickness of the skin fold is also measured in symmetrical areas of the chest to determine inflammation on one side. On the affected side, there is a thickening of the skin fold.

Next, move on to percussion of the chest. Normally, in children of all ages, both sides receive the same percussion. With various lesions of the lungs, the percussion sound changes (dull, boxy, etc.). Topographic percussion is also carried out. There are age standards for the location of the lungs, which can change with pathology.

After comparative and topographic percussion, auscultation is performed. Normally, in children up to 3-6 months, they listen to somewhat weakened breathing, from 6 months to 5-7 years - puerile breathing, and in children over 10-12 years old, it is more often transitional - between puerile and vesicular.

With pathology of the lungs, the nature of breathing often changes. Against this background, dry and wet rales, pleural friction noise can be heard. To determine the compaction (infiltration) in the lungs, the method of assessing bronchophony is often used when voice conduction is heard under symmetrical sections of the lungs. With compaction of the lung on the side of the lesion, increased bronchophony is heard. With caverns, bronchiectasis, there may also be an increase in bronchophony. The weakening of bronchophony is noted in the presence of fluid in the pleural cavity (effusion pleurisy, hydrothorax, hemothorax) and (pneumothorax).

Instrumental Research

In lung diseases, the most common study is x-ray. In this case, x-rays or fluoroscopy are performed. Each of these studies has its own indications. When x-ray examination of the lungs pay attention to the transparency of the lung tissue, the appearance of various blackouts.

Special studies include bronchography - a diagnostic method based on the introduction of a contrast agent into the bronchi.

In mass studies, fluorography is used - a method based on the study of the lungs with the help of a special X-ray attachment and output to photographic film.

Of the other methods, computed tomography is used, which allows to examine in detail the state of the mediastinal organs, the root of the lungs, to see changes in the bronchi and bronchiectasis. When using nuclear magnetic resonance, a detailed study of the tissues of the trachea, large bronchi is carried out, you can see the vessels, their relationship with the respiratory tract.

An effective diagnostic method is endoscopic examination, including anterior and posterior rhinoscopy (examination of the nose and its passages) using nasal and nasopharyngeal mirrors. The study of the lower part of the pharynx is carried out using special spatulas (direct laryngoscopy), the larynx - using a laryngeal mirror (laryngoscope).

Bronchoscopy, or tracheobronchoscopy, is a method based on the use of fiber optics. This method is used to identify and remove foreign bodies from the bronchi and trachea, drain these formations (suction of mucus) and biopsy them, and administer drugs.

There are also methods for studying external respiration based on a graphical recording of respiratory cycles. According to these records, the function of external respiration in children older than 5 years is judged. Then pneumotachometry is performed with a special apparatus that allows determining the state of bronchial conduction. The state of ventilation function in sick children can be determined using the method of peak flowmetry.

From laboratory tests, the method of studying gases (O 2 and CO 2) in the patient's capillary blood on the micro-Astrup apparatus is used.

Oxyhemography is performed using a photoelectric measurement of light absorption through the pinna.

Of the stress tests, a breath-holding test (Streni test), a test with physical activity is used. When squatting (20-30 times) in healthy children, there is no decrease in blood oxygen saturation. A test with oxygen exhalation is done when breathing is switched on for oxygen. In this case, there is an increase in the saturation of the exhaled air by 2-4% within 2-3 minutes.

The patient's sputum is examined by laboratory methods: the number, content of leukocytes, erythrocytes, squamous epithelial cells, mucus strands.

By the time the child is born, the morphological structure is still imperfect. Intensive growth and differentiation of the respiratory organs continue during the first months and years of life. The formation of the respiratory organs ends on average by the age of 7, and then only their sizes increase. All airways in a child are much smaller and narrower than in an adult. Their features morfol. structures in children of the first years of life are:

1) thin, tender, easily damaged dry mucosa with insufficient development of glands, with reduced production of secretory immunoglobulin A (SIgA) and surfactant deficiency;

2) rich vascularization of the submucosal layer, represented mainly by loose fiber and containing few elastic and connective tissue elements;

3) softness and suppleness of the cartilaginous framework of the lower respiratory tract, the absence of elastic tissue in them and in the lungs.

Nose and nasopharyngeal space . In young children, the nose and nasopharyngeal space are small, short, flattened due to insufficient development of the facial skeleton. The shells are thick, the nasal passages are narrow, the lower one is formed only by 4 years. Cavernous tissue develops by 8-9 years.

Accessory cavities of the nose . By the birth of a child, only the maxillary sinuses are formed; frontal and ethmoid are open protrusions of the mucous membrane, which are formed in the form of cavities only after 2 years, the main sinus is absent. Completely all adnexal cavities of the nose develop by 12-15 years.

Nasolacrimal canal . Short, its valves are underdeveloped, the outlet is located close to the angle of the eyelids, which facilitates the spread of infection from the nose to the conjunctival sac.

Pharynx . In young children, it is relatively wide, the palatine tonsils are clearly visible at birth, but do not protrude due to well-developed arches. Their crypts and vessels are poorly developed, which to some extent explains the rare diseases of angina in the first year of life. By the end of the first year, the lymphoid tissue of the tonsils, including the nasopharyngeal (adenoids), is often hyperplastic, especially in children with diathesis. Their barrier function at this age is low, like that of the lymph nodes. The overgrown lymphoid tissue is colonized by viruses and microbes, foci of infection are formed - adenoiditis and chronic tonsillitis.

thyroid cartilage form an obtuse rounded corner in young children, which after 3 years becomes more acute in boys. From the age of 10, a characteristic male larynx is formed. The true vocal cords in children are shorter than in adults, which explains the height and timbre of a child's voice.

Trachea. In children of the first months of life, it is often funnel-shaped; at an older age, cylindrical and conical forms predominate. Its upper end is located in newborns much higher than in adults (at the level of the IV cervical vertebrae), and gradually descends, as does the level of the tracheal bifurcation (from the III thoracic vertebra in a newborn to V-VI at 12-14 years). The framework of the trachea consists of 14-16 cartilaginous half-rings connected behind by a fibrous membrane (instead of an elastic end plate in adults). The membrane contains many muscle fibers, the contraction or relaxation of which changes the lumen of the organ. The child's trachea is very mobile, which, along with the changing lumen and softness of the cartilage, sometimes leads to its slit-like collapse on exhalation (collapse) and is the cause of expiratory dyspnea or rough snoring breathing (congenital stridor). The symptoms of stridor usually disappear by age 2, when the cartilage becomes denser.

bronchial tree . By the time of birth, the bronchial tree is formed. The dimensions of the bronchi increase intensively in the first year of life and in the pubertal period. They are based on cartilaginous semicircles in early childhood, which do not have a closing elastic plate and are connected by a fibrous membrane containing muscle fibers. Bronchial cartilage is very elastic, soft, springy and easily displaced. The right main bronchus is usually almost a direct continuation of the trachea, so it is in it that foreign bodies are more often found. The bronchi, like the trachea, are lined with multi-row cylindrical epithelium, the ciliated apparatus of which is formed after the birth of a child.

Due to the increase in the thickness of the submucosal layer and mucous membrane by 1 mm, the total area of the lumen of the bronchi of the newborn decreases by 75% (in an adult - by 19%). Active motility of the bronchi is insufficient due to poor development of muscles and ciliated epithelium. Incomplete myelination of the vagus nerve and underdevelopment of the respiratory muscles contribute to the weakness of the cough impulse in a small child; the infected mucus accumulating in the bronchial tree clogs the lumens of the small bronchi, promotes atelectasis and infection of the lung tissue. a functional feature of the bronchial tree of a small child is the insufficient performance of the drainage, cleansing function.

Lungs. In a child, as in adults, the lungs have a segmental structure. The segments are separated from each other by narrow grooves and layers of connective tissue (lobular lung). The main structural unit is the acinus, but its terminal bronchioles end not in a cluster of alveoli, as in an adult, but in a sac (sacculus). From the "lace" edges of the latter, new alveoli are gradually formed, the number of which in a newborn is 3 times less than in an adult. The diameter of each alveolus increases (0.05 mm in a newborn, 0.12 mm at 4-5 years, 0.17 mm by 15 years). In parallel, the vital capacity of the lungs increases. The interstitial tissue in the child's lung is loose, rich in blood vessels, fiber, contains very little connective tissue and elastic fibers. In this regard, the lungs of a child in the first years of life are more full-blooded and less airy than those of an adult. Underdevelopment of the elastic framework of the lungs contributes to both the occurrence of emphysema and atelectasis of the lung tissue.

The tendency to atelectasis is exacerbated by a deficiency of surfactant, a film that regulates alveolar surface tension and is produced by alveolar macrophages. It is this deficiency that causes insufficient expansion of the lungs in preterm infants after birth (physiological atelectasis).

Pleural cavity . In a child, it is easily extensible due to the weak attachment of the parietal sheets. The visceral pleura, especially in newborns, is relatively thick, loose, folded, contains villi, outgrowths, most pronounced in the sinuses, interlobar grooves.

lung root . It consists of large bronchi, vessels and lymph nodes (tracheobronchial, bifurcation, bronchopulmonary and around large vessels). Their structure and function are similar to peripheral lymph nodes. They easily respond to the introduction of infection. The thymus gland (thymus) is also placed in the mediastinum, which is large at birth and normally gradually decreases during the first two years of life.

Diaphragm. In connection with the characteristics of the chest, the diaphragm plays a large role in the mechanism of breathing in a small child, ensuring the depth of inspiration. The weakness of its contractions partly explains the extremely shallow breathing of a newborn. The main functions physiological features respiratory organs are: superficial nature of breathing; physiological shortness of breath (tachypnea), often irregular breathing rhythm; tension of gas exchange processes and easy onset of respiratory failure.

1. The depth of breathing, the absolute and relative volumes of one respiratory act in a child is much less than in an adult. When crying, the volume of breathing increases by 2-5 times. The absolute value of the minute volume of breathing is less than that of an adult, and the relative value (per 1 kg of body weight) is much larger.

2. The frequency of breathing is the greater, the younger the child, compensates for the small volume of each respiratory act and provides oxygen to the child's body. Rhythm instability and short (for 3-5 minutes) respiratory arrest (apnea) in newborns and preterm infants are associated with incomplete differentiation of the respiratory center and its hypoxia. Oxygen inhalations usually eliminate the respiratory arrhythmia in these children.

3. Gas exchange in children is carried out more vigorously than in adults, due to the rich vascularization of the lungs, blood flow velocity, and high diffusion capacity. At the same time, the function of external respiration in a small child is disturbed very quickly due to insufficient lung excursions and expansion of the alveoli.

The respiratory rate of a newborn child is 40 - 60 per 1 min, one-year-old - 30 -35, 5 - 6 years old - 20 -25, 10 years old - 18 - 20, adult - 15 - 16 per 1 min.

Percussion tone in a healthy child of the first years of life is usually high, clear, with a slightly boxy tone. When crying, it can change - to a distinct tympanitis on maximum inspiration and shortening on exhalation.

Hearing normal breath sounds depend on age: up to a year in a healthy child, breathing is weakened vesicular due to its superficial nature; at the age of 2 - 7 years, puerile (children's) breathing is heard, more distinct, with a relatively louder and longer (1/2 of inhalation) exhalation. In school-age children and adolescents, breathing is the same as in adults - vesicular.

The leading role in the origin of this syndrome is given to the deficiency of surfactant - a surfactant that lines the inside of the alveoli and prevents their collapse. The synthesis of surfactant changes in prematurely born children, and various adverse effects on the fetus, leading to hypoxia and hemodynamic disorders in the lungs, also affect. There is evidence of the participation of prostaglandins E in the pathogenesis of respiratory distress syndrome. These biologically active substances indirectly reduce the synthesis of surfactant, have a vasopressor effect on the vessels of the lungs, prevent the closure of the arterial duct and normalize blood circulation in the lungs.

There are several stages in the development of the respiratory system:

Stage 1 - up to 16 weeks of intrauterine development, the formation of bronchial glands occurs.

From the 16th week - the stage of recanalization - the cellular elements begin to produce mucus, liquid, and as a result, the cells are completely displaced, the bronchi acquire a lumen, and the lungs become hollow.

Stage 3 - alveolar - begins at 22 - 24 weeks and continues until the birth of the child. During this period, the formation of acinus, alveoli, the synthesis of surfactant takes place.

By the time of birth, there are about 70 million alveoli in the lungs of the fetus. From 22-24 weeks, differentiation of alveolocytes begins - cells lining the inner surface of the alveoli.

There are 2 types of alveolocytes: type 1 (95%), type 2 - 5%.

A surfactant is a substance that prevents the alveoli from collapsing due to changes in surface tension.

It lines the alveoli from the inside with a thin layer, on inspiration the volume of the alveoli increases, the surface tension increases, which leads to resistance to breathing.

During exhalation, the volume of the alveoli decreases (by more than 20-50 times), the surfactant prevents them from collapsing. Since 2 enzymes are involved in the production of surfactant, which are activated at different gestation periods (at the latest from 35-36 weeks), it is clear that the shorter the gestational age of the child, the more pronounced the surfactant deficiency and the higher the likelihood of developing bronchopulmonary pathology.

Surfactant deficiency also develops in mothers with preeclampsia, with complicated pregnancy, with caesarean section. The immaturity of the surfactant system is manifested by the development of respiratory distress syndrome.

Surfactant deficiency leads to collapse of the alveoli and the formation of atelectasis, as a result of which the function of gas exchange is disturbed, pressure in the pulmonary circulation increases, which leads to the persistence of the fetal circulation and the functioning of the patent ductus arteriosus and foramen ovale.

As a result, hypoxia, acidosis develops, vascular permeability increases, and the liquid part of the blood with proteins leaks into the alveoli. Proteins are deposited on the wall of the alveoli in the form of semicircles - hyaline membranes. This leads to a violation of the diffusion of gases, and the development of severe respiratory failure, which is manifested by shortness of breath, cyanosis, tachycardia, and the participation of auxiliary muscles in the act of breathing.

The clinical picture develops after 3 hours from the moment of birth and changes increase within 2-3 days.

AFO of the respiratory system

By the time the child is born, the respiratory system reaches morphological maturity and can perform the function of breathing.
In a newborn, the respiratory tract is filled with a liquid with low viscosity and a small amount of protein, which ensures its rapid absorption after the birth of the child through the lymphatic and blood vessels. In the early neonatal period, the child adapts to extrauterine existence.
After 1 breath, a short inspiratory pause occurs, lasting 1-2 seconds, after which an exhalation occurs, accompanied by a loud cry of the child. At the same time, the first respiratory movement in a newborn is carried out according to the type of gasping (inspiratory "flash") - this is a deep breath with difficult exhalation. Such breathing persists in healthy full-term babies up to the first 3 hours of life. In a healthy newborn child, with the first exhalation, most of the alveoli expand, and vasodilation occurs at the same time. Complete expansion of the alveoli occurs within the first 2-4 days after birth.
Mechanism of the first breath. The main starting point is hypoxia resulting from clamping the umbilical cord. After ligation of the umbilical cord, oxygen tension in the blood drops, carbon dioxide pressure increases and pH decreases. In addition, the newborn child is greatly influenced by the ambient temperature, which is lower than in the womb. The contraction of the diaphragm creates a negative pressure in the chest cavity, which makes it easier for air to enter the airways.

A newborn child has well-defined protective reflexes - coughing and sneezing. Already in the first days after the birth of a child, the Hering-Breuer reflex functions in him, leading, at a threshold stretching of the pulmonary alveoli, to the transition from inhalation to exhalation. In an adult, this reflex is carried out only with a very strong stretching of the lungs.

Anatomically, the upper, middle and lower airways are distinguished. The nose is relatively small at the time of birth, the nasal passages are narrow, there is no lower nasal passage, the nasal concha, which are formed by 4 years. Poorly developed submucosal tissue (matures by 8-9 years), up to 2 years underdeveloped cavernous or cavernous tissue (as a result, young children do not have nosebleeds). The mucous membrane of the nose is delicate, relatively dry, rich in blood vessels. Due to the narrowness of the nasal passages and the abundant blood supply to their mucous membrane, even a slight inflammation causes difficulty in breathing through the nose in young children. Breathing through the mouth in children of the first six months of life is impossible, since a large tongue pushes the epiglottis backwards. Particularly narrow in young children is the exit from the nose - the choana, which is often the cause of a long-term violation of their nasal breathing.

The paranasal sinuses in young children are very poorly developed or completely absent. As the facial bones (upper jaw) increase in size and teeth erupt, the length and width of the nasal passages and the volume of the paranasal sinuses increase. These features explain the rarity of diseases such as sinusitis, frontal sinusitis, ethmoiditis, in early childhood. A wide nasolacrimal duct with underdeveloped valves contributes to the transition of inflammation from the nose to the mucous membrane of the eyes.

The pharynx is narrow and small. The lymphopharyngeal ring (Waldeyer-Pirogov) is poorly developed. It consists of 6 tonsils:

2 palatine (between the anterior and posterior palatine arches)

2 tubal (near the Eustachian tubes)

1 throat (in the upper part of the nasopharynx)

1 lingual (in the region of the root of the tongue).

The palatine tonsils in newborns are not visible, by the end of the 1st year of life they begin to protrude due to the palatine arches. By 4-10 years of age, the tonsils are well developed and their hypertrophy can easily occur. In puberty, the tonsils begin to undergo reverse development. The Eustachian tubes in young children are wide, short, straight, located horizontally, and when the child is in a horizontal position, the pathological process from the nasopharynx easily spreads to the middle ear, causing the development of otitis media. With age, they become narrow, long, winding.

The larynx is funnel-shaped. The glottis is narrow and located high (at the level of the 4th cervical vertebrae, and in adults at the level of the 7th cervical vertebrae). Elastic tissue is poorly developed. The larynx is relatively longer and narrower than in adults, its cartilages are very pliable. With age, the larynx acquires a cylindrical shape, becomes wide and descends 1-2 vertebrae lower. False vocal cords and mucous membrane are delicate, rich in blood and lymphatic vessels, elastic tissue is poorly developed. The glottis in children is narrow. The vocal cords of young children are shorter than those of older children, so they have a high pitched voice. From the age of 12, the vocal cords in boys become longer than in girls.

The bifurcation of the trachea lies higher than in an adult. The cartilaginous frame of the trachea is soft and easily narrows the lumen. The elastic tissue is poorly developed, the mucous membrane of the trachea is tender and rich in blood vessels. The growth of the trachea occurs in parallel with the growth of the trunk, most intensively - in the 1st year of life and in the pubertal period.

The bronchi are richly supplied with blood, muscle and elastic fibers in young children are underdeveloped, the lumen of the bronchi is narrow. Their mucous membrane is richly vascularized.
The right bronchus is, as it were, a continuation of the trachea, it is shorter and wider than the left. This explains the frequent entry of a foreign body into the right main bronchus.
The bronchial tree is poorly developed.
The bronchi of the 1st order are distinguished - the main ones, the 2nd order - lobar (right 3, left 2), 3rd order - segmental (right 10, left 9). The bronchi are narrow, their cartilages are soft. Muscle and elastic fibers in children of the 1st year of life are still not sufficiently developed, the blood supply is good. The bronchial mucosa is lined with ciliated ciliated epithelium, which provides mucociliary clearance, which plays a major role in protecting the lungs from various pathogens from the upper respiratory tract and has an immune function (secretory immunoglobulin A). The tenderness of the mucous membrane of the bronchi, the narrowness of their lumen explain the frequent occurrence in young children of bronchiolitis with a syndrome of complete or partial obstruction, atelectasis of the lungs.

Lung tissue is less airy, elastic tissue is underdeveloped. In the right lung, 3 lobes are isolated, in the left 2. Then the lobar bronchi are divided into segmental ones. Segment - a self-functioning unit of the lung, directed by its apex to the root of the lung, has an independent artery and nerve. Each segment has independent ventilation, a terminal artery and intersegmental septa made of elastic connective tissue. The segmental structure of the lungs is already well expressed in newborns. In the right lung, 10 segments are distinguished, in the left - 9. The upper left and right lobes are divided into three segments - 1, 2 and 3, the middle right lobe - into two segments - 4 and 5. In the left lung, the middle lobe corresponds to the lingual, also consisting of two segments - the 4th and 5th. The lower lobe of the right lung is divided into five segments - 6, 7, 8, 9 and 10, the left lung - into four segments - 6, 7, 8 and 9. Acini are underdeveloped, alveoli begin to form from 4 to 6 weeks of age and their number rapidly increases within 1 year, growing up to 8 years.

The need for oxygen in children is much higher than in adults. So, in children of the 1st year of life, the need for oxygen per 1 kg of body weight is about 8 ml / min, in adults - 4.5 ml / min. The superficial nature of breathing in children is compensated by a high respiratory rate, the participation of most of the lungs in breathing

In the fetus and newborn, hemoglobin F predominates, which has an increased affinity for oxygen, and therefore the oxyhemoglobin dissociation curve is shifted to the left and up. Meanwhile, in a newborn, as in a fetus, erythrocytes contain extremely little 2,3-diphosphoglycerate (2,3-DFG), which also causes less saturation of hemoglobin with oxygen than in an adult. At the same time, in the fetus and newborn, oxygen is more easily given to the tissues.

In healthy children, depending on age, a different nature of breathing is determined:

a) vesicular - expiration is one third of inspiration.

b) puerile breathing - enhanced vesicular

c) hard breathing - exhalation is more than half of the inhalation or equal to it.

d) bronchial breathing - exhalation is longer than inhalation.

It is necessary to note the sonority of breathing (normal, enhanced, weakened). In children of the first 6 months. breathing is weakened. After 6 months up to 6 years, breathing is puerile, and from 6 years old it is vesicular or intensely vesicular (one third of inhalation and two thirds of exhalation is heard), it is heard evenly over the entire surface.

Respiratory rate (RR)

	Frequency per minute
premature
Newborn

Stange test - breath holding on inspiration (6-16 years - from 16 to 35 seconds).

Gench test - breath holding on exhalation (N - 21-39 sec).

The respiratory system is a collection of organs consisting of the respiratory tract (nose, pharynx, trachea, bronchi), lungs (bronchial tree, acini), as well as muscle groups that contribute to the contraction and relaxation of the chest. Breathing provides the cells of the body with oxygen, which in turn converts it into carbon dioxide. This process occurs in the pulmonary circulation.

The laying and development of the child's respiratory system begins during the 3rd week of a woman's pregnancy. It is formed from three rudiments:

Splanchnotome.
Mesenchyme.
Epithelium of the foregut.

From the visceral and parietal sheets of the splanchnotome, the mesothelium of the pleura develops. It is represented by a single-layer squamous epithelium (polygonal cells), lining the entire surface of the pulmonary system, separating from other organs. The outer surface of the leaf is covered with microcilia that produce a serous fluid. It is necessary for sliding between the two layers of the pleura during inhalation and exhalation.

From the mesenchyme, namely the germ layer of the mesoderm, cartilage, muscle and connective tissue structures, and blood vessels are formed. From the epithelium of the anterior intestine takes the development of the bronchial tree, lungs, alveoli.

In the intrauterine period, the airways and lungs are filled with fluid, which is removed during childbirth with the first breath, and is also absorbed by the lymphatic system and partially into the blood vessels. Breathing is carried out at the expense of maternal blood, enriched with oxygen, through the umbilical cord.

By the eighth month of gestation, pneumocytes produce a surfactant called surfactant. It lines the inner surface of the alveoli, prevents them from falling off and sticking together, and is located at the air-liquid interface. Protects against harmful agents with the help of immunoglobulins and macrophages. Insufficient secretion or absence of surfactant threatens the development of respiratory distress syndrome.

A feature of the respiratory system in children is its imperfection. The formation and differentiation of tissues, cell structures is carried out in the first years of life and up to seven years.

Structure

Over time, the child's organs adapt to the environment in which he will live, the necessary immune, glandular cells are formed. In a newborn, the respiratory tract, unlike an adult organism, has:

Narrower opening.
Short stroke length.
Many vascular vessels in a limited area of the mucosa.
Delicate, easily traumatized architectonics of the lining membranes.
Loose structure of lymphoid tissue.

Upper paths

The baby's nose is small, its passages are narrow and short, so the slightest swelling can lead to obstruction, which makes sucking difficult.

The structure of the upper tract in a child:

Two nasal sinuses are developed - the upper and middle ones, the lower one will be formed by the age of four. The cartilage framework is soft and pliable. The mucous membrane has an abundance of blood and lymphatic vessels, and therefore minor manipulation can lead to injury. Nosebleeds are rarely noted - this is due to undeveloped cavernous tissue (it will form by the age of 9). All other cases of blood flow from the nose are considered pathological.
The maxillary sinuses, the frontal and ethmoid sinuses are not closed, protrude the mucous membrane, are formed by 2 years, cases of inflammatory lesions are rare. Thus, the shell is more adapted to the purification, humidification of the inhaled air. Full development of all sinuses occurs by the age of 15.
The nasolacrimal canal is short, exits in the corner of the eye, close to the nose, which ensures a rapid ascending spread of inflammation from the nose to the lacrimal sac and the development of polyetiologic conjunctivitis.
The pharynx is short and narrow, due to which it is quickly infected through the nose. At the level between the oral cavity and the pharynx, there is a Pirogov-Waldeyer nasopharyngeal annular formation, consisting of seven structures. The concentration of lymphoid tissue protects the entrance to the respiratory and digestive organs from infectious agents, dust, allergens. Features of the structure of the ring: poorly formed tonsils, adenoids, they are loose, pliable to settlement in their crypts of inflammatory agents. There are chronic foci of infection, frequent respiratory diseases, tonsillitis, difficulty in nasal breathing. Such children develop neurological disorders, they usually walk with their mouths open and are less amenable to schooling.
The epiglottis is scapular, relatively wide and short. During breathing, it lies on the root of the tongue - opens the entrance to the lower paths, during the period of eating - prevents the foreign body from entering the respiratory passages.

lower paths

The larynx of a newborn is located higher than that of an adult individual, due to the muscular frame it is very mobile. It has the form of a funnel with a diameter of 0.4 cm, the narrowing is directed towards the vocal cords. The cords are short, which explains the high timbre of the voice. With a slight edema, during acute respiratory diseases, symptoms of croup, stenosis occur, which is characterized by heavy, wheezing breathing with the inability to perform a full breath. As a result, hypoxia develops. The laryngeal cartilages are rounded, their sharpening in boys takes place by the age of 10-12 years.

The trachea is already formed by the time of birth, is located at the level of the 4th cervical vertebra, is mobile, in the form of a funnel, then acquires a cylindrical appearance. The lumen is significantly narrowed, in contrast to an adult, there are few glandular areas in it. When coughing, it can be reduced by a third. Given the anatomical features, in inflammatory processes, narrowing and the occurrence of a barking cough, symptoms of hypoxia (cyanosis, shortness of breath) are inevitable. The frame of the trachea consists of cartilaginous semirings, muscle structures, connective tissue membrane. Bifurcation at birth is higher than in older children.

The bronchial tree is a continuation of the bifurcation of the trachea, divided into the right and left bronchus. The right one is wider and shorter, the left one is narrower and longer. The ciliated epithelium is well developed, producing physiological mucus that cleanses the bronchial lumen. Mucus cilia moves outward at a speed of up to 0.9 cm per minute.

A feature of the respiratory organs in children is a weak cough impulse, due to poorly developed torso muscles, incomplete myelin coverage of the nerve fibers of the tenth pair of cranial nerves. As a result, infected sputum does not go away, accumulates in the lumen of the bronchi of different calibers and there is a blockage with a thick secret. In the structure of the bronchus there are cartilage rings, with the exception of the terminal sections, which consist only of smooth muscles. When they are irritated, a sharp narrowing of the course may occur - an asthmatic picture appears.

The lungs are airy tissue, their differentiation continues up to 9 years of age, they consist of:

Shares (right of three, left of two).
Segments (right - 10, left - 9).
Dolek.

The bronchioles end in a sac in the baby. With the growth of the child, the lung tissue grows, the sacs turn into alveolar clusters, and the vital capacity indicators increase. Active development from the 5th week of life. At birth, the weight of the paired organ is 60–70 grams, it is well supplied with blood and vascularized by lymph. Thus, it is full-blooded, and not airy as in older age. The important point is that the lungs are not innervated, inflammatory reactions are painless, and in this case, you can miss a serious illness.

Due to the anatomical and physiological structure, pathological processes develop in the basal regions, cases of atelectasis and emphysema are not uncommon.

Functional Features

The first breath is carried out by reducing oxygen in the blood of the fetus and increasing the level of carbon dioxide, after clamping the umbilical cord, as well as changing the conditions of stay - from warm and humid to cold and dry. Signals along the nerve endings enter the central nervous system, and then to the respiratory center.

Features of the function of the respiratory system in children:

Air conduction.
Cleansing, warming, moisturizing.
Oxygenation and removal of carbon dioxide.
Protective immune function, synthesis of immunoglobulins.
Metabolism is the synthesis of enzymes.
Filtration - dust, blood clots.
lipid and water metabolism.
shallow breaths.
Tachypnea.

In the first year of life, respiratory arrhythmia occurs, which is considered the norm, but its persistence and the occurrence of apnea after one year of age is fraught with respiratory arrest and death.

The frequency of respiratory movements directly depends on the age of the baby - the younger, the more often the breath is taken.

NPV norm:

Newborn 39–60/minute.
1-2 years - 29-35 / min.
3-4 years - 23-28 / min.
5-6 years - 19-25 / min.
10 years - 19-21 / min.
Adult - 16-21 / min.

Taking into account the peculiarities of the respiratory organs in children, the attentiveness and awareness of parents, timely examination, therapy reduces the risk of transition to the chronic stage of the disease and serious complications.

The respiratory organs are several organs combined into a single bronchopulmonary system. It consists of two sections: the respiratory tract, through which air passes; the actual lungs. The respiratory tract is usually divided into: upper respiratory tract - nose, paranasal sinuses, pharynx, Eustachian tubes and some other formations; the lower respiratory tract - the larynx, the bronchial system from the largest bronchus of the body - the trachea to their smallest branches, which are commonly called bronchioles. Functions of the respiratory tract in the body Respiratory tract: carry air from the atmosphere to the lungs; clean the air masses from dust pollution; protect the lungs from harmful effects (some bacteria, viruses, foreign particles, etc. settle on the mucous membrane of the bronchi, and then are excreted from the body); warm and humidify the inhaled air. The lungs proper look like many small air-filled sacs (alveoli) connected to each other and looking like bunches of grapes. The main function of the lungs is the process of gas exchange, that is, the absorption of oxygen from atmospheric air - a gas vital for the normal, coordinated work of all body systems, as well as the release of exhaust gases into the atmosphere, and above all carbon dioxide. All these important functions of the respiratory system can be seriously impaired in diseases of the bronchopulmonary system. The respiratory organs of children are different from the respiratory organs of an adult. These features of the structure and function of the bronchopulmonary system must be taken into account when carrying out hygienic, preventive and therapeutic measures in a child. In a newborn, the respiratory tract is narrow, the mobility of the chest is limited due to weakness of the pectoral muscles. Breathing is frequent - 40-50 times per minute, its rhythm is unstable. With age, the frequency of respiratory movements decreases and is 30-35 times at the age of one year, at 3 years -25-30, and at 4-7 years old - 22-26 times per minute. The depth of breathing and pulmonary ventilation increase by 2-2.5 times. Hoc is the "watchdog" of the respiratory tract. The nose is the first to take upon itself the attack of all harmful external influences. The nose is the center of information about the state of the surrounding atmosphere. It has a complex internal configuration and performs a variety of functions: air passes through it; it is in the nose that the inhaled air is heated and moistened to the parameters necessary for the internal environment of the body; the main part of atmospheric pollution, microbes and viruses settles first of all on the nasal mucosa; in addition, the nose is an organ that provides the sense of smell, that is, it has the ability to sense odors. What ensures that a child breathes normally through the nose? Normal nasal breathing is extremely important for children of any age. It is a barrier to infection in the respiratory tract, and consequently, for the occurrence of bronchopulmonary diseases. Well-warmed clean air is a guarantee of protection against colds. In addition, the sense of smell develops a child's understanding of the external environment, is protective in nature, forms an attitude to food, appetite. Nasal breathing is physiologically correct breathing. It is necessary to ensure that the child breathes through the nose. Breathing through the mouth in the absence or severe difficulty of nasal breathing is always a sign of nasal disease and requires special treatment. Features of the nose in children The nose in children has a number of features. The nasal cavity is relatively small. The smaller the child, the smaller the nasal cavity. The nasal passages are very narrow. The mucous membrane of the nose is loose, well supplied with blood vessels, so any irritation or inflammation leads to the rapid onset of edema and a sharp decrease in the lumen of the nasal passages up to their complete obstruction. Nasal mucus, which is constantly produced by the mucous glands of the child's nose, is quite thick. Mucus often stagnates in the nasal passages, dries up and leads to the formation of crusts, which, by blocking the nasal passages, also contribute to nasal breathing disorders. In this case, the child begins to “sniff” through his nose or breathe through his mouth. What can cause a violation of nasal breathing? Breathing problems through the nose can cause shortness of breath and other respiratory disorders in children during the first months of life. In infants, the act of sucking and swallowing is disturbed, the baby begins to worry, throws the breast, remains hungry, and if nasal breathing is absent for a long time, the child may even gain weight worse. A pronounced difficulty in nasal breathing leads to hypoxia - a disruption in the supply of oxygen to organs and tissues. Children who breathe poorly through the nose develop worse, lag behind their peers in mastering the school curriculum. Lack of nasal breathing can even lead to increased intracranial pressure and dysfunction of the central nervous system. In this case, the child becomes restless, may complain of a headache. Some children have sleep disturbances. Children with impaired nasal breathing begin to breathe through their mouths, while cold air entering the respiratory tract easily leads to colds, such children are more likely to get sick. And, finally, a disorder of nasal breathing leads to a violation of the worldview. Children who do not breathe through their nose have a reduced quality of life. Paranasal sinuses Paranasal sinuses are limited air spaces of the facial skull, additional air reservoirs. In young children, they are not sufficiently formed, so diseases such as sinusitis, sinusitis, in babies under the age of 1 year are extremely rare. However, inflammatory diseases of the paranasal sinuses often disturb children at an older age. It can be quite difficult to suspect that a child has inflammation of the paranasal sinuses, but you should pay attention to symptoms such as headache, fatigue, nasal congestion, poor school performance. Only a specialist can confirm the diagnosis, and often the doctor prescribes an X-ray examination. 33. Throat The pharynx in children is relatively large and wide. It contains a large amount of lymphoid tissue. The largest lymphoid formations are called tonsils. Tonsils and lymphoid tissue play a protective role in the body, forming the Waldeyer-Pirogov lymphoid ring (palatine, tubal, pharyngeal, lingual tonsils). The pharyngeal lymphoid ring protects the body from bacteria, viruses and perform other important functions. In young children, the tonsils are poorly developed, so a disease such as tonsillitis is rare in them, but colds, on the contrary, are extremely frequent. This is due to the relative insecurity of the pharynx. Tonsils reach their maximum development by 4-5 years, and at this age children begin to suffer less from colds. Important formations such as the Eustachian tubes open into the nasopharynx, connecting the middle ear (tympanic cavity) with the pharynx. In children, the mouths of these tubes are short, which is often the cause of inflammation of the middle ear, or otitis, with the development of a nasopharyngeal infection. Ear infection occurs in the process of swallowing, sneezing, or simply from a runny nose. The prolonged course of otitis is associated precisely with inflammation of the Eustachian tubes. Prevention of the occurrence of inflammation of the middle ear in children is the careful treatment of any infection of the nose and throat. Larynx The larynx is a funnel-shaped formation following the pharynx. It is covered when swallowing with an epiglottis, similar to a cover that prevents food from entering the respiratory tract. The mucous membrane of the larynx is also richly supplied with blood vessels and lymphoid tissue. The opening in the larynx through which air passes is called the glottis. It is narrow, on the sides of the gap there are vocal cords - short, thin, so children's voices are high, sonorous. Any irritation or inflammation can cause swelling of the vocal cords and infraglottic space and lead to respiratory failure. Younger children are more susceptible to these conditions than others. The inflammatory process in the larynx is called laryngitis. In addition, if the baby has an underdevelopment of the epiglottis or a violation of its innervation, he may choke, he periodically has noisy breathing, which is called stridogh. As the child grows and develops, these phenomena gradually disappear. . In some children, breathing from birth can be noisy, accompanied by snoring and sniffling, but not in sleep, as sometimes happens in adults, but during wakefulness. In the case of anxiety and crying, these noise phenomena, which are uncharacteristic for a child, may increase. This is the so-called congenital stridor of the respiratory tract, its cause is a congenital weakness of the cartilages of the nose, larynx and epiglottis. Although there is no discharge from the nose, at first it seems to parents that the child has a runny nose, nevertheless, the treatment applied does not give the desired result - the baby's breathing is equally accompanied by a variety of sounds. Pay attention to how the child breathes in a dream: if it is calm, and before crying, it starts to “grunt” again, apparently, this is what we are talking about. Usually, by the age of two, as the cartilage tissue strengthens, stridor breathing disappears by itself, but until that time, in the case of acute respiratory diseases, the child’s breathing, which has such structural features of the upper respiratory tract, can worsen significantly. A child suffering from stridor should be observed by a pediatrician, consulted by an ENT doctor and a neuropathologist. 34. Bronchi The lower respiratory tract is represented mainly by the trachea and the bronchial tree. The trachea is the largest breathing tube in the body. In children, it is wide, short, elastic, easily displaced and squeezed by any pathological formation. The trachea is strengthened by cartilaginous formations - 14-16 cartilaginous semicircles, which serve as a frame for this tube. Inflammation of the mucous membrane of the trachea is called tracheitis. This disease is very common in children. Tracheitis can be diagnosed by a characteristic very rough, low-pitched cough. Usually parents say that the child is coughing, "like a pipe" or "like a barrel." The bronchi are a whole system of air tubes that form the bronchial tree. The branching system of the bronchial tree is complex, it has 21 orders of bronchi - from the widest, which are called the "main bronchi", to their smallest branches, which are called bronchioles. Bronchial branches are entangled with blood and lymphatic vessels. Each previous branch of the bronchial tree is wider than the next, so the entire bronchial system resembles a tree turned upside down. The bronchi in children are relatively narrow, elastic, soft, easily displaced. The mucous membrane of the bronchi is rich in blood vessels, relatively dry, since the secretory apparatus of the bronchi is underdeveloped in children, and the secret tree produced by the bronchial glands is relatively viscous. Any inflammatory disease or irritation of the respiratory tract in young children can lead to a sharp narrowing of the bronchial lumen due to edema, mucus accumulation, compression and cause respiratory failure. With age, the bronchi grow, their gaps become wider, the secret produced by the bronchial glands becomes less viscous, and respiratory disorders in the course of various bronchopulmonary diseases are less common. Every parent should know that if there are signs of difficulty breathing in a child of any age, especially in young children, an urgent consultation with a doctor is necessary. The doctor will determine the cause of the respiratory disorder and prescribe the correct treatment. Self-medication is unacceptable, since it can lead to the most unpredictable consequences. Diseases of the bronchi are called bronchitis.