Nursing Management of Acute Respiratory Distress in Hospitalized Children: A Review of Early Assessment, Oxygen Therapy, Airway Monitoring, Family Education, and Prevention of Clinical Deterioration

Abstract

Acute respiratory distress is a frequent reason for paediatric hospital assessment and can progress rapidly because infants and children have age-dependent respiratory physiology, limited reserves, and variable ability to communicate symptoms. Nursing care is central to early recognition, timely oxygen delivery, repeated assessment, airway support, family communication, and escalation when a child shows signs of deterioration. This narrative review summarises practical and evidence-informed principles for the nursing management of hospitalized children with acute respiratory distress. It discusses structured first-look assessment, the assessment of respiratory rate and work of breathing, pulse oximetry, oxygen-delivery devices, hydration and feeding, secretion management, infection prevention, documentation, paediatric early warning systems, and family education. Key danger signs include apnoea, cyanosis, altered responsiveness, exhaustion, severe recession, grunting, poor air entry, increasing oxygen requirement, and persistent hypoxaemia. Pulse oximetry is useful but should never replace direct clinical observation. Oxygen should be prescribed or initiated according to emergency protocols, with a documented target range appropriate to the diagnosis and the child’s baseline condition. High-flow nasal cannula and non-invasive respiratory support require competency-based monitoring and explicit escalation criteria. Family members should be treated as partners who can identify changes from the child’s usual behaviour and participate in comfort and safety measures. Prevention of deterioration depends on repeated assessment, clear communication, accurate recording, timely senior review, and a culture in which staff and caregivers can raise concerns. The review provides a practical framework rather than a substitute for local protocols, specialist advice, or emergency response pathways.