# Pediatric respiratory distress

Distinguish wheeze, croup-like cough, anaphylaxis, and poor perfusion.

Population: Pediatric. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See linked source for document revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/pediatric-respiratory-distress/
Official source: [SO-P-035 — Acute Respiratory Distress - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-P-35%20Respiratory%2010-2025.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- IM asthma epinephrine requires the base-order pathway; anaphylaxis has its own standing-order criteria.
- Do not use pediatric CPAP below age 8 or above the pediatric pressure limit.

## Source documents

- [SO-P-035 — Acute Respiratory Distress - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-P-35%20Respiratory%2010-2025.pdf)
- [PR-120 — Continuous Positive Airway Pressure (CPAP)](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/PR-120%20CPAP%2004-2026.pdf)
- [SO-P-060 — Allergic Reaction / Anaphylaxis - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2023-04/SO-P-60%20Allergic%20Rxn%204-2023.pdf)
- [310.00 — 9-1-1 Advanced Life Support Base Contact, Standing Order, and Transport Criteria](https://www.ochealthinfo.com/sites/healthcare/files/2025-03/310.00%20ALS%20Base%20Contact%204-2025.pdf)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)

## First assessment

- Assess appearance, work of breathing, and circulation, then support the airway and ventilation as needed.
- When SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated.
- Check for an allergic trigger, upper-airway obstruction, wheeze, barking cough, and poor perfusion.

## Wheeze or anaphylaxis

- For suspected asthma with wheeze: albuterol 5 mg in 6 mL by continuous nebulization as tolerated. If there is no improvement, consider a base-order request for IM epinephrine.
- For possible anaphylaxis with upper-airway obstruction or respiratory distress: epinephrine 0.01 mg/kg IM of the 1 mg/mL preparation, maximum 0.5 mg, and the fuller SO-P-060 pathway.
- CPAP requires an appropriate mask and the separate PR-120 criteria; the current procedure applies from age 8, with pediatric pressure no higher than 5 cm H₂O.

## Croup-like cough & perfusion

- For recurrent barking-type cough, the source lists 3 mL normal saline by continuous nebulization as tolerated.
- With poor perfusion, obtain IV/IO and give 20 mL/kg saline, maximum 250 mL, with base contact. May repeat twice for 3 total boluses.

## Reassess & escalate

- Use ALS escort to the nearest appropriate ERC. Contact base, pediatric-capable preferred, if there is no response or status worsens.
- 310.00 also includes pediatric respiratory distress as a base-contact trigger. Record the child’s weight, respiratory findings, treatment, and response.
- The I-20 newborn band lists a different albuterol amount from the general respiratory-order wording. Reconcile neonatal dosing with base rather than silently substituting a chart row.