Features of the respiratory system in children. Respiratory diseases in children

All airways in a child are much smaller and narrower than in an adult. Structural features in children of the first years of life are the following: 1) thin, easily vulnerable dry mucosa with glandular underdevelopment, reduced production of immunoglobulin A and surfactant deficiency; 2) rich vascularization of the submucosal layer, represented by loose fiber and containing few elastic elements; 3) softness and suppleness of the cartilaginous framework of the lower respiratory tract, the absence of elastic tissue in them.

Nose and nasopharyngeal space small size, the nasal cavity is low and narrow 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 the age of 8-9, so nosebleeds in young children are rare and are caused by pathological conditions.

Paranasal sinuses only the maxillary sinuses are formed; frontal and ethmoid are open protrusions of the mucosa, formed in the form of cavities only after 2 years, the main sinus is absent. Completely all the paranasal sinuses develop by the age of 12-15, however, sinusitis can also develop in children of the first two years of life.

Nasolacrimal duct. Short, its valves are underdeveloped, the outlet is located close to the corner of the eyelids.

Pharynx relatively wide, the palatine tonsils are clearly visible at birth, their crypts and vessels are poorly developed, which 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 is often hyperplastic, especially in children with diathesis. Their barrier function at this age is low, like that of the lymph nodes.

Epiglottis. In newborns, it is relatively short and wide. The incorrect position and softness of its cartilage can cause a functional narrowing of the entrance to the larynx and the appearance of noisy (stridor) breathing.

Larynx is higher than in adults, lowers with age, very mobile. Its position is changeable even in the same patient. It has a funnel-shaped shape with a distinct narrowing in the region of the subglottic space, limited by the rigid cricoid cartilage. The diameter of the larynx in this place in a newborn is only 4 mm and increases slowly (6–7 mm at 5–7 years, 1 cm by 14 years), its expansion is impossible. The thyroid cartilages form an obtuse angle in young children, which after 3 years becomes more acute in boys. From the age of 10, the male larynx is formed. The true vocal cords in children are shorter, which explains the height and timbre of the child's voice.

Trachea. In children of the first months of life, the trachea 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 and VI cervical vertebrae, respectively), 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 old). 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 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.

The bronchial tree birth is formed. With growth, the number of branches does not change. They are based on cartilaginous semirings that do not have a closing elastic plate, connected by a fibrous membrane. 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 and trachea are lined with a cylindrical epithelium, the ciliated apparatus of which is formed after the birth of a child. Bronchial motility is insufficient due to underdevelopment 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 young child.

Lungs have a segmental structure. The structural unit is the acinus, but the terminal bronchioles end not in a cluster of alveoli, as in an adult, but in a sac. 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 also increases (0.05 mm in a newborn, 0.12 mm in 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 surfactant deficiency. It is this deficiency that leads to insufficient expansion of the lungs in preterm infants after birth (physiological atelectasis), and also underlies respiratory distress syndrome, which is clinically manifested by severe DN.

Pleural cavity easily extensible due to weak attachment of parietal sheets. The visceral pleura, especially relatively thick, loose, folded, contains villi, most pronounced in the sinuses and interlobar grooves. In these areas, there are conditions for a more rapid emergence of infectious foci.

The root of the lung. Consists of large bronchi, vessels and lymph nodes. The root is an integral part of the mediastinum. The latter is characterized by easy displacement and is often the site of the development of inflammatory foci.

Diaphragm. In connection with the characteristics of the chest, the diaphragm plays an important role in the mechanism of breathing in a small child, providing a depth of inspiration. The weakness of its contractions explains the shallow breathing of the newborn.

Main functional features: 1) the depth of breathing, the absolute and relative volumes of the respiratory act are 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. It compensates for the small volume of the respiratory act. Rhythm instability and short apnea in newborns are associated with incomplete differentiation of the respiratory center;

3) gas exchange 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 is disturbed very quickly due to insufficient lung excursions and expansion of the alveoli. Tissue respiration is carried out at higher energy costs than in adults, and is easily disturbed with the formation of metabolic acidosis due to the instability of enzyme systems.

The respiratory organs are in close connection with the circulatory system. They enrich the blood with oxygen, which is necessary for oxidative processes occurring in all tissues.

Tissue respiration, that is, the use of oxygen directly from the blood, occurs even in the prenatal period, along with the development of the fetus, and external respiration, that is, the exchange of gases in the lungs, begins in the newborn after cutting the umbilical cord.

What is the mechanism of respiration?

With each breath, the chest expands. The air pressure in it decreases and, according to the laws of physics, the outside air enters the lungs, filling the rarefied space formed here. When you exhale, the chest shrinks and the air from the lungs rushes out. The chest is set in motion due to the work of the intercostal muscles and the diaphragm (abdominal obstruction).

The act of breathing is controlled by the center of breathing. It is located in the medulla oblongata. Carbonic acid accumulated in the blood serves as an irritant of the respiratory center. Inhalation is replaced by exhalation reflexively (unconsciously). But the higher department, the cerebral cortex, also takes part in the regulation of respiration; by an effort of will, you can hold your breath for a short time or make it more frequent, deeper.

The so-called airways, that is, the nasal cavities, larynx, bronchi, are relatively narrow in a child. The mucous membrane is tender. It has a dense network of the thinnest vessels (capillaries), easily inflames, swells; this leads to the exclusion of breathing through the nose.

Meanwhile, nasal breathing is very important. It warms, moisturizes and cleans (which helps to preserve tooth enamel) the air passing into the lungs, irritates the nerve endings that affect the stretching of the bronchi and pulmonary vesicles.

Increased metabolism and, in connection with this, an increased need for oxygen and active motor activity lead to an increase in the vital capacity of the lungs (the amount of air that can be exhaled after a maximum breath).

In a three-year-old child, the vital capacity of the lungs is close to 500 cubic cm; by the age of 7 it doubles, by 10 it triples, and by 13 it quadruples.

Due to the fact that the volume of air in the airways in children is less than in adults, and the need for oxidative processes is great, the child has to breathe more often.

The number of respiratory movements per minute in a newborn is 45-40, in a one-year-old - 30, in a six-year-old - 20, in a ten-year-old - 18. Physically trained people have a lower respiratory rate at rest. This is because they have deeper breathing. and the oxygen utilization rate is higher.

Hygiene and airway training

It is necessary to pay serious attention to the respiratory hygiene of children, in particular to hardening and accustoming to nasal breathing.

The respiratory tract is divided into three sections: upper (nose, pharynx), middle (larynx, trachea, bronchi), lower (bronchioles, alveoli). By the time of the birth of a child, their morphological structure is still imperfect, with which the functional features of breathing are also associated. F The formation of the respiratory organs ends on average before the age of 7, and then only their sizes increase. All airways in children are much smaller and narrower than in adults. The mucous membrane is thinner, more delicate, easily damaged. The glands are underdeveloped, the production of IgA and surfactant is negligible. The submucosal layer is loose, contains a small amount of elastic and connective tissue elements, many are vascularized. The cartilaginous framework of the airways is soft and supple. This contributes to a decrease in the barrier function of the mucous membrane, easier penetration of infectious and atopic agents into the bloodstream, and the appearance of prerequisites for the narrowing of the airways due to edema.

Another feature of the respiratory organs in children is that in young children they are small in size. The nasal passages are narrow, the shells are thick (the lower ones develop before the age of 4), so even slight hyperemia and swelling of the mucous membrane predetermine the obstruction of the nasal passages, cause shortness of breath, and make sucking difficult. From the paranasal sinuses, by the time of birth, only the maxillary sinuses are formed (they develop up to 7 years of life). The ethmoidal, sphenoidal, and two frontal sinuses complete their development before the age of 12, 15, and 20 years, respectively.

The nasolacrimal duct is short, located close to the corner of the eye, its valves are underdeveloped, so the infection easily penetrates from the nose into the conjunctival sac.

The pharynx is relatively wide and small. The Eustachian (auditory) tubes, which connect the nasopharynx and the tympanic cavity, are short, wide, straight, and horizontal, making it easier for infection to pass from the nose to the middle ear. In the pharynx there is the Waldeer-Pirogov lymphoid ring, which includes 6 tonsils: 2 palatine, 2 tubal, 1 nasopharyngeal and 1 lingual. When examining the oropharynx, the term "pharynx" is used. The pharynx is an anatomical formation surrounded below by the root of the tongue, on the sides by the palatine tonsils and brackets, at the top by the soft palate and uvula, behind by the posterior wall of the oropharynx, and in front by the oral cavity.

The epiglottis in newborns is relatively short and wide, which can cause functional narrowing of the entrance to the larynx and the occurrence of stridor breathing.

The larynx in children is located higher and longer than in adults, has a funnel-shaped shape with a clear narrowing in the region of the subglottic space (4 mm in a newborn), which gradually expands (up to 1 cm at the age of 14). The glottis is narrow, its muscles get tired easily. The vocal cords are thick, short, the mucous membrane is very delicate, friable, significantly vascularized, rich in lymphoid tissue, easily leads to submucosal edema in respiratory infections and the occurrence of croup syndrome.

The trachea is relatively longer and wider, funnel-shaped, contains 15-20 cartilaginous rings, is very mobile. The walls of the trachea are soft and collapse easily. The mucous membrane is tender, dry, well vascularized.

By the time of birth formed. The dimensions of the bronchi increase intensively in the 1st year of life and in adolescence. they are also formed by cartilaginous semicircles, which in early childhood do not have end plates connected by a fibrous membrane. Bronchial cartilage is very elastic, soft, easily displaced. The bronchi in children are relatively wide, the right main bronchus is almost a direct continuation of the trachea, so foreign objects often find themselves in it. The smallest bronchi are characterized by absolute narrowness, which explains the occurrence of obstructive syndrome in young children. The mucous membrane of the large bronchi is covered with ciliated ciliated epithelium, which performs the function of bronchial cleansing (mucociliary clearance). Incomplete myelination of the vagus nerve and underdevelopment of the respiratory muscles contribute to the absence of a cough reflex in young children or a very weak cough impulse. The mucus accumulated in the small bronchi easily clogs them and leads to atelectasis and infection of the lung tissue.

Lungs in children, as in adults, have a segmental structure. The segments are separated from each other by thin connective tissue septa. The main structural unit of the lung is the acinus, but its terminal bronchioles end not with a brush of alveoli, as in adults, but with a sac (sacculus), with the “lace” edges of which new alveoli are gradually formed, the number of which in newborns is 3 times less than in adults. With age, the diameter of each alveolus also increases. In parallel, the vital capacity of the lungs increases. The interstitial tissue of the lungs is loose, rich in blood vessels, fiber, contains little connective tissue and elastic fibers. In this regard, the lung tissue in children of the first years of life is more saturated with blood, less airy. Underdevelopment of the elastic framework leads to emphysema and atelectasis. The tendency to atelectasis also occurs due to a deficiency of surfactant - a film that regulates the surface alveolar tension and stabilizes the volume of the terminal air spaces, i.e. alveoli. Surfactant is synthesized by type II alveolocytes and appears in a fetus weighing at least 500-1000 g. The lower the gestational age of the child, the greater the deficiency of surfactant. It is the deficiency of surfactant that forms the basis of insufficient expansion of the lungs in premature infants and the occurrence of respiratory distress syndrome.

The main functional physiological features of the respiratory organs in children are as follows. Breathing in children is frequent (which compensates for the small volume of breathing) and superficial. The frequency is higher the younger the child (physiological dyspnea). A newborn breathes 40-50 times per minute, a child aged 1 year - 35-30 times in 1 minute, 3 years - 30-26 times in 1 minute, 7 years - 20-25 times in 1 minute, at 12 years old - 18-20 times in 1 minute, adults - 12-14 times in 1 min. Acceleration or deceleration of respiration is noted when the respiration rate deviates from the average by 30-40% or more. In newborns, breathing is irregular with short stops (apnea). The diaphragmatic type of breathing predominates, from 1-2 years of age it is mixed, from 7-8 years of age - in girls - chest, in boys - abdominal. The respiratory volume of the lungs is the smaller, the younger the child. Minute respiratory volume also increases with age.. However, this indicator relative to body weight in newborns is 2-3 times higher than in adults. The vital capacity of the lungs in children is significantly lower than in adults. Gas exchange in children is more intense due to the rich vascularization of the lungs, high blood circulation rate, and high diffusion capabilities.

About 70% of diseases characteristic of childhood are due to a violation of the normal functioning of the respiratory system. They are involved in passing air through the lungs, while preventing the entry of pathogenic microorganisms into them and the further development of the inflammatory process. At the slightest failure in the full functioning of the respiratory organs, the entire body suffers.

Photo: Respiratory organs

Features of the respiratory system in childhood

Respiratory diseases in children occur with some features. This is due to a number of factors:

narrowness of the nasal passages and glottis;
insufficient depth and increased respiratory rate;
low airiness and increased lung density;
underdevelopment of the respiratory muscles;
unstable respiratory rhythm;
tenderness of the nasal mucosa (rich in blood vessels and swells easily).

Photo: Respiratory muscles

Mature respiratory system becomes no earlier than 14 years. Up to this point, pathologies related to it should be given increased attention. Detection of diseases of the respiratory system should occur in a timely manner, which increases the chances of a speedy cure, bypassing complications.

Causes of diseases

The child's respiratory organs are often exposed. Most often, pathological processes develop under the influence of activation of staphylococci and streptococci. Allergies often lead to respiratory problems.

Among the disposing factors are not only the anatomical features of the respiratory system in childhood, but also an unfavorable external environment, hypovitaminosis. Modern children with noticeable regularity do not follow the daily routine and eat improperly, which affects the body's defenses and subsequently leads to diseases. The lack of hardening procedures can aggravate the situation.

Photo: Activation of staphylococci is the cause of the disease

Symptoms

Despite the existence of signs characteristic of each individual disease of the respiratory system of a child, doctors distinguish common ones:

(mandatory symptom, a kind of protective reaction of the body);
dyspnea(indicates a lack of oxygen);
sputum(special mucus produced in response to the presence of irritants);
nasal discharge(can be of different colors and textures);
labored breathing;
temperature rise(this also includes general intoxication of the body, which is a set of biological reactions of the body to infection).

Photo: Phlegm

Diseases of the respiratory system are divided into two groups. The first affect the upper respiratory tract (URT), the second - the lower sections (LRT). In general, it is not difficult to determine the onset of one of the respiratory diseases in a child, especially if a doctor takes up the work. With the help of a special device, the doctor will listen to the child and perform an examination. If the clinical picture is blurred, a detailed examination will be required.

Photo: Examination of a child by a doctor

Diseases of the upper respiratory tract

Viruses and bacteria can lead to pathologies. It is known that the presented group of diseases is one of the frequent reasons for the child's parents to visit a pediatrician.

According to statistical data, a child of preschool and primary school age can suffer from 6 to 10 episodes of violations of the VRT per year.

Inflammation of the nasal mucosa due to a viral infection. The impetus for the development of rhinitis can be a banal hypothermia, as a result of which it reduces the body's defenses.

Photo: Rhinitis

Acute rhinitis can be a symptom of an acute infectious disease or manifest itself as an independent pathology.

Photo: Lower respiratory tract

As an independent disease, tracheitis is extremely rare.

Photo: Breathing exercises

Can trouble be prevented?

Any respiratory disease can be prevented. To this end, it is necessary to temper the child's body, regularly take walks with him in the fresh air, and always dress according to the weather. It is very important to avoid hypothermia and wet feet. In the off-season, the health of the child should be maintained with vitamin complexes.

At the first sign of discomfort, you should contact a specialist.

Photo: At the doctor's appointment

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 is concentrated a large number 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 structure 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.