18: Shayma

You are on placement with the health visitor. Three-month-old Shayma is brought to the baby weight clinic by her mother. Shayma’s mother reports that she has been ‘snuffly’ for a couple of days and has not been feeding as well as normal. Shayma is breathing quickly and when she is undressed, you notice that she is drawing in her ribcage. Shayma is also making a ‘grunting’ noise.

  • Who should you contact to make an assessment of Shayma?
  • What observations should you carry out?
  • What other information might be useful to gather from Shayma’s mother?

› Suggested answers

  • Who should you contact to make an assessment of Shayma?

Shayma needs to be assessed by a medical professional. In the community, this would most likely be the on-call GP.

  • What observations should you carry out?

NICE guidelines state that pulse oximetry (oxygen saturation) should be carried out on all children where bronchiolitis is suspected. A respiratory rate and temperature should also be taken. Visual observation of Shayma’s work of breathing should be carried out, observing for nasal flaring, chest recession, tracheal tug, head bobbing, etc., which indicates the severity of respiratory distress.

  • What other information might be useful to gather from Shayma’s mother?

Shayma’s mother has already indicated that she is not feeding as well as normal, so it would be useful to know when she last fed, how much feed she has taken each feed since becoming unwell and when she last had a wet nappy. Young children are at high risk of dehydration when they are unwell.