Respiratory Symptoms in Children — Severity Assessment

A general severity-grading framework applicable across paediatric respiratory presentations — see also bronchiolitis and croup, which use this same structure.

	Mild	Moderate	Severe
Behaviour	Normal; talks normally	Some/intermittent irritability; some limitation of talking	Increasing irritability and/or lethargy; marked limitation or inability to talk
Tachypnoea (at rest, not crying)	Normal or mildly increased respiratory rate	Increased respiratory rate	Increased or markedly reduced RR as the child tires
Work of breathing (retraction, paradoxical abdominal breathing, accessory muscle use, nasal flaring, head bobbing, forward posture)	None or minimal	Moderate retraction and/or accessory muscle use	Marked accessory muscle use with prominent chest retraction
Oxygenation	—	—	SpO₂ <90% (room air); any oxygen requirement in croup is classed as severe; cyanosis
Heart rate	Normal or slight increase	Mildly increased	Significantly increased, or bradycardia
Blood pressure	Normal	Increased	Increased, or decreased (a late sign)

Oxygenation is of limited use alone for judging severity in many paediatric respiratory conditions — don’t fixate on the SpO₂ monitor; weigh it alongside the other signs above.