Children with neurodisability (ND) have an increased susceptibility to respiratory problems.
Children with ND often present with acute respiratory failure due to infection.
Exacerbating physiological impairments, like aspiration, reflux and epilepsy, are more common and should be identified and treated.
Acutely, the child with ND in respiratory distress should be assessed using the usual ABC approach paying particular attention to obstructed airway, poor secretion management and whether usual non-invasive ventilation is tolerated, with escalation to paediatric intensive care unit (PICU)/high dependency unit (HDU) where appropriate.
A multidisciplinary, holistic, ethical approach, placing the child in context of the family is important.
In the outpatient setting, management should be tailored to identify physiological deficits and to mitigate exacerbating factors.
Advanced care directives and pre-agreed access plans to acute paediatric services should be discussed where appropriate.
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