Are grunting respirations a sign of serious bacterial infection in children?

To assess the significance of grunting respirations in children and their potential association with serious bacterial infections, and to identify characteristics unique to this patient group.

A prospective case-control design was used. Data were collected on all children who were hospitalized with grunting respirations in our department of paediatrics over a 13-month period. The enrolled patients were divided into three groups: previously healthy children aged 3 months or less, previously healthy children aged more than 3 months and children with chronic illness at any age. The findings were compared to matched controls hospitalized for similar symptoms but without grunting respirations.

Grunting respirations were documented in 149 of the 3334 admissions (4.5%) during the period of study. The incidence was higher in children aged 3 months or less (7.5%) and lower in children older than 3 months (3.9%). Fever and respiratory symptoms were common (83.9% and 65.1%, respectively). Heart rate was the only vital sign that was significantly different between the study and control groups. Serious bacterial infection occurred more frequently in the study group (31.5% vs. 14.8%, p < 0.001, OR 2.14, 95% CI 1.36-3.36). Comparisons between the groups showed that grunting respirations were a sign of serious bacterial infection in previously healthy children older than 3 months (p = 0.007, OR 1.95, 95% CI 1.21-3.13) and in children with a chronic disease of any age (p = 0.033, OR 7.0, 95% CI 1.0-49.7 respectively), but not in previously healthy children younger than 3 months (p = 1).

The incidence and importance of grunting respirations in hospitalized children depend on patient's age and previous medical status. A finding of grunting respirations in a previously healthy child aged over 3 months or in a chronically ill child should alert the physician to seek further evidence of bacterial infection, especially pneumonia.