Respiratory dysfunction is seen in some children with cervical-level lesions. Use of ventilators may be necessary either during the night or full time. Even in those with no need for early ventilator support, respiratory difficulty may develop due to increasing spasticity of abdominal muscles or muscular fatigue. When children present with respiratory difficulty, attention must be paid to pulmonary toilet, use of assistive devices, and the presence of previous respiratory difficulties or progression of respiratory difficulties. Impaired motor control may result in reflux and aspiration, which may contribute to the difficulties being experienced. Pulmonary consultation, if available, may allow the emergency physician to adjust the ventilator and prevent hospitalization. Children with phrenic nerve stimulators may need to be hospitalized for management.
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