A parent rushes their 3-year-old child to the emergency department with an asthma exacerbation. Which additional finding should alert the nurse that the child is in acute respiratory distress?

A. Flaring of the nares: Nasal flaring is a classic sign of increased work of breathing in young children and indicates that the child is experiencing significant respiratory distress. This compensatory mechanism helps increase airway intake of oxygen. B. Bilateral bronchial breath sounds: While bronchial breath sounds may be present in some respiratory conditions, their presence alone does not indicate acute distress. The focus should be on signs of increased effort and hypoxia. C. A resting respiratory rate of 35 breaths/minute: For a 3-year-old, a respiratory rate of 35 can be within the upper normal range (20–30 breaths/min) or mildly elevated, but it is not as sensitive an indicator of acute distress as nasal flaring. D. Diaphragmatic respirations: Using the diaphragm for breathing is normal in young children and does not by itself indicate respiratory compromise. Acute distress is better identified by accessory muscle use and other compensatory signs.