Stridor in children is a high-pitched, harsh sound that occurs when airflow is disrupted in the upper airway. It is a symptom, not a condition, and needs prompt evaluation. In this guide, we’ll explore what stridor is, its types, its causes, and how to treat it effectively in children. Let’s dive into this topic to help you better understand and approach this condition.
What is Stridor?
Stridor is a high-pitched, wheezing-like sound that occurs when airflow is partially blocked in your child’s upper airway. It often sounds harsh and can be alarming. Stridor is most noticeable when a child breathes in, but it can also happen when they breathe out.
This condition typically signals a problem with the throat, voice box (larynx), or windpipe (trachea). Stridors can occur suddenly or develop over time, depending on the underlying cause. Since it’s linked to airway obstruction, prompt medical attention is often necessary to determine its severity and treatment.
Stridor is more common in infants and young children because their airways are smaller and more sensitive to swelling. Understanding the causes and recognizing the sound of stridor is key to helping your child get the right care.
Key Characteristics:
- Sound: High-pitched, harsh, or musical.
- Timing: More noticeable during inhalation (inspiratory stridor), exhalation (expiratory stridor), or both (biphasic stridor).
- Cause: Indicates a potential airway blockage or narrowing.
If you suspect stridor, consult your pediatrician right away. Early diagnosis and treatment can prevent complications and improve your child’s breathing.
Read More: How to Choose the Right Stethoscope for Your Medical Practice
Causes of Stridor in Children
Several conditions can cause stridor, ranging from infections to structural abnormalities. Here are the common causes:
| Cause | Description |
| Croup | Viral infection causes swelling in the airway. |
| Foreign Object Aspiration | Objects blocking the airway, like toys or food. |
| Epiglottitis | A severe bacterial infection causes airway inflammation. |
| Laryngomalacia | A congenital condition where the larynx is floppy and collapses during breathing. |
| Allergic Reactions | Swelling of the airway due to allergens. |
Types of Stridor
Stridor is a high-pitched, wheezing sound caused by disrupted airflow in the upper airway. It is usually classified into types based on the timing during respiration and the underlying cause. Here are the main types of stridor:
1. Inspiratory Stridor
- Description: Occurs during inhalation.
- Cause: Often associated with obstructions in the upper airway, such as the larynx (voice box) or above.
- Common Conditions:
- Laryngomalacia
- Vocal cord paralysis
- Acute epiglottitis
- Croup (laryngotracheobronchitis)
2. Expiratory Stridor
- Description: Occurs during exhalation.
- Cause: Typically linked to obstructions in the lower trachea or bronchi.
- Common Conditions:
- Tracheomalacia
- Foreign bodies in the lower airway
- Bronchial obstruction
3. Biphasic Stridor
- Description: Present during both inhalation and exhalation.
- Cause: Suggests a fixed obstruction or severe narrowing at the level of the glottis, subglottis, or upper trachea.
- Common Conditions:
- Subglottic stenosis
- Vocal cord abnormalities
- Tracheal tumors or masses
4. Congenital Stridor
- Description: Present from birth or early infancy.
- Cause: Often due to congenital anomalies affecting the airway.
- Common Conditions:
- Laryngomalacia (most common)
- Congenital subglottic stenosis
- Vascular rings or slings
5. Acquired Stridor
- Description: Develops later in life due to an illness, trauma, or other conditions.
- Cause: May result from infection, injury, or inhalation of foreign bodies.
- Common Conditions:
- Croup
- Tumors
- Post-intubation injury
6. Intermittent Stridor
- Description: Occurs only at specific times or with certain triggers.
- Cause: Often linked to functional or positional issues.
- Common Conditions:
- Gastroesophageal reflux disease (GERD) affecting the airway
- Positional laryngomalacia
Clinical Importance
The type of stridor provides critical information for identifying the location and cause of the airway obstruction. Immediate medical evaluation is essential, especially for acute or severe stridor, as it may indicate life-threatening conditions like epiglottitis or anaphylaxis.
Stridor vs. Wheezing
Stridor and wheezing are often confused but differ significantly:
| Feature | Stridor | Wheezing |
| Sound Location | Upper airway | Lower airway (lungs) |
| Timing | Often during inhalation | Often during exhalation |
| Pitch | High-pitched, harsh | Whistling or musical |
Approach to Stridor in Children
Proper assessment is key to managing stridor. Here’s an outline for approaching this condition:
- History: Understand the onset, triggers, and associated symptoms like fever or difficulty swallowing.
- Physical Examination: Listen for stridor sound using a stethoscope. Check for associated signs like cyanosis or drooling.
- Diagnostic Tests: Use imaging (X-ray, CT) or laryngoscopy to confirm the cause.
How to Treat Stridor in Infants and Children
Treatment depends on the severity and underlying cause. Here are common methods:
| Condition | Treatment |
| Croup | Steroids and humidified air to reduce airway swelling. |
| Foreign Object | Immediate removal by a healthcare provider. |
| Epiglottitis | Hospitalization, antibiotics, and airway management. |
| Laryngomalacia | Surgery in severe cases; most mild cases resolve with age. |
| Allergic Reaction | Administer antihistamines or epinephrine for severe cases. |
Treatment for Stridor in Adults
Treatment for stridor in adults focuses on addressing the underlying cause of the airway obstruction. Since stridor can range from mild to life-threatening, the treatment approach depends on the severity and the specific condition causing it. Here are the common treatment options:
1. Emergency Management
- Acute Stridor (Severe/Life-threatening)
- Oxygen Therapy: Administer supplemental oxygen to ensure adequate oxygenation.
- Airway Stabilization:
- Intubation: In cases of severe obstruction where the airway is compromised.
- Tracheostomy: If intubation fails or the obstruction is below the vocal cords.
- Medications:
- Epinephrine Nebulization: For swelling (e.g., anaphylaxis or croup-like symptoms).
- Corticosteroids: To reduce inflammation and edema (e.g., dexamethasone or prednisone).
- Antihistamines or epinephrine injection for anaphylaxis.
2. Treatment Based on Underlying Cause
a. Infections
- Croup or Epiglottitis:
- Corticosteroids to reduce inflammation.
- Antibiotics for bacterial infections.
- Hospitalization for severe cases to monitor the airway.
- Laryngeal or Tracheal Infections:
- Broad-spectrum antibiotics.
- Antiviral therapy if indicated.
b. Vocal Cord Paralysis
- Speech therapy to improve vocal cord function.
- Surgery:
- Medialization procedures (e.g., thyroplasty).
- Reinnervation techniques for long-term correction.
c. Allergic Reactions (Anaphylaxis)
- Intramuscular epinephrine.
- Antihistamines and corticosteroids.
- Observation in a medical setting for rebound symptoms.
d. Foreign Body Aspiration
- Rigid or flexible bronchoscopy to remove the foreign object.
e. Structural Abnormalities
- Laryngomalacia or Tracheomalacia:
- Continuous positive airway pressure (CPAP) therapy for mild cases.
- Surgical intervention (e.g., supraglottoplasty or tracheoplasty) for severe cases.
- Subglottic Stenosis:
- Balloon dilation to widen the airway.
- Surgical resection or reconstruction.
f. Tumors or Masses
- Benign Tumors:
- Laser surgery or excision.
- Malignant Tumors:
- Radiation therapy, chemotherapy, or surgical removal.
g. Gastroesophageal Reflux Disease (GERD)
- Proton pump inhibitors (PPIs) or H2 blockers.
- Lifestyle changes to reduce reflux symptoms.
- Surgical interventions (e.g., fundoplication) in severe cases.
3. Long-term Monitoring and Rehabilitation
- Regular follow-ups with an otolaryngologist (ENT specialist).
- Pulmonary function tests for recurrent or chronic cases.
- Voice therapy for vocal cord-related issues.
4. Lifestyle and Home Management
- Avoid allergens or irritants that may trigger airway inflammation.
- Stay hydrated to keep mucus membranes moist.
- Use a humidifier to alleviate dryness in the airway.
Conclusion
Auscultation of stridor in children plays a vital role in diagnosing the problem. By understanding the types, causes, and treatments, you can take the right steps to help your child. If you notice stridor, consult a healthcare provider immediately. Early intervention can prevent complications and ensure your child’s safety.
