CONDITIONS PRESENTING WITH STRIDOR IN CHILDREN

Stridor is a harsh sound heard during inspiration when there is narrowing of the upper airways, including oropharynx, subglottis, larynx, and trachea.

Conditions presenting with stridor include:

  • Viral croup including that due to measles
  • Retropharyngeal abscess
  • Foreign body inhalation
  • Diphtheria
  • Pressure on the airways by masses in the neck or mediastinum
  • Congenital laryngeal anomaly

Clinical Features

  • Viral croup: Barking cough, hoarse voice, respiratory distress if obstruction is severe (tachypnoea, supraclavicular, suprasternal, subcostal and intercostal inspiratory retractions, cyanosis). Fever in 50% of children. Signs of measles if it is the cause.
  • Retropharyngeal abscess: Swelling in the neck, difficulty in swallowing, drooling, fever.
  • Foreign body: History of choking, sudden onset of respiratory distress.
  • Diphtheria: Severe neck swelling, membrane on throat and tonsils.
  • Congenital anomaly: Stridor from birth.
  • Pressure on airways: Obvious masses in neck or mediastinum on x-ray.

Management

  • Mild croup can be treated at home. Encourage adequate intake of fluids and feeding according to age.
  • Ask the mother to bring child back immediately she notices difficulty in breathing or feeding
  • Foreign body: This may be life threatening if main airway is blocked. Action should be immediate if the child is to survive.
  • Severe cases will need care in an intensive care unit:
    • Be prepared for intubation and/or tracheostomy
    • Administer O2
    • Nasotracheal intubation if signs of severe obstruction occur: Severe chest indrawing, agitation, anxiety (air-hunger) and cyanosis
    • Tracheostomy may be done if intubation is impossible.