Stridor in Children: Croup Is Not the Only Cause

Stridor is a high-pitched sound that is caused by a disrupted airflow. It is a sign of an upper airway obstruction that affects children more than adults. A disrupted airflow is caused by a blockage in the voice box (larynx) or windpipe (trachea). Stridor is most noticeable during inhalation, but sometimes, it can also be heard when breathing out. It is not a diagnosis; it is more of a symptom. Thus, it is very important to find out the underlying cause.

Stridor begins as a low-pitched croaking sound then will progress to a high-pitched sound during vigorous respiration. Stridor usually develops in smaller airways. That is why children are most commonly affected. An upper respiratory tract infection is the most common cause of stridor in children.

Stridor is not that common in adults since the breathing tube has already become wider and firmer. However, adults with chronic stridor may indicate a serious underlying disease.

What are the Causes of Stridor in Children?

• Croup – this is the most common cause of acute stridor in children during the age of 6 months to 2 years. Stridor is commonly experienced and gets worse at night, which is characterized by a barking, seal-like cough.

• Inhaled foreign body – a common cause of stridor in children who are one to two years old. It is often preceded by coughing or choking.

• Tracheitis – this is an uncommon cause of stridor. Tracheitis usually affects children who are three years old and below. The cause of tracheitis in toddlers is mostly a bacterial infection that is followed by a viral infection.

• Anaphylaxis – it is experienced within 30 minutes of allergen exposure and is usually accompanied by other symptoms of allergic reaction. It causes inspiratory stridor and hoarseness.

• Congenital problems - can also lead to the development of stridor. The most common congenital problem that causes stridor is laryngomalacia. With this condition, stridor can be aggravated by crying, feeding, and prone position. The second most common cause is vocal cord dysfunction.

As you have seen, there are a lot of conditions that can cause stridor in children. Thus, a thorough medical history can give helpful clues to the exact cause. A physical examination can help confirm a diagnosis as well as some laboratory procedures.

Managing Stridor

The treatment for stridor depends on its cause, as the management may be different for each illness. With croup as the most common cause of stridor in children, the most important way to help ease your child’s condition is keeping your child calm and relaxed. The obstruction in the airway may be relieved when the child is calm. Crying and agitation will only exacerbate the child’s condition. Comfort your child so he/she will stay calm, especially at night.

Below are some general points in managing stridor:

• The use of corticosteroids to antibiotics can be helpful.
• Maintain a clear airway.
• If a clear airway cannot be maintained, the next step must be resuscitation procedures.
• Children with moderate to severe stridor must be kept nil by mouth.
• Tracheotomy and removal of obstructing tumors are some of the surgical procedures that can be done in severe cases.