Child with Stridor
Lesson Objectives
By the end of this lesson, learners should be able to:
-
Define stridor and describe its pathophysiology.
-
Identify the common causes of stridor in children.
-
Recognize the signs and symptoms of viral croup, acute epiglottitis, and foreign body inhalation.
-
Assess severity of croup and determine the appropriate level of care.
-
Describe supportive and pharmacological management for each condition.
-
Demonstrate emergency first aid for choking in infants and older children.
-
Identify referral criteria for advanced care.
Description
Stridor is a high-pitched sound produced during inspiration due to narrowing of the airway from the oropharynx, glottis, or trachea. It indicates partial upper airway obstruction. Common causes include viral croup, foreign body inhalation, acute epiglottitis, congenital anomalies in neonates, anaphylaxis, burns, retropharyngeal abscess, and laryngeal papilloma.
Causes of Stridor
| Cause | Typical Age/Notes |
|---|---|
| Viral Croup | Toddlers 1–3 years; inflammation in laryngeal region |
| Acute Epiglottitis | Usually children under 5; Hib vaccine has reduced incidence |
| Foreign Body Inhalation | All ages; commonly lodges in right main bronchus |
| Congenital anomalies | Neonates |
| Other causes | Anaphylaxis, burns, retropharyngeal abscess, laryngeal papilloma |
Viral Croup (Laryngotracheobronchitis)
Signs and Symptoms:
-
Sudden inspiratory stridor, worsens when agitated
-
Low-grade fever, coryzal symptoms
-
Barking cough
-
Hoarseness
-
Pain in the larynx
-
Resolves usually within 3–4 days
Investigations:
-
Clinical diagnosis
-
Neck X-ray only if diagnosis uncertain
Assessment of Severity:
| Sign | Mild Croup | Moderate Croup | Severe Croup |
|---|---|---|---|
| Stridor | Only when agitated | At rest | Severe, inspiratory and expiratory |
| Recession | Mild subcostal | Moderate tracheal tug | Use of accessory muscles |
| Level of consciousness | Restless when disturbed | Anxious, agitated | Lethargic, drowsy |
Treatment:
Supportive:
-
Mild: Home care, steam inhalation; antibiotics NOT required
-
Moderate: Calm child on parent’s lap, minimal handling, defer cannulation
-
Severe: Admit to hospital; oxygen via nasal prongs for chest in-drawing
Pharmacological:
| Severity | Medication |
|---|---|
| Mild/Moderate | Prednisone oral 2 mg/kg single dose (max 20–40 mg/day depending on age) OR Dexamethasone 0.6 mg/kg stat |
| Severe | Dexamethasone 0.6 mg/kg daily in 1–2 divided doses AND Nebulized Adrenaline 1:1000, 0.4 ml/kg stat (repeat 15–30 min if needed) |
| All | Paracetamol 10–15 mg/kg every 4 hours; injectable Dexamethasone can be used if tablets unavailable |
Acute Epiglottitis
Signs and Symptoms:
-
Sore throat, difficulty speaking
-
Difficulty breathing, stridor
-
Fever, drooling, difficulty swallowing
-
Prefers tripod position
Treatment:
Supportive:
-
Keep child calm in seated/leaning forward (tripod) position
-
Provide humidified oxygen
-
Avoid supine position and throat examination
-
Elective intubation or tracheostomy if severe obstruction
Pharmacological:
-
IV Ceftriaxone 80 mg/kg once daily for 5 days
-
Paracetamol 15 mg/kg 6-hourly orally or Ibuprofen 10 mg/kg 8-hourly when airway is secure
Foreign Body Inhalation
Signs and Symptoms:
-
Sudden choking, stridor, cough, acute/persistent wheeze
-
Tracheal tug, use of accessory muscles
-
Can cause lobar collapse or consolidation
Investigations:
-
Clinical suspicion
-
Chest X-ray (full expiration), CT if X-ray inconclusive
Emergency First Aid:
Infants (<1 year):
-
Head-down on arm/thigh
-
5 back slaps, then 5 chest thrusts if obstruction persists
-
Remove visible obstruction
Older Children (>1 year):
-
Back blows while sitting/kneeling
-
Heimlich maneuver: 5 abdominal thrusts, check mouth, repeat if necessary
Post-Obstruction Care:
-
Ensure airway patency, maintain open airway, monitor recovery
Referral Criteria:
-
Hospital referral for imaging and bronchoscopy
Do you want me to continue immediately with Common Cold next?