Etiology, Clinical Features, and Management of Stridor in Children

Introduction

Stridor is a high-pitched, noisy breathing sound resulting from turbulent airflow through a narrowed upper airway. It is a critical symptom in pediatric patients that requires prompt evaluation and management.

Etiology of Stridor

Stridor can be caused by various conditions affecting the upper airway. The most common etiologies include:

• Congenital Causes: Laryngomalacia, vocal cord paralysis, subglottic stenosis
• Infectious Causes: Croup, epiglottitis, bacterial tracheitis
• Inflammatory Causes: Allergic reactions, anaphylaxis
• Traumatic Causes: Foreign body aspiration, post-intubation injury

Clinical Features

The presentation of stridor varies depending on the underlying cause. Key clinical features include:

• Inspiratory Stridor: Suggests upper airway obstruction (e.g., laryngomalacia, croup)
• Expiratory Stridor: Indicates lower airway involvement (e.g., tracheomalacia)
• Biphasic Stridor: Seen in fixed airway obstructions (e.g., subglottic stenosis)
• Associated Symptoms: Fever, drooling, cyanosis, respiratory distress

Differential Diagnosis – Common Conditions Mimicking Stridor

Several conditions can mimic stridor, making accurate diagnosis essential:

• Asthma: Presents with wheezing rather than stridor
• Bronchiolitis: Characterized by diffuse wheezing and crackles
• Vocal Cord Dysfunction: Often mistaken for asthma, but lacks true airway obstruction
• Foreign Body Aspiration: Sudden onset respiratory distress, often unilateral wheezing

Management of Stridor

Management depends on the severity and underlying cause:

Emergency Management

• Ensure airway patency and oxygenation
• Administer nebulized epinephrine for croup
• Intubation or tracheostomy for severe obstruction

Medical Treatment

• Corticosteroids for inflammatory causes
• Antibiotics for bacterial infections
• Antihistamines and epinephrine for allergic reactions

Surgical Interventions

• Endoscopic removal of foreign bodies
• Tracheostomy for chronic airway obstruction
• Surgical correction for congenital anomalies

Conclusion

Stridor in children is a serious symptom that requires careful evaluation and prompt management. Understanding its etiology, clinical features, and differential diagnoses helps in providing effective treatment and ensuring optimal patient outcomes.