Stridor
Learn about causes,
symptoms, and treatments
for stridor in children.
Learn about causes, symptoms, and treatments for stridor in children. Discover when to see a pediatric ENT specialist for noisy breathing.
What is Stridor?
Stridor is a high-pitched, noisy breathing sound that occurs due to a partial blockage or narrowing in the upper airway. It is most noticeable when a child breathes in (inspiration) but can also occur during exhalation or both. Stridor is not a disease, but a sign of an underlying airway issue that may require evaluation by a pediatric ear, nose, and throat (ENT) specialist.
Types of Stridor
- Inspiratory Stridor:
Occurs during inhalation – usually due to issues in the larynx or above (e.g., laryngomalacia). - Expiratory Stridor:
Occurs during exhalation – typically from intrathoracic airway obstruction (e.g., tracheomalacia). - Biphasic Stridor:
Heard during both inspiration and expiration – may indicate a fixed obstruction near the vocal cords or subglottis.
Common Causes of Stridor in Children
Newborns & Infants
- Laryngomalacia (most common cause)
- Vocal cord paralysis
- Subglottic stenosis
- Tracheomalacia
- Congenital anomalies (e.g., laryngeal web, vascular rings)
Toddlers & Older Children
- Croup (viral infection causing swelling of the airway)
- Foreign body aspiration
- Recurrent respiratory papillomatosis
- Post-intubation injury
- Allergic reactions or infections (e.g., epiglottitis)
Signs and Symptoms of Stridor
- Noisy, high-pitched breathing
- Retractions (pulling in of the chest or neck muscles during breathing)
- Difficulty feeding or poor weight gain
- Choking, coughing, or noisy breathing during feeding
- Voice changes or hoarseness
- Cyanosis (bluish skin around lips and mouth – medical emergency)
- Symptoms worsen with crying, agitation, or lying flat
How is Stridor Diagnosed?
Evaluation involves a combination of clinical assessment and diagnostic procedures:
History & Physical Exam
- Onset and timing of symptoms
- Positioning impact (e.g., worse when lying down)
- Associated feeding or respiratory issues
Flexible Fiberoptic Laryngoscopy
- A quick, well-tolerated procedure to look at the airway using a tiny camera.
- Allows real-time assessment of vocal cords and laryngeal structures.
Imaging Tests
- X-rays, CT scans, or MRI may be needed for deeper airway concerns or structural abnormalities.
Swallow studies or sleep studies
- May be performed if aspiration or obstructive sleep apnea is suspected.
Treatment Options for Stridor
Treatment depends on the underlying cause and severity of the stridor.
Mild or Intermittent Stridor
- Often monitored closely.
Medical Management
- Acid reflux management (GERD) if contributing to airway irritation
- Steroids or nebulized medications for inflammation (e.g., in croup)
Surgical Intervention
- Procedures like supraglottoplasty for laryngomalacia
- Foreign body removal
- Tracheostomy or airway reconstruction for severe obstruction
When to See a Specialist
You should seek evaluation by a pediatric ENT specialist if your child has:
- Persistent noisy breathing or stridor
- Feeding difficulties or poor growth
- Signs of airway distress (e.g., labored breathing, cyanosis)
- Recurrent croup or episodes of breathing difficulty
- Stridor that worsens with activity or infections
Related Links
Laryngomalacia
Learn about laryngomalacia (Floppy Voice Box).
Tracheomalacia
Noisy breathing or a barky cough? Learn about tracheomalacia, its causes, and advanced treatment options.
Subglottic and Tracheal Stenosis
Discover expert care for subglottic and tracheal stenosis in children.