Stridor (peds) - Revision history

Danbot: Add verified PubMed references (PMIDs 25213283, 35337541)

2026-03-22T10:49:30Z

Add verified PubMed references (PMIDs 25213283, 35337541)

← Older revision		Revision as of 10:49, 22 March 2026
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	[[File:Cross section of a trachea and esophagus.png\|thumb\|Cross section of a trachea and esophagus anatomy.]]		[[File:Cross section of a trachea and esophagus.png\|thumb\|Cross section of a trachea and esophagus anatomy.]]
	[[File:Blausen 0865 TracheaAnatomy.png\|thumb\|Tracheal anatomy.]]		[[File:Blausen 0865 TracheaAnatomy.png\|thumb\|Tracheal anatomy.]]
	*Stridor refers to harsh upper airway sounds caused by turbulent airflow through a narrowed airway		*Stridor refers to harsh upper airway sounds caused by turbulent airflow through a narrowed airway<ref>Ida JB, Thompson DM. Pediatric stridor. Otolaryngol Clin North Am. 2014 Oct;47(5):795-819. PMID 25213283</ref>
	*Classically inspiratory, indicating extrathoracic obstruction		*Classically inspiratory, indicating extrathoracic obstruction
	*Pediatric airways are particularly vulnerable due to anatomical differences:		*Pediatric airways are particularly vulnerable due to anatomical differences:
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	**More compliant airway cartilage		**More compliant airway cartilage
	**Relatively larger tongue and occiput		**Relatively larger tongue and occiput
	*Croup is the most common cause of acute stridor in children ages 6 months to 6 years		*Croup is the most common cause of acute stridor in children ages 6 months to 6 years<ref>Zalzal HG, Zalzal GH. Stridor in the Infant Patient. Pediatr Clin North Am. 2022 Apr;69(2):301-317. PMID 35337541</ref>
	*A minimal amount of edema or inflammation can result in significant obstruction and rapid decompensation		*A minimal amount of edema or inflammation can result in significant obstruction and rapid decompensation

Danbot: Strip excess bold

2026-03-22T09:32:27Z

Strip excess bold

Danbot: Expanded with EM-focused content: age-based DDx, red flags, croup management, epiglottitis precautions, disposition criteria

2026-03-20T23:40:11Z

Expanded with EM-focused content: age-based DDx, red flags, croup management, epiglottitis precautions, disposition criteria

Show changes

Ostermayer at 17:14, 17 January 2026

2026-01-17T17:14:51Z

← Older revision		Revision as of 17:14, 17 January 2026
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	{{~~Peds top~~}} ~~[[stridor]].''~~		{{PediatricPage\|stridor}}
	==Background==		==Background==
	[[File:Cross section of a trachea and esophagus.png\|thumb\|Cross section of a trachea and esophagus anatomy.]]		[[File:Cross section of a trachea and esophagus.png\|thumb\|Cross section of a trachea and esophagus anatomy.]]

Rossdonaldson1 at 19:41, 17 January 2024

2024-01-17T19:41:07Z

← Older revision		Revision as of 19:41, 17 January 2024
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	{{Peds top}} [[stridor]].''		{{Peds top}} [[stridor]].''
	==Background==		==Background==
			[[File:Cross section of a trachea and esophagus.png\|thumb\|Cross section of a trachea and esophagus anatomy.]]
			[[File:Blausen 0865 TracheaAnatomy.png\|thumb\|Tracheal anatomy.]]
	*Stridor refers to harsh upper airway sounds, classically inspiratory		*Stridor refers to harsh upper airway sounds, classically inspiratory
	*A minimal amount of edema or inflammation in the pediatric airway can result in significant obstruction and can lead to rapid decompensation		*A minimal amount of edema or inflammation in the pediatric airway can result in significant obstruction and can lead to rapid decompensation

Rossdonaldson1 at 16:47, 1 July 2020

2020-07-01T16:47:57Z

← Older revision		Revision as of 16:47, 1 July 2020
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	==Evaluation==		==Evaluation==
			*Assess airway
			**If unstable, see [[Difficult Airway Algorithm]], [[Intubation]] and consider surgical intervention/consultation
			**If stable, consider imaging or direct visualization of larynx with fiberoptic scope or video laryngoscope [[GEMC:Airway Procedures]]
			*CT of neck if mass/infection suspected

	==Management==		==Management==
			*Treat underlying cause

	==Disposition==		==Disposition==
			*Based on underlying cause

	==See ~~also~~==		==See Also==
	*[[Stridor]]		*[[Stridor]]

Rossdonaldson1 at 16:26, 1 July 2020

2020-07-01T16:26:25Z

← Older revision		Revision as of 16:26, 1 July 2020
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	{{Peds top}} [[stridor]].''		{{Peds top}} [[stridor]].''
	==Background==		==Background==
			*Stridor refers to harsh upper airway sounds, classically inspiratory
	*A minimal amount of edema or inflammation in the pediatric airway can result in significant obstruction and can lead to rapid decompensation		*A minimal amount of edema or inflammation in the pediatric airway can result in significant obstruction and can lead to rapid decompensation

	==Clinical Features==		==Clinical Features==
			*Inspiratory stridor
			**Suggestive of extrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>atm</sub>)
			**[[Croup]], metapneumovirus, [[aspirated foreign body\|foreign body]], [[epiglottitis]]
			*Expiratory stridor vs. [[wheezing]]
			**Suggestive of intrathoracic obstruction (Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>)
			**[[Asthma]], [[bronchiolitis]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1 at 16:25, 1 July 2020

2020-07-01T16:25:49Z

← Older revision		Revision as of 16:25, 1 July 2020
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			{{Peds top}} [[stridor]].''
	==Background==		==Background==
	*A minimal amount of edema or inflammation in the pediatric airway can result in significant obstruction and can lead to rapid decompensation		*A minimal amount of edema or inflammation in the pediatric airway can result in significant obstruction and can lead to rapid decompensation

Rossdonaldson1 at 16:24, 1 July 2020

2020-07-01T16:24:49Z

← Older revision		Revision as of 16:24, 1 July 2020
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			==Background==
			*A minimal amount of edema or inflammation in the pediatric airway can result in significant obstruction and can lead to rapid decompensation

			==Clinical Features==

	==Differential Diagnosis==		==Differential Diagnosis==
	{{Pediatric stridor DDX}}		{{Pediatric stridor DDX}}

			==Evaluation==

			==Management==

			==Disposition==

	==See also==		==See also==
	*[[Stridor]]		*[[Stridor]]

			==External Links==

	==References==		==References==

Rossdonaldson1: Rossdonaldson1 moved page Stridor (Peds) to Stridor (peds)

2019-04-02T06:11:58Z

Rossdonaldson1 moved page Stridor (Peds) to Stridor (peds)

← Older revision	Revision as of 06:11, 2 April 2019
(No difference)

← Older revision		Revision as of 09:32, 22 March 2026
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	**More compliant airway cartilage		**More compliant airway cartilage
	**Relatively larger tongue and occiput		**Relatively larger tongue and occiput
	*~~'''~~Croup is the most common cause~~'''~~ of acute stridor in children ages 6 months to 6 years		*Croup is the most common cause of acute stridor in children ages 6 months to 6 years
	*A minimal amount of edema or inflammation can result in significant obstruction and rapid decompensation		*A minimal amount of edema or inflammation can result in significant obstruction and rapid decompensation

	==Clinical Features==		==Clinical Features==
	===Phase of Respiration===		===Phase of Respiration===
	*~~'''~~Inspiratory stridor~~'''~~: extrathoracic obstruction (supraglottic/glottic)		*Inspiratory stridor: extrathoracic obstruction (supraglottic/glottic)
	**Pressure<sub>trach</sub> < Pressure<sub>atm</sub>		**Pressure<sub>trach</sub> < Pressure<sub>atm</sub>
	**[[Croup]], [[epiglottitis]], [[aspirated foreign body\|foreign body]], [[anaphylaxis]], laryngomalacia		**[[Croup]], [[epiglottitis]], [[aspirated foreign body\|foreign body]], [[anaphylaxis]], laryngomalacia
	*~~'''~~Expiratory stridor~~'''~~ (vs. [[wheezing]]): intrathoracic obstruction		*Expiratory stridor (vs. [[wheezing]]): intrathoracic obstruction
	**Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>		**Pressure<sub>trach</sub> < Pressure<sub>pleura</sub>
	**[[Asthma]], [[bronchiolitis]], foreign body, vascular ring		**[[Asthma]], [[bronchiolitis]], foreign body, vascular ring
	*~~'''~~Biphasic stridor~~'''~~: fixed obstruction (subglottic stenosis, hemangioma, foreign body lodged at glottis)		*Biphasic stridor: fixed obstruction (subglottic stenosis, hemangioma, foreign body lodged at glottis)

	===By Age===		===By Age===
	*~~'''~~Neonates~~'''~~: laryngomalacia (most common cause of chronic stridor in infants), subglottic stenosis, vocal cord paralysis, congenital hemangioma, vascular ring		*Neonates: laryngomalacia (most common cause of chronic stridor in infants), subglottic stenosis, vocal cord paralysis, congenital hemangioma, vascular ring
	*~~'''~~Infants (6 months - 2 years)~~'''~~: [[croup]], foreign body, laryngomalacia, subglottic hemangioma		*Infants (6 months - 2 years): [[croup]], foreign body, laryngomalacia, subglottic hemangioma
	*~~'''~~Toddlers/Preschool (2-6 years)~~'''~~: [[croup]] (most common), foreign body, [[epiglottitis]], bacterial tracheitis		*Toddlers/Preschool (2-6 years): [[croup]] (most common), foreign body, [[epiglottitis]], bacterial tracheitis
	*~~'''~~School-age and older~~'''~~: [[epiglottitis]], [[peritonsillar abscess]], [[retropharyngeal abscess]], foreign body		*School-age and older: [[epiglottitis]], [[peritonsillar abscess]], [[retropharyngeal abscess]], foreign body

	===Red Flags (Impending Respiratory Failure)===		===Red Flags (Impending Respiratory Failure)===
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	===Stable Patient===		===Stable Patient===
	*~~'''~~AP and lateral neck X-rays~~'''~~:		*AP and lateral neck X-rays:
	**Steeple sign (subglottic narrowing) = croup		**Steeple sign (subglottic narrowing) = croup
	**Thumbprint sign (swollen epiglottis) = epiglottitis		**Thumbprint sign (swollen epiglottis) = epiglottitis
	**Prevertebral soft tissue widening = retropharyngeal abscess		**Prevertebral soft tissue widening = retropharyngeal abscess
	**Radiopaque foreign body		**Radiopaque foreign body
	*~~'''~~CT neck with contrast~~'''~~ if deep space infection, abscess, or mass suspected		*CT neck with contrast if deep space infection, abscess, or mass suspected
	*Direct visualization (nasopharyngoscopy / fiberoptic laryngoscopy) if available and safe		*Direct visualization (nasopharyngoscopy / fiberoptic laryngoscopy) if available and safe

	===Unstable Patient===		===Unstable Patient===
	*~~'''~~Defer imaging~~'''~~ — proceed directly to airway management		*Defer imaging — proceed directly to airway management
	*Prepare for [[difficult airway]] — have smaller ETT sizes available, call for backup (anesthesia, ENT)		*Prepare for [[difficult airway]] — have smaller ETT sizes available, call for backup (anesthesia, ENT)
	*See [[Intubation (peds)]] and [[Difficult Airway Algorithm]]		*See [[Intubation (peds)]] and [[Difficult Airway Algorithm]]
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	==Management==		==Management==
	===Croup (Most Common)===		===Croup (Most Common)===
	*~~'''~~[[Dexamethasone]]~~'''~~ 0.6 mg/kg PO/IM (single dose, max 10mg) — cornerstone of treatment, effective even in mild croup		*[[Dexamethasone]] 0.6 mg/kg PO/IM (single dose, max 10mg) — cornerstone of treatment, effective even in mild croup
	*~~'''~~Racemic [[epinephrine]]~~'''~~ (2.25%) 0.5 mL nebulized in 3 mL NS for moderate-severe croup		*Racemic [[epinephrine]] (2.25%) 0.5 mL nebulized in 3 mL NS for moderate-severe croup
	**Or L-epinephrine (1:1000) 0.5 mL/kg nebulized (max 5 mL)		**Or L-epinephrine (1:1000) 0.5 mL/kg nebulized (max 5 mL)
	**Observe for 2-3 hours after racemic epinephrine (rebound possible)		**Observe for 2-3 hours after racemic epinephrine (rebound possible)