206 - Evaluation and Management of the Pediatric Airway

Abstract

Noisy breathing in a child is caused by turbulent airflow through a narrow anatomic area. The narrow portion of the airway can be superior to, at, or inferior to the level of the larynx. The term stridor is used to describe noisy breathing at the level of the larynx or trachea. The most common cause of stridor in an infant is laryngomalacia, caused by collapse of the supraglottic structures on inspiration. Laryngomalacia usually improves spontaneously with increasing age but sometimes requires endoscopic surgical intervention to improve the airway. Unilateral or bilateral vocal fold paralysis is another common cause of neonatal stridor. Infants may present with a weak cry, airway obstruction, and/or symptoms of aspiration. Children of all ages can develop paradoxical vocal fold motion, which is thought to be due to laryngeal hypersensitivity. Congenital or acquired laryngeal webs may cause aphonia or stridor and, in their most severe form, complete airway obstruction (laryngeal atresia). Congenital subglottic stenosis, laryngeal cysts, and subglottic hemangiomas are less common causes of airway obstruction in infants. Failure of fusion of the posterior cricoid lamina, leading to an abnormal communication between the posterior portion of the larynx and the esophagus, is called a laryngeal cleft. The symptoms of laryngeal clefts vary depending on the length of the cleft and can range from no symptoms at all to severe, life-threatening airway obstruction. Flexible laryngoscopy performed in the awake patient is typically the first step in evaluating children of all ages with stridor.