An approach to chronic upper airway noisy breathing in neonates, infants and children in the outpatient setting

Abstract

Noisy breathing in children is a common clinical sign. Parents often present to health care professionals with concerns about the pattern and nature of their child's breathing. In this article, we will discuss causes of chronic noisy breathing in children and our approach to their management. Evaluation begins with careful assessment of the child and video or audio recordings are particularly helpful. The characteristic findings will depend on the affected level of the airway. The most common cause of noisy breathing in an infant is laryngomalacia, although there are several other differential diagnoses for stridor to be considered. Visualization of the airway by either a rigid or a flexible bronchoscope, is the gold standard procedure for identifying any pathology. Red flags include severe respiratory distress, recurrent stridor in early months, feeding difficulties and/or failure to gain weight in neonates and infants. Older children can present with chronic wet cough or wheeze. In this age group trials of treatment and careful documentation of the responses can be helpful in clarifying the diagnosis.