A change in the way a child breathes is not always easy to interpret. One sound that deserves particular attention is a harsh, high-pitched noise coming from the throat while breathing. This is called stridor.
Stridor in children occurs when air has difficulty moving through a narrowed part of the upper airway. The narrowing may be caused by swelling, inflammation, a structural problem or something blocking the airway. Because a child’s airway is smaller than an adult’s, even a small amount of swelling can have a noticeable effect on breathing. Stridor is a symptom rather than a condition on its own. It can occur with common childhood illnesses such as croup or with conditions such as laryngomalacia in babies. If it starts suddenly after a child has choked on food or a small object, however, an airway blockage needs to be considered. The circumstances around the noisy breathing matter. When it starts, whether the child is comfortable at rest and whether there is any difficulty breathing can help determine how urgently the child needs to be assessed.
Stridor vs wheezing: what is the difference?
Stridor and wheezing are both unusual breathing sounds, but they usually come from different parts of the respiratory system. Stridor is caused by narrowing or obstruction in the upper airway, such as around the throat or larynx, while wheezing generally occurs when the smaller airways inside the lungs become narrowed. The timing of the sound can also be different. Stridor is often more noticeable when a child breathes in, although it can occur during breathing out or both. Wheezing is more commonly heard during breathing out, and it tends to have a softer, musical or whistling quality.
The causes are different too. Stridor may occur with croup, laryngomalacia or an object blocking the upper airway, whereas wheezing can be associated with conditions such as asthma, viral infections or inflammation of the lower airways. For parents, the distinction is useful but not always easy to make by listening alone. If a child has a new or persistent breathing sound, particularly along with difficulty breathing, feeding problems, a change in skin colour or unusual tiredness, the child should be assessed by a healthcare professional rather than relying on the sound to determine what is wrong.
What causes stridor in children?
There are several stridor causes children may experience. Age, the way the sound began, and other symptoms can all help point towards the cause.
Croup
Croup is a common viral infection in young children. It causes swelling around the voice box and windpipe, making the upper airway narrower than usual. The usual signs are a barking cough, hoarse voice and stridor, particularly when the child breathes in. Some children may also have a fever or find it harder to breathe. Croup can range from mild symptoms to more significant narrowing of the airway. If the noisy breathing is present even when the child is calm and resting, or if the child is working hard to breathe or becoming increasingly distressed, they need prompt medical attention.
Laryngomalacia
Laryngomalacia is a common cause of noisy breathing in babies. In this condition, the tissues around the voice box are softer than usual and can partly fall inward when the baby breathes in. The sound may be present from the first few weeks of life and can become more noticeable when the baby is feeding, crying, or lying in certain positions. This is often what parents mean when searching for laryngeal stridor baby symptoms.
Many babies with laryngomalacia grow out of the problem as the tissues around the airway become firmer. However, noisy breathing should be assessed if the baby has trouble feeding, is not gaining weight properly, has pauses in breathing or seems to be working hard to breathe.
A foreign object in the airway
A stridor that starts suddenly is more concerning, particularly if it happens while a child is eating or playing with a small object. Food or another object can accidentally enter the airway instead of the food pipe. The child may suddenly cough, choke, develop noisy breathing or struggle to breathe. This situation needs prompt medical attention. Even if the child seems to settle after the initial choking episode, continued coughing, noisy breathing or other breathing changes should not be ignored because an object may still be partly blocking the airway.
Other causes
Not every episode of stridor is caused by croup or an infection. Problems involving the vocal cords, swelling from an allergic reaction or infection, an injury to the airway, or a structural problem present from birth can also narrow the airway and produce stridor. This is why the way the stridor began is useful information for a doctor. Stridor that develops during a viral illness, has been present since infancy, or appears suddenly after choking points to very different possibilities and may require different treatment.
When does stridor require emergency care?
The loudness of the sound is not the best measure of how serious the problem is. A more useful question is whether the child is able to breathe normally. Get emergency medical help if a child with stridor has:
- difficulty breathing or visibly increased effort when breathing
- skin pulling in around the ribs, neck or breastbone
- blue, grey or unusually pale lips or skin
- drooling or difficulty swallowing
- difficulty feeding or drinking
- unusual sleepiness, confusion or reduced responsiveness
- rapidly worsening breathing
- stridor that continues while the child is calm and resting
- sudden stridor after choking or possible inhalation of an object
If the child is struggling to breathe, do not wait for the noise to settle on its own. Contact your local emergency service or take the child to an emergency department. Do not put your fingers or another object into the child’s mouth or throat to look for a possible obstruction.
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How is stridor treated?
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