Pediatric upper airway conditions: Clinical

The upper airways include the nasal cavity, paranasal sinuses, pharynx and larynx.

In children, the upper airways can be affected by mechanical obstruction - like in a foreign body aspiration or by a structural defect like in laryngomalacia. There can also be inflammation in these anatomic regions due to an infection.

Let’s start with foreign body aspiration, which most commonly occurs in young toddlers who get something like a small coin or a peanut, lodged in their respiratory tree.

Most of the time, the foreign body goes into the lower respiratory tract, because of gravity and because that main bronchus is a bit larger. But if it’s large and unlucky enough to get stuck in an upper, larger airway, then symptoms are more severe.

Typically, if there’s a partial upper airway obstruction, children begin coughing, gagging, choking, or drooling, and on auscultation, there’s inspiratory stridor.

But, if there’s a complete obstruction, children may be unable to cough or speak and can even pass out. And in this case, we should immediately start Basic Life Saving, or BLS maneuvers to relieve obstruction.

For infants less than one year of age, five back blows are delivered, followed by five chest thrusts. And for children one year of age or older, five abdominal thrusts or Heimlich maneuver should be performed.

Okay, now, if the child is stable, then usually a chest Xray is done - and objects like coins and batteries are radiopaque, and are visible, whereas pieces of food are usually radiolucent, so don’t show up.

If an upper airway foreign body aspiration is suspected, then it’s important to do a neck radiograph.

Sometimes, there are indirect signs of obstruction, like a subglottic density or swelling.

A CT scan can also be done to confirm the suspicion.