Pediatric upper airway conditions: Clinical

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Pediatric upper airway conditions: Clinical

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 A 3-year-old boy is brought to the office because of fever, and hoarseness for 2 days. His family says that he developed a sharp “barking” cough last night. Physical examination shows mild erythema of the oral mucosa, moderate chest wall retraction, and inspiratory stridor at rest. There are no other abnormalities present. Which of the following is the most appropriate next step in management? 


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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.


Pediatric upper airway conditions refer to the disorders affecting children's nasal cavities, paranasal sinuses, pharynx, or larynx. These conditions include foreign body aspiration, tonsillitis, epiglottitis, and laryngomalacia, which is characterized by congenitally malformed laryngeal cartilages that obstruct the airflow.

Symptoms vary depending on each condition but may include difficulty breathing, noisy breathing, recurrent throat infections, and difficulty swallowing. Treatment options depend on each specific condition. It may require antibiotics, steroids, and in some cases, surgery. Early detection and intervention can help to prevent complications and improve outcomes.


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