Stridor is an inspiratory noise (heard when the child is breathing in) which has been described as sounding like the bark of a seal. It generally indicates some obstruction or narrowing of the windpipe (trachea). The most common cause is croup, which is relatively common in young toddlers, and which is caused by a viral infection. However, stridor is occasionally caused by a condition called epiglottitis, which is due to a germ and which is serious and potentially life threatening (and for which immunisation is now available). It may also be caused by an inhaled foreign body.
Croup
Croup is very common in young children. It is usually associated with a cold (and is therefore more common in winter), and for the most part is not a serious condition. However, the obstruction to the breathing tube is occasionally severe enough to cause breathing difficulties, and the child needs urgent medical attention and sometimes observation and treatment in hospital.
Cause
The stridor or croup that is heard when the child breathes in is caused by swelling of the breathing tube just below the vocal cords. This is caused by one of the viruses that are responsible for the common cold.
Clinical features
The child usually has symptoms of a cold before the onset of croup, including a runny nose, sore throat, fever, and irritability. He then develops a harsh, barking cough, sometimes a hoarse voice, and then noisy breathing. The noise is heard when he breathes in (in contrast to asthma, in which the wheeze occurs as the child breathes out).
The stridor and the cough are usually worse at night and when the child is distressed. In the majority of children, the symptoms improve over a few days and then disappear. In a small number of children the croup is more severe and the child has difficulty with breathing. Sometimes there will be drawing in of the child’s breastbone and the muscles between the ribs, as well as flaring of the nostrils. He may appear restless and have trouble feeding and drinking, and will not want to lie down. Severe croup requires emergency medical attention.
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