Airway Obstruction and Stridor in Pediatric Patients

Management of Airway Obstruction and Stridor in Pediatric Patients

Below is a free preview. Log in or subscribe for full access. Or, get a free sample article ED Assessment and Management of Pediatric Acute Mild Traumatic Brain Injury and Concussion:
Please provide a valid email address.

*NEW* Quick Search this issue!

Table of Contents
About This Issue

Children are more likely than adults to experience upper airway obstruction, which often presents with stridor. Because stridor is a sign and not a diagnosis, the underlying etiology must be determined to guide management. In this issue, you will learn:

Key findings on the history and physical examination that will help make the diagnosis

How to determine when imaging studies are necessary and which provide the most information

Evidence-based recommendations for proper management of infectious, noninfectious, and chronic etiologies of stridor

How to decide when a patient can be safely discharged home and when they need to be admitted 

Table of Contents
  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Critical Appraisal of the Literature
  5. Anatomy and Pathophysiology
  6. Etiology and Epidemiology
    1. Croup
    2. Epiglottitis
    3. Bacterial Tracheitis
  7. Differential Diagnosis
  8. Prehospital Care
  9. Emergency Department Evaluation
    1. History
      1. Patient Age
      2. Timing and Onset of Symptoms
      3. Precipitating Events
    2. Physical Examination
      1. Initial Evaluation
      2. Examination
  10. Diagnostic Studies
    1. Radiographic Imaging
    2. Endoscopy
      1. Acute Stridor
      2. Chronic Stridor
  11. Management
    1. Emergent Airway Management
    2. Management of Infectious Etiologies
      1. Croup
      2. Epiglottitis
      3. Bacterial Tracheitis
      4. Mononucleosis
      5. Diphtheria
      6. Deep Space Neck Infections
    3. Management of Noninfectious Etiologies
      1. Foreign Bodies
      2. Anaphylaxis
      3. Airway Ingestions and Burns
      4. Vocal Cord Disorders
    4. Management of Chronic Etiologies
      1. Laryngomalacia
      2. Tracheomalacia
      3. Subglottic and Tracheal Stenosis
      4. Rings, Slings, and Other Etiologies
  12. Special Circumstances
  13. Controversies and Cutting Edge
  14. Disposition
  15. Summary
  16. Key Points
  17. Risk Management Pitfalls for Management of Children With Stridor
  18. Time- and Cost-Effective Strategies
  19. Case Conclusions
  20. Clinical Pathway for Management of Pediatric Patients With Stridor in the Emergency Department
  21. Tables and Figures
    1. Table 1. Differential Diagnosis of Stridor
    2. Figure 1. Airway Diameter and the Effect of Edema on Resistance in Infants and Adults
    3. Figure 2. Lateral Neck X-ray Demonstrating the Thumbprint Sign of Edema of the Epiglottis
    4. Figure 3. Lateral Neck X-Ray Demonstrating 2 Magnets Around the Epiglottis
    5. Figure 4. Neck MRIs Demonstrating a Soft-Tissue Mass Obstructing the Airway at the Base of the Tongue
  22. References


Stridor is a result of turbulent air-flow through the trachea from upper airway obstruction, and although in children it is often due to croup, it can also be caused by noninfectious and/or congenital conditions as well as life-threatening etiologies. The history and physical examination guide initial management, which includes reduction of airway inflammation, treatment of bacterial infection, and, less often, imaging, emergent airway stabilization, or surgical management. This issue discusses the most common as well as the life-threatening etiologies of acute and chronic stridor and its management in the emergency department.

Case Presentations

A 20-month-old boy is brought into the ED by his mother who is concerned because he woke up with a barky cough and he sounded like he was having difficulty breathing. Prior to tonight, he had 2 days of fever and a runny nose. The mother states that her son's voice sounds more hoarse than usual. The boy’s vital signs are notable for a fever of 39.2°C (102.6°F), a respiratory rate of 60 breaths/min, and a pulse oximetry reading of 98% on room air. He is not in significant acute distress when you walk into the room, but you immediately notice inspiratory stridor at rest, and subcostal retractions. The physical examination is otherwise notable for clear rhinorrhea and transmitted upper airway sounds in the lungs. The nurse asks if you would like to order urgent medications or imaging. Do you give racemic epinephrine and/or dexamethasone immediately? Is a chest x-ray necessary? How long should you observe this patient before deciding on his disposition?

A few minutes later, EMS brings in a 4-year-old boy for stridor and drooling. Per the paramedics' report, he’s had 6 days of rhinorrhea and cough, followed by fever for the past 2 days. Tonight, his mother called 911 when he started drooling at the dinner table and would not participate in the family’s conversation. On EMS arrival, he is febrile to 40°C (104°F), his respiratory rate is 44 breaths/min, and he has a pulse oximetry reading of 92% on room air. The EMS team started supplemental oxygen via facemask and attempted to place a peripheral IV catheter, without success. On ED arrival, the boy is sitting up on the stretcher, unwilling to move. You ask him his name, but he just looks at you and doesn’t answer. The collar of his shirt is wet from drooling, and he looks afraid. At this point, what initial steps should be taken? Should you make another attempt to obtain IV access? Is imaging necessary?

Near the end of your shift, a 3-month-old girl is brought into the ED by her parents for noisy breathing while feeding tonight. She was born at 34 weeks and has had several visits to her pediatrician for intermittent stridor and noisy breathing that started approximately 1 month after birth. She has been treated multiple times for croup over the past 4 weeks. On examination, she is very active and well-appearing, with intermittent stridor. She has no retractions or tachypnea, and her vital signs are all within normal limits. What additional questions on history would aid in making the diagnosis? How will you confirm a diagnosis in this patient? Is imaging useful in this scenario?


Respiratory distress is one of the most common reasons children present to the emergency department (ED), accounting for 10% of visits.1 Life-threatening airway emergencies are often secondary to obstruction and must be recognized quickly. Upper airway obstruction in children can range from partial to complete, and often presents with stridor, a high-pitched breath sound produced by turbulent air-flow through a partially obstructed airway. Stridor can be acute or chronic, and acquired or congenital. Because stridor is a sign and not a diagnosis, the underlying etiology must be identified to guide management.2,3 In the ED, identifying severe and life-threatening causes of stridor and acting quickly are crucial to preventing respiratory failure.

The cause of upper airway obstruction can often be identified through history and physical examination alone. The age of the child is an important consideration. While chronic and congenital etiologies of stridor are more common in neonates and infants aged < 6 months, acute infectious etiologies are more prevalent in older infants and children.4 The most common cause of acute stridor in children presenting to the ED is croup; the most common cause of chronic stridor is laryngomalacia.5,6

The management of upper airway obstructions continues to evolve. The development of the Haemophilus influenzae type B (Hib) vaccine has greatly reduced the number of cases of H influenzae type B epiglottitis. Increased knowledge regarding intubation of neonates has led to a dramatic decline in acquired subglottic stenosis, and technological advances in endoscopic airway visualization have revolutionized surgical management of pediatric airways.7

This issue of Pediatric Emergency Medicine Practice focuses on the etiology, diagnosis, and management of upper airway obstruction in the ED, specifically, the most common and life-threatening etiologies of acute and chronic stridor. Prompt recognition and appropriate treatment of stridor in the ED are key to recovery for children with upper airway obstruction.

Critical Appraisal of the Literature

A literature search was performed in PubMed using the terms stridorupper airway obstructioncroupepiglottitisbacterial tracheitismononucleosisforeign bodyanaphylaxisbiphasic reactionairway burnsthermal burnslaryngomalaciasubglottic stenosisvocal cord paralysisvocal cord dysfunctionrespiratory papillomasubglottic hemangiomavascular rings, and bronchogenic cysts. The search was filtered for patients aged 0 to 18 years. A total of 193 articles published from 1988 to the present were reviewed. The Cochrane Database of Systemic Reviews was searched using the terms stridor and upper airway obstruction; 14 reviews were identified, with 3 of them pertinent to this article. The American Academy of Pediatrics (AAP) and National Guideline Clearinghouse ( were also searched, but there are no official guidelines or clinical algorithms relevant to the scope of this article.

The majority of studies on stridor are retrospective chart reviews, with very few randomized controlled trials or prospective studies. Much of the focus on newer research on stridor and upper airway obstruction has been on the treatment of croup with steroids and nebulized epinephrine. Because many acute causes of stridor—especially those that are life-threatening—are rare in pediatric patients, many of the articles on these topics consist of case reports and case series. High-quality pediatric studies are still needed on the topic of upper airway obstruction, as many clinical questions remain unanswered.

Risk Management Pitfalls for Management of Children With Stridor

1. “We must start an IV and get labs now!”

Children with stridor should be left in positions of comfort, with as little manipulation as possible. Agitating the patient with supplemental oxygen, unnecessary intravenous access, and blood work can lead to worsening respiratory distress; these interventions should be reserved for patients who require parenteral therapy or are deteriorating after history and physical examination.

2. “I didn't want to waste time observing a patient with stridor.”

Observation is important in guiding initial management and can provide a significant amount of information almost immediately. Watching for increased work of breathing and drooling after placing the patient in a position of comfort can determine necessary initial interventions.

3. “This must be croup. The patient is a 26-month old with stridor.”

All stridor is not croup. When a patient is not responding to initial management, consider other less common etiologies.

4. “The child looks comfortable now, so he must be out of the woods.”

Do not underestimate the potential for rapid deterioration in children with stridor. In cases of acute stridor, the airway can be quickly obstructed, so it is important to remain vigilant in monitoring these patients after treatment is initiated.

5. “The chances we will need an emergent airway are pretty small, so let’s just watch and wait.”

Failure to plan ahead and prepare for an advanced airway can result in morbidity and mortality. If there is the possibility that an emergent airway will be needed, ensure the necessary equipment is available and essential personnel are notified.

6. “The child responded to corticosteroids almost immediately, so he is safe for discharge now.”

Steroids do not work immediately. Remain vigilant and take advantage of the observation period. A child can deteriorate after the initial response and may need further interventions.

7. “We should give antibiotics just in case this isn’t viral croup.”

Most well-appearing children with acute stridor will have croup, which is most likely viral and should not be treated with antibiotics. Antibiotics are warranted in cases of epiglottitis, bacterial tracheitis, peritonsillar abscess, and retropharyngeal abscess.

8. “The child needs a CT scan, so he must go off the floor.”

Be judicious in determining which patients are stable enough to leave the ED for diagnostic testing. Consider how the testing will change management acutely.

9. “The patient is up-to-date on all vaccines, so this can’t be epiglottitis.”

The epidemiology of epiglottitis is changing and is often seen in fully immunized patients. Do not rule out the diagnosis on the basis of vaccine status.

10. “We should probably get an x-ray to confirm that this is croup.”

Many cases of stridor are diagnosed clinically and do not require diagnostic testing for confirmation. Additionally, radiographic findings for croup lack sensitivity and specificity.

Tables and Figures

Table 1. Differential Diagnosis of Stridor


Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study is included in bold type following the references, where available. The most informative references cited in this paper, as determined by the author, are noted by an asterisk (*) next to the number of the reference.

  1. Rafei K, Lichenstein R. Airway infectious disease emergencies. Pediatr Clin North Am. 2006;53(2):215-242. (Review article)
  2. Sasidaran K, Bansal A, Singhi S. Acute upper airway obstruction. Indian J Pediatr. 2011;78(10):1256-1261. (Protocol summary)
  3. Boudewyns A, Claes J, Van de Heyning P. Clinical practice: an approach to stridor in infants and children. Eur J Pediatr. 2010;169(2):135-141. (Review article)
  4. Daniel M, Cheng A. Neonatal stridor. Int J Pediatr. 2012;2012:859104. (Review article)
  5. Bjornson CL, Johnson DW. Croup. Lancet. 2008;371(9609):329-339. (Review article)
  6. Thorne MC, Garetz SL. Laryngomalacia: review and summary of current clinical practice in 2015. Paediatr Respir Rev. 2016;17:3-8. (Review article)
  7. Ida JB, Thompson DM. Pediatric stridor. Otolaryngol Clin North Am. 2014;47(5):795-819. (Review article)
  8. Mandal A, Kabra SK, Lodha R. Upper airway obstruction in children. Indian J Pediatr. 2015;82(8):737-744. (Review article)
  9. Dalal PG, Murray D, Messner AH, et al. Pediatric laryngeal dimensions: an age-based analysis. Anesth Analg. 2009;108(5):1475-1479. (Epidemiology study; 128 patients)
  10. Wani TM, Bissonnette B, Rafiq Malik M, et al. Age-based analysis of pediatric upper airway dimensions using computed tomography imaging. Pediatr Pulmonol. 2016;51(3):267-271. (Retrospective review; 220 patients)
  11. Litman RS, Weissend EE, Shibata D, et al. Developmental changes of laryngeal dimensions in unparalyzed, sedated children. Anesthesiology. 2003;98(1):41-45. (Epidemiology study; 99 patients)
  12. Darras KE, Roston AT, Yewchuk LK. Imaging acute airway obstruction in infants and children. Radiographics. 2015;35(7):2064-2079. (Review article)
  13. Bew S. Acute and chronic airway obstruction. Anaesth Inten Care Med. 2006;7(5):164-168. (Review article)
  14. Maloney E, Meakin GH. Acute stridor in children. Contin Educ Anaesth, Crit Care & Pain. 2007;7(6):183-186. (Review article)
  15. Primhak R. Evaluation and management of upper airway obstruction. Paediatr Child Health. 2013;23(7):301-306. (Review article)
  16. Eber E. Evaluation of the upper airway. Paediatr Respir Rev. 2004;5(1):9-16. (Review article)
  17. Leung AK, Kellner JD, Johnson DW. Viral croup: a current perspective. J Pediatr Health Care. 2004;18(6):297-301. (Review article)
  18. * Petrocheilou A, Tanou K, Kalampouka E, et al. Viral croup: diagnosis and a treatment algorithm. Pediatr Pulmonol. 2014;49(5):421-429. (Systematic review)
  19. Jenkins IA, Saunders M. Infections of the airway. Paediatr Anaesth. 2009;19 Suppl 1:118-130. (Review article)
  20. Loftis L. Acute infectious upper airway obstructions in children. Semin Pediatr Infect Dis. 2006;17(1):5-10. (Review article)
  21. Shah RK, Roberson DW, Jones DT. Epiglottitis in the Hemophilus influenzae type B vaccine era: changing trends. Laryngoscope. 2004;114(3):557-560. (Retrospective chart review; 19 patients)
  22. Acevedo JL, Lander L, Choi S, et al. Airway management in pediatric epiglottitis: a national perspective. Otolaryngol Head Neck Surg. 2009;140(4):548-551. (Case series; 342 patients)
  23. * Hopkins A, Lahiri T, Salerno R, et al. Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis. Pediatrics. 2006;118(4):1418-1421. (Retrospective case series; 107 patients)
  24. Digoy GP, Burge SD. Laryngomalacia in the older child: clinical presentations and management. Curr Opin Otolaryngol Head Neck Surg. 2014;22(6):501-505. (Review article)
  25. Sharma BS, Shekhawat DS, Sharma P, et al. Acute respiratory distress in children: croup and acute asthma. Indian J Pediatr. 2015;82(7):629-636. (Review article)
  26. Choi J, Lee GL. Common pediatric respiratory emergencies. Emerg Med Clin North Am. 2012;30(2):529-563. (Review article)
  27. Pfleger A, Eber E. Management of acute severe upper airway obstruction in children. Paediatr Respir Rev. 2013;14(2):70-77. (Review article)
  28. Al-Mutairi B, Kirk V. Bacterial tracheitis in children: approach to diagnosis and treatment. Paediatr Child Health. 2004;9(1):25-30. (Review article)
  29. Bedwell J, Zalzal G. Laryngomalacia. Semin Pediatr Surg. 2016;25(3):119-122. (Review article)
  30. Richards AM. Pediatric respiratory emergencies. Emerg Med Clin North Am. 2016;34(1):77-96. (Review article)
  31. Lee SS, Schwartz RH, Bahadori RS. Retropharyngeal abscess: epiglottitis of the new millennium. J Pediatr. 2001;138(3):435-437. (Retrospective chart review; 26 patients)
  32. Leboulanger N, Garabedian EN. Airway management in pediatric head and neck infections. Infect Disord Drug Targets. 2012;12(4):256-260. (Review article)
  33. Kawaguchi A, Joffe A. Evidence for clinicians: nebulized epinephrine for croup in children. Paediatr Child Health. 2015;20(1):19-20. (Systematic review; 8 studies, 225 patients)
  34. Rotta AT, Wiryawan B. Respiratory emergencies in children. Respir Care. 2003;48(3):248-258. (Review article)
  35. Sobol SE, Zapata S. Epiglottitis and croup. Otolaryngol Clin North Am. 2008;41(3):551-566. (Review article)
  36. Al-Gazi M, Quinn K. Case 1: a toddler with stridor. Paediatr Child Health. 2012;17(6):307-308. (Case report)
  37. Mauro RD, Poole SR, Lockhart CH. Differentiation of epiglottitis from laryngotracheitis in the child with stridor. Am J Dis Child. 1988;142(6):679-682. (Retrospective chart review; 155 patients)
  38. Stoner MJ, Dulaurier M. Pediatric ENT emergencies. Emerg Med Clin North Am. 2013;31(3):795-808. (Review article)
  39. Ibrahimov M, Yollu U, Akil F, et al. Laryngeal foreign body mimicking croup. J Craniofac Surg. 2013;24(1):e7-e8. (Case report)
  40. Cirilli AR. Emergency evaluation and management of the sore throat. Emerg Med Clin North Am. 2013;31(2):501-515. (Review article)
  41. Tanizaki S. Assessing inhalation injury in the emergency room. Open Access Emerg Med. 2015;7:31-37. (Review article)
  42. Berg E, Naseri I, Sobol SE. The role of airway fluoroscopy in the evaluation of children with stridor. Arch Otolaryngol Head Neck Surg. 2008;134(4):415-418. (Retrospective chart review; 39 patients)
  43. Kulendra K, Mullineux J, McDermott AL, et al. Are contrast swallows a relevant investigation for paediatric stridor? Eur Arch Otorhinolaryngol. 2013;270(3):969-973. (Retrospective audit study; 117 cases)
  44. * Cohen S, Avital A, Godfrey S, et al. Suspected foreign body inhalation in children: what are the indications for bronchoscopy? J Pediatr. 2009;155(2):276-280. (Prospective cohort study; 142 patients)
  45. Najada AS, Dahabreh MM. Bronchoscopy findings in children with recurrent and chronic stridor. J Bronchology Interv Pulmonol. 2011;18(1):42-47. (Retrospective chart review; 64 patients)
  46. Fraga JC, Jennings RW, Kim PC. Pediatric tracheomalacia. Semin Pediatr Surg. 2016;25(3):156-164. (Review article)
  47. Javia L, Harris MA, Fuller S. Rings, slings, and other tracheal disorders in the neonate. Semin Fetal Neonatal Med. 2016;21(4):277-284. (Review article)
  48. Dobbie AM, White DR. Laryngomalacia. Pediatr Clin North Am. 2013;60(4):893-902. (Review article)
  49. Cheng J, Smith LP. Endoscopic surgical management of inspiratory stridor in newborns and infants. Am J Otolaryngol. 2015;36(5):697-700. (Consecutive case series with chart review; 30 patients)
  50. Ayari S, Aubertin G, Girschig H, et al. Management of laryngomalacia. Eur Ann Otorhinolaryngol Head Neck Dis. 2013;130(1):15-21. (Update article)
  51. * Parkes WJ, Propst EJ. Advances in the diagnosis, management, and treatment of neonates with laryngeal disorders. Semin Fetal Neonatal Med. 2016;21(4):270-276. (Review article)
  52. Midyat L, Cakir E, Kut A. Upper airway abnormalities detected in children using flexible bronchoscopy. Int J Pediatr Otorhinolaryngol. 2012;76(4):560-563. (Retrospective chart review; 1076 patients)
  53. Rankin I, Wang SM, Waters A, et al. The management of recurrent croup in children. J Laryngol Otol. 2013;127(5):494-500. (Retrospective chart review; 90 patients)
  54. Kwong K, Hoa M, Coticchia JM. Recurrent croup presentation, diagnosis, and management. Am J Otolaryngol. 2007;28(6):401-407. (Retrospective chart review; 17 patients)
  55. Arslan Z, Cipe FE, Ozmen S, et al. Evaluation of allergic sensitization and gastroesophageal reflux disease in children with recurrent croup. Pediatr Int. 2009;51(5):661-665. (Prospective observational study; 57 patients)
  56. D’Agostino J. Pediatric airway nightmares. Emerg Med Clin North Am. 2010;28(1):119-126. (Review article)
  57. Diep J, Kam D, Kuenzler KA, et al. Emergent airway management of an uncooperative child with a large retropharyngeal and posterior mediastinal abscess. A A Case Rep. 2016;6(3):61-64. (Case report)
  58. Shah S, Sharieff GQ. Pediatric respiratory infections. Emerg Med Clin North Am. 2007;25(4):961-979. (Review article)
  59. Johnson DW. Croup. BMJ Clin Evid. 2014 Sep 29;2014. pii: 0321. (Systematic review)
  60. * Fitzgerald DA. The assessment and management of croup. Paediatr Respir Rev. 2006;7(1):73-81. (Review article)
  61. Russell KF, Liang Y, O’Gorman K, et al. Glucocorticoids for croup. Cochrane Database Syst Rev. 2011(1):CD001955. (Cochrane review; 38 studies)
  62. * Amir L, Hubermann H, Halevi A, et al. Oral betamethasone versus intramuscular dexamethasone for the treatment of mild to moderate viral croup: a prospective, randomized trial. Pediatr Emerg Care. 2006;22(8):541-544. (Prospective randomized trial; 52 patients)
  63. Rittichier KK, Ledwith CA. Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing. Pediatrics. 2000;106(6):1344-1348. (Single-blind prospective study; 277 patients)
  64. Geelhoed GC. Budesonide offers no advantage when added to oral dexamethasone in the treatment of croup. Pediatr Emerg Care. 2005;21(6):359-362. (Randomized controlled trial; 72 patients)
  65. Geelhoed GC, Macdonald WB. Oral dexamethasone in the treatment of croup: 0.15 mg/kg versus 0.3 mg/kg versus 0.6 mg/kg. Pediatr Pulmonol. 1995;20(6):362-368. (2 sequential double-blind randomized trials; 60 children in each group)
  66. Chub-Uppakarn S, Sangsupawanich P. A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup. Int J Pediatr Otorhinolaryngol. 2007;71(3):473-477. (Randomized comparison study; 41 patients)
  67. Moraa I, Sturman N, McGuire T, et al. Heliox for croup in children. Cochrane Database Syst Rev. 2013(12):CD006822. (Cochrane review; 3 randomized controlled trials, 91 patients)
  68. Myers TR. Use of heliox in children. Respir Care. 2006;51(6):619-631. (Review article)
  69. * Kline-Krammes S, Reed C, Giuliano JS Jr, et al. Heliox in children with croup: a strategy to hasten improvement. Air Med J. 2012;31(3):131-137. (Retrospective chart review; 35 patients)
  70. * Bjornson C, Russell K, Vandermeer B, et al. Nebulized epinephrine for croup in children. Cochrane Database Syst Rev. 2013(10):CD006619. (Cochrane review; 8 studies, 225 patients)
  71. Eghbali A, Sabbagh A, Bagheri B, et al. Efficacy of nebulized L-epinephrine for treatment of croup: a randomized, double-blind study. Fundam Clin Pharmacol. 2016;30(1):70-75. (Randomized double-blind clinical trial; 174 patients)
  72. Moore M, Little P. Humidified air inhalation for treating croup: a systematic review and meta-analysis. Fam Pract. 2007;24(4):295-301. (Systematic review and meta-analysis; 3 studies, 135 patients)
  73. Cherry JD. Clinical practice. Croup. N Engl J Med. 2008;358(4):384-391. (Clinical practice)
  74. Cooper T, Kuruvilla G, Persad R, et al. Atypical croup: association with airway lesions, atopy, and esophagitis. Otolaryngol Head Neck Surg. 2012;147(2):209-214. (Case series with chart review; 88 patients)
  75. Tibballs J, Watson T. Symptoms and signs differentiating croup and epiglottitis. J Paediatr Child Health. 2011;47(3):77-82. (Prospective observational study; 203 patients)
  76. Kavanagh KR, Batti JS. Traumatic epiglottitis after foreign body ingestion. Int J Pediatr Otorhinolaryngol. 2008;72(6):901-903. (Case report)
  77. Orenstein JB, Thomsen JR, Baker SB. Pneumococcal bacterial tracheitis. Am J Emerg Med. 1991;9(3):243-245. (Case report)
  78. Chan PW, Goh A, Lum L. Severe upper airway obstruction in the tropics requiring intensive care. Pediatr Int. 2001;43(1):53-57. (Retrospective chart review; 56 patients aged < 12 years)
  79. Nagler J, Ruebner RL. Suppurative complications and upper airway obstruction in infectious mononucleosis. J Hosp Med. 2007;2(4):280-282. (Case report)
  80. Glynn FJ, Mackle T, Kinsella J. Upper airway obstruction in infectious mononucleosis. Eur J Emerg Med. 2007;14(1):41-42. (Case report)
  81. Jain V, Singhi S, Desai RV. Infectious mononucleosis presenting as upper airway obstruction. Indian J Chest Dis Allied Sci. 2003;45(2):135-137. (Case report)
  82. Chan SC, Dawes PJ. The management of severe infectious mononucleosis tonsillitis and upper airway obstruction. J Laryngol Otol. 2001;115(12):973-977. (Retrospective chart review; 36 patients)
  83. Chen TH, Tseng YH, Yang SN. A child with severe stridor. Emerg Med J. 2013;30(7):603. (Case report)
  84. Lin HW, O’Neill A, Cunningham MJ. Ludwig’s angina in the pediatric population. Clin Pediatr (Phila). 2009;48(6):583-587. (Review article)
  85. Shubha AM, Das K. Tracheobronchial foreign bodies in infants. Int J Pediatr Otorhinolaryngol. 2009;73(10):1385-1389. (Retrospective chart review; 102 patients)
  86. Sittel C. Pathologies of the larynx and trachea in childhood. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2014;13:Doc09. (Review article)
  87. Mandal S, Ghosh A, Saha S, et al. Dilemma in diagnosis between acute laryngotracheobronchitis and airway foreign body. Journal of Case Reports. 2015;5(1):33-36. (Case report)
  88. Linscott MS, Horton WC. Management of upper airway obstruction. Otolaryngol Clin North Am. 1979;12(2):351-373. (Review article)
  89. Rudders SA, Banerji A, Clark S, et al. Age-related differences in the clinical presentation of food-induced anaphylaxis. J Pediatr. 2011;158(2):326-328. (Retrospective chart review, 605 patients)
  90. Kim H, Dinakar C, McInnis P, et al. Inadequacy of current pediatric epinephrine autoinjector needle length for use in infants and toddlers. Ann Allergy Asthma Immunol. 2017;118(6):719-725. (Prospective observational study; 53 patients)
  91. * Simons FE, Sampson HA. Anaphylaxis: unique aspects of clinical diagnosis and management in infants (birth to age 2 years). J Allergy Clin Immunol. 2015;135(5):1125-1131. (Review article)
  92. Chipps B. Update in pediatric anaphylaxis: a systematic review. Clin Pediatr. 2013;52(5):451-461. (Systematic review)
  93. Einhorn A, Horton L, Altieri M, et al. Serious respiratory consequences of detergent ingestions in children. Pediatrics. 1989;84(3):472-474. (Case reports)
  94. Riffat F, Cheng A. Pediatric caustic ingestion: 50 consecutive cases and a review of the literature. Dis Esophagus. 2009;22(1):89-94. (Retrospective chart review; 50 patients)
  95. Madnani DD, Steele NP, de Vries E. Factors that predict the need for intubation in patients with smoke inhalation injury. Ear Nose Throat J. 2006;85(4):278-280. (Retrospective chart review; 41 patients)
  96. Dorsey DP, Bowman SM, Klein MB, et al. Perioperative use of cuffed endotracheal tubes is advantageous in young pediatric burn patients. Burns. 2010;36(6):856-860. (Retrospective chart review, 327 patients)
  97. Chen EY, Inglis AF Jr. Bilateral vocal cord paralysis in children. Otolaryngol Clin North Am. 2008;41(5):889-901. (Review article)
  98. Kothur K, Singh M, Dayal D, et al. Bilateral idiopathic vocal cord palsy. Pediatr Emerg Care. 2007;23(3):171-172. (Case report)
  99. Rosin DF, Handler SD, Potsic WP, et al. Vocal cord paralysis in children. Laryngoscope. 1990;100(11):1174-1179. (Retrospective chart review; 51 patients)
  100. Gimenez LM, Zafra H. Vocal cord dysfunction: an update. Ann Allergy Asthma Immunol. 2011;106(4):267-274. (Review article)
  101. Vats A, Worley GA, de Bruyn R, et al. Laryngeal ultrasound to assess vocal fold paralysis in children. J Laryngol Otol. 2004;118(6):429-431. (Case series; 55 patients)
  102. Lyons M, Vlastarakos PV, Nikolopoulos TP. Congenital and acquired developmental problems of the upper airway in newborns and infants. Early Hum Dev. 2012;88(12):951-955. (Review article)
  103. Setlur J, Hartnick CJ. Management of unilateral true vocal cord paralysis in children. Curr Opin Otolaryngol Head Neck Surg. 2012;20(6):497-501. (Review article)
  104. Tilles SA, Ayars AG, Picciano JF, et al. Exercise-induced vocal cord dysfunction and exercise-induced laryngomalacia in children and adolescents: the same clinical syndrome? Ann Allergy Asthma Immunol. 2013;111(5):342-346. (Retrospective chart review; 143 patients)
  105. Daniel SJ. The upper airway: congenital malformations. Paediatr Respir Rev. 2006;7 Suppl 1:S260-S263. (Review article)
  106. Faria J, Behar P. Medical and surgical management of congenital laryngomalacia: a case-control study. Otolaryngol Head Neck Surg. 2014;151(5):845-851. (Case-control study; 51 patients)
  107. Ortiz R, Dominguez E, De La Torre C, et al. Early endoscopic dilation and mitomycin application in the treatment of acquired tracheal stenosis. Eur J Pediatr Surg. 2014;24(1):39-45. (Retrospective chart review; 18 patients)
  108. Bitar MA, Al Barazi R, Barakeh R. Airway reconstruction: review of an approach to the advanced-stage laryngotracheal stenosis. Braz J Otorhinolaryngol. 2017;83(3):299-312. (Retrospective review; 25 patients)
  109. Avelino MG, Fernandes EJ. Balloon laryngoplasty for subglottic stenosis caused by orotracheal intubation at a tertiary care pediatric hospital. Int Arch Otorhinolaryngol. 2014;18(1):39-42. (Prospective cohort study; 9 patients)
  110. Aubin A, Lescanne E, Pondaven S, et al. Stridor and lingual thyroglossal duct cyst in a newborn. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128(6):321-323. (Case report)
  111. Busino RS, Quraishi HA, Cohen IT. Stridor secondary to a bronchogenic cyst in a neonate. Ear Nose Throat J. 2011;90(11):E8-E10. (Case report)
  112. Cheng J. Isolated subglottic hemangiomas: a potential diagnostic challenge in the absence of a cutaneous clue. Am J Otolaryngol. 2015;36(3):399-401. (Consecutive case series with chart review; 2 patients)
  113. Meier JD, Grimmer JF. Evaluation and management of neck masses in children. Am Fam Physician. 2014;89(5):353-358. (Review article)
  114. Licari A, Manca E, Rispoli GA, et al. Congenital vascular rings: a clinical challenge for the pediatrician. Pediatr Pulmonol. 2015;50(5):511-524. (Review article)
  115. Tola H, Ozturk E, Yildiz O, et al. Assessment of children with vascular ring. Pediatr Int. 2017;59(2):134-140. (Retrospective chart review; 21 patients)
  116. Leibowitz JM, Smith LP, Cohen MA, et al. Diagnosis and treatment of pediatric vallecular cysts and pseudocysts. Int J Pediatr Otorhinolaryngol. 2011;75(7):899-904. (Retrospective chart review; 11 patients)
  117. Burns SC, Leonard P. Recurrent respiratory papillomatosis presenting to an emergency department. Eur J Emerg Med. 2010;17(2):116-118. (Case report)
  118. Elluru RG, Friess MR, Richter GT, et al. Multicenter evaluation of the effectiveness of systemic propranolol in the treatment of airway hemangiomas. Otolaryngol Head Neck Surg. 2015;153(3):452-460. (Case series with chart review; 27 patients)
  119. Vivas-Colmenares GV, Fernandez-Pineda I, Lopez-Gutierrez JC, et al. Analysis of the therapeutic evolution in the management of airway infantile hemangioma. World J Clin Pediatr. 2016;5(1):95-101. (Retrospective chart review; 23 patient)
  120. Hamilton J, Yaneza MM, Clement WA, et al. The prevalence of airway problems in children with Down’s syndrome. Int J Pediatr Otorhinolaryngol. 2016;81:1-4. (Retrospective chart review; 239 patients)
  121. * Rudinsky SL, Sharieff GQ, Law W, et al. Inpatient treatment after multi-dose racemic epinephrine for croup in the emergency department. J Emerg Med. 2015;49(4):408-414. (Retrospective chart review; 200 patients)
  122. Narayanan S, Funkhouser E. Inpatient hospitalizations for croup. Hosp Pediatr. 2014;4(2):88-92. (Retrospective chart review; 327 patients)
  123. Alqurashi W, Stiell I, Chan K, et al. Epidemiology and clinical predictors of biphasic reactions in children with anaphylaxis. Ann Allergy Asthma Immunol. 2015;115(3):217-223. (Chart review; 484 patients)
  124. Lee JM, Greenes DS. Biphasic anaphylactic reactions in pediatrics. Pediatrics. 2000;106(4):762-766. (Retrospective chart review; 108 patients)
  125. Lieberman P. Biphasic anaphylactic reactions. Ann Allergy Asthma Immunol. 2005;95(3):217-226. (Review article)
  126. Manuyakorn W, Benjaponpitak S, Kamchaisatian W, et al. Pediatric anaphylaxis: triggers, clinical features, and treatment in a tertiary-care hospital. Asian Pac J Allergy Immunol. 2015;33(4):281-288. (Retrospective chart review; 160 patients)
  127. Greifer M, Santiago MT, Tsirilakis K, et al. Pediatric patients with chronic cough and recurrent croup: the case for a multidisciplinary approach. Int J Pediatr Otorhinolaryngol. 2015;79(5):749-752. (Retrospective chart review; 40 patients)
Publication Information

Ashley Marchese, MD; Melissa L. Langhan, MD, MHS

Publication Date

November 2, 2017

Content you might be interested in
Already purchased this course?
Log in to read.
Purchase a subscription

Price: $449/year

140+ Credits!

Money-back Guarantee
Get A Sample Issue Of Emergency Medicine Practice
Enter your email to get your copy today! Plus receive updates on EB Medicine every month.
Please provide a valid email address.