PE25.4 | Stridor — Summary & Reflection

KEY TAKEAWAYS

Stridor is a symptom of airway narrowing producing turbulent, noisy airflow. The phase of stridor localises the anatomical level: inspiratory stridor indicates extrathoracic obstruction (supraglottis, glottis, or subglottis); expiratory wheeze indicates intrathoracic obstruction; biphasic stridor indicates tracheal or fixed subglottic disease. The most common cause of acute stridor in children is croup (parainfluenza, subglottic, barking cough, steeple sign); the most dangerous acute cause is epiglottitis (Hib or post-vaccine, supraglottic, thumbprint sign, tripod, never examine throat in ED). Foreign body aspiration causes sudden-onset unilateral stridor without fever in a child who was playing with small objects. The most common cause of chronic inspiratory stridor in infancy is laryngomalacia (floppy supraglottic structures, onset first 2 weeks, worsens with feeds, improves prone, resolves by 18-24 months in 90%). Management is always cause-specific; the universal initial priority is maintaining the airway and avoiding distress-provoking manoeuvres until the diagnosis is clear.

REFLECT

Reflect on the clinical journey of a parent who has been watching their infant struggle with stridor at every feed for 3 months before seeing a paediatrician. They have been told by multiple practitioners that it is 'just noise.' How does your understanding of laryngomalacia — its mechanism, its typical course, and its expected resolution — allow you to offer genuine, evidence-based reassurance rather than dismissive or false reassurance? And in contrast, think about how you would respond if the same infant developed a sudden worsening of their stridor with a fever one evening — how do you communicate the critical difference between chronic laryngomalacia and the acute-on-chronic emergency that may need immediate evaluation?