The acute onset of
stridor in a young child usually represents
viral croup, particularly during the fall and early winter. If the clinical picture is entirely consistent with this diagnosis and gas exchange is maintained, management with cool mist at home is appropriate. Rapid deterioration is unusual in
viral croup; however, if obstruction is prolonged or becomes unusually severe,
racemic epinephrine aerosols, hospitalization for careful observation, a brief course of
corticosteroid therapy, and, rarely, endotracheal intubation may be required. Many of the other causes of acute
stridor in childhood represent true pediatric emergencies:
epiglottitis,
foreign body aspiration, bacterial
tracheitis, allergic airway
edema, and
retropharyngeal abscess, all requiring management with a consultant. Chronic
stridor in infancy most often represents
laryngomalacia, a developmental abnormality of the laryngeal cartilage which usually resolves by the second year of life and rarely requires specific treatment. Other causes of chronic
stridor in childhood include subglottic
hemangioma,
vocal cord paralysis, and a long list of abnormalities. In the older child with chronic
stridor or in the infant whose clinical picture is unusual for
laryngomalacia, airway roentgenograms,
barium studies, or laryngoscopy/bronchoscopy should be obtained to establish the definitive diagnosis.