Stridor in a baby: what is it? when should you be worried?

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 Stridor in a baby: what is it?  when should you be worried?

The stridoris a inspiratory sound – that is to say that we hear on inspiration – that comes from larynx. It manifests From birth Where in the first weeks of life of the baby. “Above all, you should know that stridor is a clinical sign, not a disease, specifies Professor Nicolas Leboulanger. This more or less high-pitched noise can be permanent or intermittent and have several underlying causes, the most common of which, in young children, is laryngomalacia. »

What are the signs of this inspiratory noise?

the stridor is manifested by a noise on inspiration. This can:

  • be acute Where severe and hoarse (croaking) especially in the case of a laryngitis,
  • appear or increase during sleep,
  • be plus during foodwhen the child is crying, fidgets west lying on the back,
  • accompany swallowing disorders.

What causes stridor?

We distinguish the acute causes -usually of infectious origin as in stridulous laryngitis – chronic causes related to congenital or acquired anomalies. Apart from infectious pathologies such as laryngitis, the most common cause of stridor in infants is the laryngomalacia. More rarely, this inspiratory noise can also be caused by other pathologies such as paralysis or reduced mobility of the vocal cords, or even a hemangioma, specifies Professor Nicolas Leboulanger.

stridulous laryngitis

Inflammation of the larynx most often of viral origin, acute laryngitis particularly affects children aged 6 to 36 months. It usually begins with symptoms of the common cold. Then a not very high fever (below 38.5°C) appears as well as a hoarse voice and a cough rauque accompanied by a stridor on inspiration. An appointment with the pediatrician or a general practitioner will confirm the diagnosis.

Laryngomalacia

Most cases of stridor in infants are related to laryngomalacia. This typically manifests as a acute stridorincreased when the child cries, eats or is lying on his back.

others symptoms can be associated as:

  • a cough,
  • a cyanosis,
  • of the regurgitation,
  • of the vomiting,
  • a slow food intake in moderate to severe cases.

” The laryngomalacia is the most important cause frequent stridor and represents approximately 60 to 70% of congenital laryngeal anomalies, specifies the Swiss medical journal (source 1). Symptoms are mostly mild and disappear on their own before the age of two. About 20% of patients have important symptomssevere stridor, food difficulties and growth retardation – requiring treatment by endoscopic surgery (supraglottoplasty). Its success rate is good with little risk of recurrence or complications. Remarks echoed by those of Prof. Leboulanger:

“Laryngomalacia or “soft larynx” is frequent and of variable severity. In the majority of cases, it disappears as the child grows and does not require surgery. »

And to specify: “On the other hand, if it is not well tolerated – that is to say if it interferes with food intake and breathing – we may have to intervene surgically. »

Partial paralysis of the vocal cords

A stridor can also be observed as part of a total paralysis Where partial vocal cords. “Most of the time, this one is congenital but she can also occur after chest surgery or neck. For example, among very prematureit happens during a surgical intervention on the ductus arteriosus that the recurrent nerve – which controls part of the movement of the larynx and vocal cords – be harmed resulting in partial paralysis of the vocal cords. »

Finally, faced with the occurrence of a sudden cough and incoercible in babies, stridor can also be a sign ofinhalation of a foreign body : piece of food, small object, etc. If the child is having difficulty breathing, call immediately on the 15th.

Is stridor serious? When should an ENT opinion be sought?

Any noise on inspiration requires consult your doctor Where his pediatrician. Depending on the diagnosis and the etiology of the stridor, he may refer you to an ENT specialist. “It is important to consult a specialist when a child presents with stridor, confirms Prof. Nicolas Leboulanger. Diagnosis is made by passing a small flexible fiberscope through the nose to visualize the larynx and spot any tissue collapse. At the same time, the examination makes it possible to exclude other birth defects like the vocal cord paralysissome subglottic strictures, etc »

It all depends on the cause of the stridor – infectious, congenital, etc. – and its tolerance.

In stridulous laryngitis

In the absence of signs of seriousness – difficulty breathing, high fever, etc. – the treatment will be carried out at home. The pediatrician or attending physician will prescribe oral corticosteroids to reduce inflammation of the larynx. At the same time, it is recommended to humidify the indoor air of the rooms. If there are signs of respiratory distressthe treatment will be at the hospital and the treatment will combine adrenaline sprays as well as corticosteroids.

In case of stridor related to laryngomalacia

Symptoms are often mild and disappear spontaneously as the child grows. In fact, with age, the soft tissues become firmer and their relaxation no longer obstructs the airways. “Stridor can be resolve on its own in the first months of the child’s life, confirms the specialist. In contrast, if the baby’s condition deteriorates Where if he has difficulty eating and his weight curve slows down, a surgical intervention will be needed. This consists of removing part of the soft tissues so that they obstruct the larynx less. In general, there is then a very rapid improvement in the diet. »

When does congenital stridor disappear?

In the vast majority of cases (80 to 90%), stridor related to laryngomalacia disappears spontaneously around the age of 12 to 24 months. Nevertheless, in 10 to 20% of cases, the symptoms are severe and young patients must be treated surgically.

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