Noisy Breathing in Infants: Causes, Investigations and treatment?

Noisy breathing is quite common, in children especially in infants less than 2 years of age. Noisy breathing in infants can be due to many conditions ranging from very benign to some serious problems. Noisy breathing happens due to a partial blockage or narrowing in the child’s airways. The blockage can be in the nose, back of the nose, throat, voice box (called larynx), windpipe (called trachea) or lower airways (called bronchi). The noise is produced by the turbulent and irregular airflow through the narrowed airway.

Noisy Breathing in Infants: Causes, Investigations and treatment?

What are the types of noisy breathing in children?
Noisy breathing can be of various types depending on the site of obstruction in the child’s airways. The common types of noisy breathing are stertor, stridor and wheezing. Stertor is a sound produced due to block at the level of the nose and back of the throat. The sound of stertor is low pitched and heard during breathing-in and breathing-out. Stridor is a sound produced due to a block at the level of the voice box (larynx) and upper part of the windpipe (trachea). Stridor is a high pitched sound and heard when the child is breathing-in (inspiration). Wheezing a sound produced due to block in the lower part of the windpipe (trachea) or the smaller lower airways (bronchi). Wheezing is a musical sound heard when the child is breathing-out (expiration).

What are the common causes of noisy breathing in infants and children?
The causes of noisy breathing depends on the age of the child, time of appearance of the symptoms (since birth or later) and site of obstruction in the airway. Common causes of stertor are viral nasal infections, nasal allergies and enlarged adenoids. Stridor when it happens suddenly can happen due to croup (viral infection of the voice box and airways), foreign objects in the voice box or windpipe and epiglottitis (bacterial infection of the voice box). A long standing stridor which happens since around birth occurs due to floppy tissues in the respiratory tract (laryngomalacia, tracheomalacia), paralysis of the vocal cords (vocal cord palsy), narrowing of the subglottic space (just below the vocal cords) and compression on the windpipe/trachea. Wheezing can occur due to viral infections, asthma or foreign objects in the lower airways.

What are the danger signs which parents should recognize?
Since it can be a bit difficult for parents and caregivers to discern the causes and severity of noisy breathing in children, medical attention should be sought immediately. Signs indicating a severe problem are flaring of the nose, chest indrawings between and under the ribs, increased effort of breathing, irritability, lethargy and poor feeding. Signs suggesting emergent problems are pauses in the breathing, cyanosis (colour change of the lips, face and fingers turning blue) and very tired infants. If the baby seems to have any of these concerning signs and symptoms immediate medical attention should be sought.

How do we evaluate children with noisy breathing?
The evaluation of noisy breathing in children and infants needs a detailed clinical case history and examination of the child. This helps to determine the type of noisy breathing and severity of the symptoms. Further investigations and treatment depends on a case-to-case basis. Some investigations might be required like a Xray of chest and neck, sleep studies or polysomnography and a flexible diagnostic bronchoscopy.

In case a child or infant is having noisy breathing you need to get in touch with a child pulmonologist for proper evaluation.

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