Airway

Pediatric Obstructed Airway Causes

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Pediatric Obstructed Airway Causes, Pediatric Airway Obstruction Causes, Upper Airway Compromise in Children

  • See Also
  1. Advanced Airway
  2. Foreign Body Aspiration
  3. Heimlich Maneuver
  4. Heimlich Maneuver in Infants
  • Pathophysiology
  1. Airway diameter is significantly smaller in children with reduced airflow
    1. Poiseuille's Law defines airflow resistance as inversely proportional to the fourth power of the radius
    2. An 8 mm airway diameter in a 2 year old may decrease to 4 mm (50%) with edema from croup
      1. Airflow resistance in this case will increase 16 fold (2^4)
  2. Even mild reductions in pediatric airway diameter results in significant airflow restriction
    1. Turbulent airflow
    2. Inspiratory Stridor
  • Findings
  1. Stridor
  2. Drooling
  3. Muffled voice
  4. Tripod position
  5. Accessory Muscle use
  6. Altered Mental Status
  • Precautions
  1. Maintain close monitoring (progression to Respiratory Failure may be rapid)
  2. Oxygen Saturation may be reassuring until imminent complete airway obstruction
  • Differential Diagnosis
  • Child
  1. Foreign Body Aspiration
    1. Rapidly progresses from Choking to Stridor and decreased breath sounds
    2. Partial obstructions may present only as cough
  2. Anaphylaxis
    1. Angioedema, Stridor and Wheezing
    2. Shock onset within minutes to hours
  3. Croup
    1. Barking cough, harsh voice and Stridor developing over days
  4. Epiglottitis
    1. Rapid onset and progression within 24 hours to fever, Pharyngitis, Drooling, muffled voice and no cough
  5. Bacterial Tracheitis
    1. URI symptoms abruptly progressing to high fever, toxic appearance, Stridor and cough
  6. Retropharyngeal Abscess or Peritonsillar Abscess
    1. Fever and Pharyngitis progressing to Drooling and stiff, painful neck
  7. Ludwig's Angina
    1. Dental Infection spread to submaxillary space with secondary fever, Cellulitis, Stridor and Trismus
  8. Diphtheria
    1. Thick, gray, Exudative Pharyngitis with fever, Dysphagia and toxic appearance
  • Imaging
  1. Chest XRay (AP, Lateral)
    1. Croup
      1. Steeple sign (secondary to tracheal narrowing and subglottic edema)
    2. Foreign Body Aspiration
      1. Upper airway: Foreign body may be visible, pharynx over-inflated
      2. Lower airway: Air trapping with hyperinflation, Atelectasis
  2. Soft Tissue Neck (Lateral)
    1. Retropharyngeal Abscess
      1. Pre-Vertebral soft tissue thickening or air-fluid level
    2. Epiglottitis
      1. Thumbprint sign (secondary to Epiglottis swelling)
  3. Advanced imaging
    1. CT Soft tissue neck with IV contrast (gold standard, but ionizing radiation)
    2. MRI Neck
      1. Requires sedation in young children
      2. Prolonged scan time (higher risk in a patient whose stability may change within 1-2 hours)
      3. Often unavailable
  • Management
  1. See ABC Management
  2. See Advanced Airway
  • References
  1. Ayoub (2026) Crit Dec Emerg Med 40(10): 4-12
  2. Fuchs and Yamamoto (2011) APLS, Jones and Bartlett, Burlington, p. 48, 58