🫁 Stridor Types by Location
• Inspiratory: extrathoracic (supraglottic/glottic) - croup, laryngomalacia, epiglottitis
• Expiratory: intrathoracic (tracheobronchial) - foreign body, tracheomalacia
• Biphasic: fixed obstruction (subglottic stenosis, vascular ring)
👶 Congenital Stridor
• Laryngomalacia: MOST common congenital cause (60-70%), onset 2-4 weeks, worse supine/agitated, resolves by 12-18 months
• Vocal cord paralysis: unilateral (breathy cry) vs bilateral (stridor)
• Subglottic stenosis: congenital or post-intubation
• Vascular rings: complete rings cause biphasic stridor, dysphagia
⚠️ Infectious Emergencies
• Croup (laryngotracheobronchitis): ages 3m-3y, barky cough, stridor, worse at night
• Epiglottitis (Hib vaccine ↓): toxic, drooling, tripod, thumbprint sign → OR for airway
• Bacterial tracheitis: high fever, toxicity, no drooling, membranes on bronchoscopy
• Retropharyngeal abscess: neck pain, torticollis, dysphagia, lateral neck X-ray
📋 Diagnostic Approach
• History: onset (congenital vs acute), position effects, feeding difficulty, choking, fever
• Exam: level of distress, drooling, tripod position, cutaneous hemangiomas
• Imaging: AP/lateral neck only if stable and diagnosis unclear
• Stridor + respiratory distress + drooling + toxicity = secure airway FIRST, no imaging
📌 Decision strategy: Laryngomalacia is most common congenital stridor. Any child with stridor + drooling + toxicity = epiglottitis until proven otherwise. Secure airway before imaging. Croup is clinical diagnosis.