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Noisy breathing or stridor

It is quite common for newborns and infants to experience noisy breathing or stridor. Look for changes in cry or wheeze, cough or other signs of upper respiratory tract infection, and any episodes of apnea or cyanosis. The disappearance of symptoms when changing body position is also important diagnostic sign. The appearance or worsening of symptoms during feeding is characteristic of aspiration, which may be a consequence of a laryngotracheal cleft or tracheoesophageal fistula. Previous episodes of intubation may indicate the presence of subglottic or tracheal stenosis. It is also important to pay attention to the constant nature of the breath sounds or the presence of periods when they disappear. It is necessary to evaluate the nature of breathing sounds during deep sleep when the child's spontaneous tidal volume decreases. Snoring during sleep may indicate obstructive apnea attacks during sleep, usually caused by hypertrophy of the adenoids or tonsils. For functional disorders, such as laryngomalacia, is characterized by improvement at rest or with calm breathing. It should also be noted that any combined swallowing disorders are possible. In all children starting to walk, if acute symptoms Ingestion or aspiration of a foreign body should be considered first. Despite the fact that the swallowed object may be in the esophagus, it can put pressure on the back wall of the trachea and partially block its lumen. In children school age and adolescents, the appearance of shortness of breath and chest pain may indicate a mediastinal tumor. You need to remember about gastroesophageal reflux, and also pay attention to the connection between respiratory sounds and cough and note their features.

Noisy breathing in newborns - diagnosis

Auscultation will be more informative if additional breath sounds are correlated with the phase of the respiratory cycle. Upper airway obstruction is characterized by stridor that occurs on inspiration. Large airway sounds associated with tracheomalacia are heard during expiration, but with severe obstruction they are heard during both inspiration and expiration. To differentiate noise from upper sections respiratory tract from noises from lower sections, the child should be auscultated with open mouth and listen to the lateral surfaces of the neck. If the child reacts calmly to the examination, the doctor may try to stir him up a little to identify pathological respiratory sounds or evaluate new ones that appear as the volume of breathing increases. In infants, breath sounds should be heard. be assessed in the supine and prone positions, as supralaryngeal obstruction worsens in the supine position.

Palpation of the liver and spleen during examination of the digestive organs helps to suspect storage diseases, which can cause abnormal respiratory sounds, secondary to laryngeal infiltration. A thorough neurological examination for hypotonia or dysreflexia is important.

Noisy breathing in newborns - radiography

All children with noisy breathing should have an x-ray of their organs. chest in two projections (direct and lateral). On the x-ray, you should carefully evaluate the shadow of the heart and large vessels, determine their size and orientation. Lung involvement may be secondary to aspiration, infection, or cardiac pathology. It is necessary to carefully examine the chest organs to identify a tumor, since compression of the airways by a tumor often leads to noisy breathing.

X-ray studies of a child with stridor should include studies of the lateral projections of the neck and nasopharynx and a direct projection of the neck taken at the time of head extension. The space under the glottis should be symmetrical on direct view, and the lateral walls of the airways should slope steeply. Asymmetry indicates subglottic stenosis or damage extensive education, while a narrow cone-shaped narrowing indicates subglottic edema.

Direct visualization of the respiratory tract is the most informative method with noisy breathing. The flexible bronchoscope allows for clear detection of dynamic compression as patients receive only light sedation and breathe spontaneously. However, to carry out full examination the posterior pharynx may require rigid bronchoscopy.

Noisy breathing in children - examination for possible foreign bodies

A common cause of stridor in children aged 1 to 3 years is ingestion or aspiration of a foreign body. Foreign body pressure on the airway causes coughing, and this problem is characterized by localized unilateral wheezing. Detection of secondary asymmetric hyperextension due to the valve effect on a radiograph requires immediate action. X-rays of the chest organs during inhalation and exhalation can lead to increased asymmetric hyperextension and help in clarifying the diagnosis. In infants who cannot inhale and exhale voluntarily, lateral x-rays to the right and left in the supine position may reveal hyperdistension because in this position the mediastinum does not shift towards the affected lung. However, radiography will be informative only if the foreign body is radio-contrast. In children, the most common foreign body is peanuts. With foreign body aspiration in children, symptoms may be absent until the development of secondary infection.

Lower airway obstruction

In contrast to upper airway obstruction, lower airway obstruction is more often accompanied by expiratory rather than inspiratory dyspnea. During inspiration, intrathoracic pressure becomes negative relative to atmospheric pressure. Consequently, the airways tend to increase their diameter during inspiration, and unless there is a real, relatively fixed obstruction (or increased secretion in respiratory tract), little or no breath sounds are produced during inspiration. Intrathoracic pressure increases relative to atmospheric pressure during expiration, thus tending to collapse the lower respiratory tract and causing wheezing. Whistling is a relatively continuous expiratory sound, usually more musical than stridor, which is caused by turbulent airflow. Partial airway obstruction may cause whistling only during late phase exhale.

The etiology of wheezing is multiple, most common reason-this is diffuse bronchial obstruction as a result of contraction of bronchial smooth muscle, inflammation of the airways or excess secretion.

Children often have breathing problems. But most often, parents are worried about the child’s noisy breathing, which manifests itself in different shapes and depends on the degree of obstruction (obstruction) in the airways. Experienced doctor by the sounds of the noise produced, it is easy to determine its cause. For example, snoring often indicates congestion in the nasal cavity, or at the back of it.

A bubbling sound when a newborn baby inhales or exhales is a sign that mucus has accumulated in his throat and airways, preventing the free passage of air. Over time, the baby will learn to clear his throat. In any case, it is necessary to determine whether the child is healthy or not. Some children feel quite normal, they have a good appetite, and bubbling when breathing occurs due to the flow of mucus from the nasal cavity into the nasopharynx. Others, on the contrary, get sick with a high temperature and feel unwell, which indicates a serious respiratory disease: pneumonia or bronchitis.

Whistling is the name of the sound produced by the throat only when inhaling. It usually appears when hit windpipe foreign object, with croup and inflammation of the epiglottis - bacterial disease, affecting the epiglottis, which protects the windpipe from food entering it. When the epiglottis is inflamed, the child feels worse, has a sore throat, a croupy cough appears, similar to a seal barking while fishing, the child has difficulty swallowing, and when the epiglottis becomes even more inflamed, it becomes difficult to breathe. Further inflammation can completely block breathing, so as soon as a characteristic whistling sound appears, consult a doctor immediately.

Wheezing is heard only when exhaling. This is a characteristic high, even melodic sound, similar to the sound of a musical wind instrument. Most often it appears with asthma, sometimes the cause may be an infectious disease and a foreign object. In infants aged one to six months the usual reason Winter wheezing is a disease called bronchiole inflammation, caused by a virus that causes non-diphtheria croup and colds in older children and adults. In infants, however, the problem can be very serious. I note that any wheezing in infancy must be taken very seriously.

Recurrent wheezing is almost always caused by asthma, which often runs in families. In addition, eczema and hay fever. Almost every fifth child suffers from asthma, and due to pollution environment the disease is becoming very common. A sign of asthma can be not only wheezing, but also a dry cough at night or a cough caused by physical activity in the cold. Parents often note that when a child has a cold, the chest is almost always affected, and wheezing worsens at night and occurs with renewed vigor immediately after waking up in the morning. There are many causes of asthma. These include colds, physical activity, different kinds infections, allergies and emotional factors.

What can you do?

If your child has trouble breathing, you need to find out what his overall health is. Some alarming sounds in your baby's throat may simply be the result of a buildup of mucus that is easily coughed up. But if the child heat This is probably an infectious disease. Pay attention to how the child breathes, how difficult it is for him to do it, whether he raises his arms and shoulders, leaning on something, trying to help himself breathe. Sometimes his neck and chest muscles may become very tense. A serious sign, which requires urgent health care, is blue lips. Sometimes alarming symptom is the child's breathing rate. In general, if a child’s severe illness does not go away for a long time hoarse breathing, if he feels unwell, if he is depressed and lethargic, call a doctor immediately.

What can a doctor do?

The doctor can determine the severity of the child's condition by his breathing and as a result general examination. Exists a big difference between coughing during children's games and running and that state when a child suffocates while lying calmly in bed, covered with a blanket. By the breathing rate you can determine how saturated the child’s blood is with oxygen. Breathing with extra tension and blue lips is a sign serious illness. The loudness of the breathing noise does not necessarily indicate the severity of the condition, since the greater the obstruction, the quieter the sound. Listening with a stethoscope helps identify the location where this sound is produced. If the source of noise is in the throat, breathing in the chest will be free of noise. But if the lungs are affected, a sound characteristic of this condition will be heard.

The doctor’s task is to accurately determine the cause of noisy breathing and take appropriate measures. Nasal congestion due to a runny nose or allergies can be relieved using the most common medications, antiallergic sprays. For inflammation of the epiglottis, serious infectious disease, hospitalization is required, where the child must be treated with antibiotics, and, if necessary, ventilation and oxygen therapy. Inflammation of bronchioles in infants also requires treatment in inpatient conditions because if the breathing difficulty gets worse, you may need to artificial respiration. Psychotherapy, oxygen therapy and antibiotic treatment may also be used to prevent the infection from spreading.

When treating asthma, the help of not only doctors, but also the child’s parents is required. With this disease, it is necessary to teach the child to control his breathing using a special device that determines the strength of the flow of exhaled air, and then, using all kinds of inhalers, to help himself during asthma attacks. It is useful to keep a diary of the child’s health, in which you need to record the dependence of the baby’s well-being on various methods treatment, doing this under the supervision of a doctor.

If you don't know this yet, remember this:

• The causes of noise during breathing are varied.
• In case of inspiratory noise, urgent treatment is required.
• Constant wheezing when exhaling usually occurs with asthma.

Do you easily recognize your baby from thousands of other children by his breathing? Have you ever thought that noisy breathing in a child can mean serious problems in the respiratory system? Let's assess the situation without panic - in our article.

The word "stridor" comes from the Latin "stridor" - hissing, whistling.

Noisy breathing - stridor - occurs due to a narrowed lumen of the larynx or trachea.

This narrowing can be caused by two main reasons:

• congenital (features of the structure of the respiratory tract of newborns);
• acquired (for example, hitting foreign objects V respiratory system child).

Stridor is a symptom, not a diagnosis.

There are three forms of stridor:

Inspiratory stridor:

• noisy breathing is heard when inhaling;
• low sound.

Expiratory stridor:

• noisy breathing occurs when exhaling;
• average pitch.

Biphasic stridor:

• loud, noisy breathing.

The main task of parents is to notice how and when the baby’s usual breathing has changed and tell the doctor about it.

Expert opinion

Alexander Perfilyev, pediatrician at the clinic for children and adolescents “SM-Doctor”": Signs of breathing problems can also include wheezing heard at a distance, increased breathing (shortness of breath), cyanosis of the nasolabial triangle (the appearance of a bluish coloration of the skin), retraction (retraction) of the intercostal spaces.

How can you tell if your child has trouble breathing?

The main symptom of the disease is a whistling, ringing noise that can occur during inhalation, exhalation, or both. The intensity of noisy breathing increases when the baby lies on his back, is overexcited or screams. However, stridor may disappear during sleep. First of all, it is necessary to prevent foreign bodies from entering the respiratory tract.

Causes of noisy breathing, or stridor, in children

Let's look at the most common causes of noisy breathing in children.

Other causes of stridor may include foreign bodies in the airway, various tumors larynx, trachea or esophagus, infections, swelling, for example due to an allergic reaction.

Stridor in children: which doctor should I contact?

To understand what causes noisy breathing in a child, great importance have data obtained by the doctor during examination little patient, as well as parental observations.

Expert opinion

Alexander Perfilyev, pediatrician at the clinic for children and adolescents “SM-Doctor”: Due to the variety of forms and causes of difficulty breathing, consultation and intervention may be required various specialists- ENT doctor, allergist, pulmonologist, infectious disease specialist. IN mandatory X-rays and other examinations will be prescribed according to the specialist’s indications. It is worth noting that for any respiratory disorders it is necessary to carry out the entire range of diagnostic and medical procedures as soon as possible!

Noisy breathing may be a consequence wide range disorders in the body. Therefore, if stridor in a child causes problems with feeding or sleeping, consultations with specialists such as,

Quite often, children in the first months of life snore loudly and heavily while sleeping. Most often, a child's noisy breathing is caused by excessive dryness of the nasal mucosa, which occurs due to a decrease in air humidity. In addition, constant inhalation of dry air contributes to the appearance of dry crusts in the nasal cavity, which makes breathing difficult.

Also, snoring may be associated with anatomical and physiological features of the structure of the nasopharynx, characteristic of infants. The nasal passages in infants are significantly narrow, which contributes to the appearance of noise when inhaled air passes through the nose. As the baby develops, the nasal passages become larger, and closer to one year old breathing becomes quieter. Define the real reason Only an otolaryngologist, whom you should definitely visit, can determine why a child sniffles during sleep.

As a rule, the causes of noisy breathing in a child at night are various anatomical changes in the nasopharynx, which provoke a narrowing of the nasal passages.

These include:

• adenoid growths;
• acute or chronic form runny nose;
• deformation of the nasal septum;
• nasal polyps;
• swelling of the mucous membrane of inflammatory origin;
• anatomical abnormalities of the nasal cavity;
• malformations of the hard and soft palate.

A child may also wheeze heavily during sleep if they regurgitate excessively after feeding. When the baby is in a lying position, the gastric contents enter the posterior section nasal cavity. In this case, the inhaled air passes through the nasopharynx, accompanied by wheezing sounds. To prevent such phenomena, you should keep your baby in vertical position 10 minutes after each meal.

If a child sniffs loudly through his nose in his sleep, but there is no disturbance in appetite, general malaise, or sleep disturbance, he is active and does not experience any discomfort, then there is no reason to worry. It is only necessary to ensure optimal temperature and humidity conditions in the room and proper hygienic care.

In case of lack of air during feeding, breast refusal, increased irritability baby, you should definitely seek medical help.

What should mom do?

Only after it has been established why the child is sniffling night period time, you can begin to eliminate this problem.

Comfort

First of all, it is necessary to ensure comfortable microclimatic conditions in the room where the child is; the air in the room should not be dry and polluted. The best option To maintain the required temperature and humidity conditions, it is considered to use a humidifier. If it is not possible to purchase one, as an alternative, you can place towels soaked in water on the radiator, or place containers filled with water in the room. In addition, we should not forget about wet cleaning and regular ventilation of the room.

Hydration

In addition, you should moisturize the nasal mucosa. Nasal drops made from a 0.9% sodium chloride solution help eliminate crusts that have formed and prevent dryness in the nasal cavity. You can also use for this purpose water-salt solutions, which can be purchased at the pharmacy or prepared yourself.

It is recommended to carry out the procedure three times a day, instilling 2-3 drops into each nasal passage. After the manipulations, if necessary, you can remove crusts from the nose using homemade wicks made of sterile cotton wool dipped in olive, peach or vaseline oil.

Drops

In order to normalize nasal breathing, it is necessary to use vasoconstrictor nasal agents. However, you need to know that the effectiveness of such drops is significantly reduced with prolonged use. To prevent excessive drying of the mucous membrane, it is recommended to apply drops to the child’s nose half an hour after the use of drugs with a vasoconstrictor effect. sea ​​buckthorn oil or other lubricating drops.

Operation

If sniffling during sleep is caused by anatomical obstacles to full breathing (adenoid growths, polyposis, abnormalities of the nose, etc.), apply surgical methods Treatments aimed at eliminating the causes of noisy breathing at night.

For every caring parent, the child’s anxiety is real torture. If you find any problems with nasal breathing, you should definitely visit a pediatrician and otolaryngologist. Because the sooner the cause is identified and appropriate measures are taken, the faster the problem can be solved.