If you’ve noticed your child making high-pitched, squeaky or harsh breathing sounds, especially when they breathe in, they may be experiencing stridor. This is essentially noisy breathing caused by air turbulence at the level of the larynx/upper airway.
Noisy breathing (stridor)
Noisy Breathing in babies and children (Stridor)
Several conditions can cause stridor:
- Laryngomalacia – sometimes termed “a floppy voice box”. This is the commonest cause of noisy breathing in babies
- Narrowing of the upper airway BELOW the level of the vocal cords (Subglottic stenosis) – this may be the case if there is a history of prematurity or previous intubation, or rarely, can be be congenital.
- Vocal cord paralysis – usually this is associated with other symptoms such as a poor cry, or swallow.
- Occasionally, other structural causes may include: tracheomalacia (floppy airway), cysts or masses within the airway, airway haemangioma, glottic webs.
Diagnosis
During a consultation, I’ll begin by taking a detailed history: understanding when the noisy breathing started, whether it’s constant or intermittent, and if it’s linked to feeding, sleep or a recent illness. I’ll then carry out a careful examination of your child, checking their nose, throat, and breathing pattern.
Depending on the findings, I might also:
- Recommend a flexible nasal endoscopy (a tiny camera gently passed through the nose to look at the airway), which can often be done quickly in my consulting room.
- If the diagnosis is unclear or symptoms are severe, the patient might need a detailed examination of the voice box and windpipe under general anaesthetic, this is called Microlaryngoscopy and bronchoscopy (MLB)
Treatments
Treatment varies widely and really depends on what’s causing the noisy breathing. Some of the most common treatments for my patients are:
- ‘Watch and wait’, so no intervention at all. Mild cases of laryngomalacia often require just monitoring over time and in fact if laryngomalacia is mild, this can resolve entirely by itself by the age of 18-24 months.
- If the noisy breathing is due to enlarged adenoids or tonsilitis, we may discuss surgery to remove them, especially if your child has sleep difficulties or frequent infections.
- Laryngomalacia (“floppy voice box”) can resolve naturally and monitoring of feeding, growth and breathing is all that is needed. But for babies with severe symptoms—such as respiratory distress or poor weight gain—a procedure called supraglottoplasty can be performed, where floppy tissue above the voice box is trimmed to open the airway. This is done under general anaesthesia and typically involves a short hospital stay afterwards for observation.
- In severe cases, where complex structural issues have been diagnosed with a MLB, airway surgery may be needed.
Make an Enquiry
If your baby or child is experiencing noisy breathing, trust your instincts; it’s always worth having it checked. As an experienced ENT surgeon working in both the NHS and private practice, I’m here to help you find clear answers and the right treatment for your child.
