Noisy breathing is common in children, and can be a sign of many different conditions, some of which are very benign and some of which require urgent treatment. Noisy breathing is typically caused by a partial blockage or narrowing at some point in the airways (respiratory tract). This can occur in the mouth or nose, in the throat, in the larynx (voice box), in the trachea (breathing tube) or further down into the lungs. It is created by turbulent or irregular airflow caused by the narrowed airway. This can cause the surrounding tissues to collapse, or can be a single fixed point of narrowing.
It can be difficult for a parent or family member to discern the severity of a problem when there is noisy breathing. If you are concerned, you should seek medical evaluation immediately.
Signs that indicate more severe conditions include: irritability, poor feeding, pulling in of the skin at the collar bone, between the ribs, or under the ribs, flaring of the nose, increasing effort to breathe and poor weight gain or weight loss, especially in infants.
Symptoms that should trigger emergency evaluation include: pauses in the breathing, color change of the skin (particularly if the lips, face or hands are turning blue), drooling, appearing lethargic or tired, or any other sudden change from a child’s normal breathing pattern. If any of these or other concerning signs develop, please seek immediate medical attention.
Evaluation of noisy breathing starts with documenting the patient’s history and performing a physical examination. This information is critical in narrowing down the cause of noisy breathing and in determining how severe the symptoms are. Important aspects of the history include whether it was present at birth, or developed later on, and the course in time over which it developed. Certain characteristics of the noisy breathing help to determine the location of narrowing. These include whether noisy breathing occurs on inspiration, expiration or both. The pitch and loudness of noisy breathing also is an important factor.
Depending on the history and examination findings, a pediatric otolaryngologist may recommend an in-office laryngoscopy/nasopharyngoscopy or an operative laryngoscopy and bronchoscopy. At times, certain x-rays or other tests, like sleep studies and swallowing studies, may be recommended.
Many treatment options are available for noisy breathing and depend on the cause of the symptoms. At times, monitoring and supportive care are recommended. Certain medications may be helpful in treating symptoms or managing related conditions.
For more severe issues, surgery may be recommended. A pediatric otolaryngologist will discuss all possible treatment options and make recommendations for the most appropriate treatment.
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