The Infant With Noisy Breathing

Opinion statement Evaluation of the infant with noisy breathing can be intimidating as it suggests some degree of airway obstruction. Knowledge of airway anatomy and the common causes of noisy breathing in this patient population is critical in making the diagnosis and determining the next step in clinical management. A focused history with emphasis on birth, intubation, and feeding history as well as a complete head and neck examination often yield the diagnosis. The clinician must be able to differentiate stridor from stertor as well as determine whether the airway noise is inspiratory, expiratory, or biphasic. The phase of respiration in which the noise is best heard is an important clue to the level of airway obstruction. Evaluation with awake flexible fiberoptic laryngoscopy (FFL) and/or sedated airway endoscopy is often required for diagnosis and intervention. Differentiating nasal and pharyngeal sources of obstruction from laryngeal anomalies is important for determining urgency of management. Laryngomalacia, congenital or acquired subglottic stenosis, and airway hemangioma are the most common laryngeal sources of noisy breathing in infants. Respiratory papillomatosis and airway foreign body should also be considered but are less common causes. Proper identification, management, and understanding of the current trends in treating these conditions will ensure the best possible patient outcomes.