Airway Obstruction in Children

Question 1

How does mild and severe airway obstruction differ in presentation

Answer 1

Life threatening emergency whether complete or partial

Mild airway obstruction
• Patient responds questions and states they are choking
• Can speak, cough and breathe

Severe airway obstruction 
•	Unable to speak – merely nods 
•	Unable to breath or cough 
•	Unconscious 
•	Breathing sounds wheezy if present

Question 2

How is choking managed?

Answer 2

Mild – encourage coughing
Severe – follow PBLS giving 5 back blows and then 5 chest/abdominal thrusts
Unconscious – call for help then start CPR

Question 3

When are foreign bodies most likely to be swallowed/inhaled?

Answer 3

Common in young infants especially after 6 months when they start to oralise everything. Unusual after 4 years.

Risk factors
Decreased consciousness
Male
< 4 years

Question 4

What are the clinical features of inhaled foreign bodies?

Answer 4

Cough
Stridor 
Dyspnoea 
Sudden onset 
Unilateral decreased breath sounds

Question 5

How should foreign bodies be investigated?

Answer 5

Chest X-ray

Bronchoscopy – more likely in right main bronchus due to it being more vertical

Question 6

How are foreign bodies managed?

Answer 6

Removal of foreign body by encouraging cough and external manoeuvres and then internal removal. If below diaphragm then no intervention needed unless button battery.

Question 7

What are the risk factors for obstructive sleep apnoea?

Answer 7

Craniofacial abnormalities
Adeno-tonsillar hypertrophy
Macroglossia
Gastro Oesophageal reflux

Question 8

What are the clinical features of obstructive sleep apnoea?

Answer 8

Snoring, gasping and choking whilst sleeping 
Apnoeic episodes 
Keeping siblings/parents awake 
Night sweats
Breathing through open mouth 
Sleep walking/talking 
Still tired in the morning

Question 9

How should suspected sleep apnoea be investigated?

Answer 9

A good history
Polysomnogram
Nasal endoscopy

Question 10

How is sleep apnoea managed?

Answer 10

Adenotonsillectomy
CPAP
Treat any other precipitants or related disorders
Montelukast or intranasal budesonide

Question 11

What is stridor?

Answer 11

• High-pitched, harsh, high-intensity inspiratory sound.
• Produced as turbulent flow passes through a narrow segment of UA.
• Suggests upper airway narrowing.
• Can be heard over the upper airways at a distance without a stethoscope.
• Usually inspiratory; can be biphasic.

Question 12

What is stertor?

Answer 12

• Low-pitched snoring or gasping.
• Caused by partial obstruction of the airway above the level of the larynx.
• Produced by vibrations of the naso-pharynx, pharynx and soft palate.

Question 13

What is the difference between stridor and stertor?

Answer 13

Stridor occurs due to obstruction around the glottis, sterotor occurs due to obstruction in the oro/nasopharynx