In pediatric medical practice, there are a number of pathological conditions that require emergency medical care. One of these pathologies is laryngeal stenosis.

What is it?

Severe narrowing of the larynx is called stenosis. This pathological condition can occur at any age. Usually the disease develops rapidly. A variety of reasons can lead to the development of stenosis. This pathology is most dangerous in newborns and infants.

The larynx is the organ that is responsible for the production of voice. The vocal cords, which are located inside this anatomical element, take an active part in this. Narrowing or stenosis of the glottis, which is normally found in the larynx, and leads to the appearance of dangerous symptoms of respiratory disorders in the child.

Some doctors also use other terms to designate this pathological condition in children. They also call this narrowing stenosing laryngotracheitis or acute laryngeal stenosis. These terms largely explain the essence and mechanism of development of unfavorable symptoms in a baby.

Babies have several functional and anatomical features of the development of their body. This explains the mechanism of development of pathological narrowing of the glottis.

The mucous membranes lining the respiratory organs are well supplied with blood and are closely connected with lymphoid formations. This leads to the fact that any infection that enters the body can lead to the development of severe narrowing of the glottis.

The abundance of lymphoid tissue in the submucosal space of the vocal apparatus contributes to the development of severe edema and swelling of damaged tissues in a sick baby.

Such manifestations are especially dangerous in children. at the age of 2-6 months of life. In this case, the course of the disease can be extremely unfavorable. Without timely medical care, the baby may even die.

The larynx in children is quite small in size and resembles a “funnel” in shape. The location of the vocal cords in babies is completely different from that of adults. They are slightly higher.

During its development, the disease can sequentially spread to several adjacent anatomical elements. The process begins with the glottis. Then it moves to the subglottic space and the anterior wall of the larynx. In this case, doctors talk about an extensive pathological narrowing. Involvement of the posterior wall of the organ in the pathological process leads to the development of posterior stenosis.

If the tissues of the larynx are damaged in a circle, then this clinical variant of the disease is called circular narrowing. In this case, the course of the disease is already noticeably worsening.

A huge process causes development total stenosis. This condition is extremely dangerous, as it leads to the development of immediate acute respiratory failure. Without medical care, such a pathology can even lead to death.

Reasons

The severity of adverse symptoms largely depends on the initial cause that led to the development of this pathological condition in the child. The most common causes of stenosis in a baby are infectious pathologies. A variety of bacteria and viruses can lead to their development.

Stenosis is becoming a fairly common complication acute laryngitis. This pathological condition is usually caused in children by staphylococcal or streptococcal flora. Much less often, viral infections lead to the appearance of unfavorable symptoms of laryngitis.

Quite often they lead to the development of pathological narrowing of the glottis in children. parainfluenza, scarlet fever, diphtheria, influenza, typhus and others infectious pathologies. These diseases are also dangerous due to the development of a pronounced intoxication syndrome, which is manifested by an increase in body temperature in the child and the development of severe general weakness.

Traumatic injury larynx can also lead to the development of dangerous symptoms of acute respiratory failure in the baby. This pathological condition in newborns is promoted by improperly performed childbirth.

Surgeries on the thyroid gland can cause dangerous complications in the baby, manifested by the development of severe pathological narrowing of the glottis.

In the youngest patients, the cause of laryngeal stenosis is also quite often entry of foreign objects into the respiratory tract. Even a small piece of a toy that the baby twirls in his hands can close the lumen of a child’s bronchus.

This feature is due to the rather narrow lumen of the bronchi in children. An object lodged in the respiratory tract can lead to asphyxia - severe narrowing of the larynx and complete cessation of breathing. In this case, emergency medical care is required to save the child's life.

Congenital diseases of the trachea can also lead to the development of a severe narrowing of the glottis in the child. In this case, unfavorable clinical signs of stenosis appear in newborn babies already in the first hours after birth.

As a rule, treatment of pronounced anatomical defects in the structure of the larynx is carried out only through surgical operations. The decision on the need for surgery is made by the operating pediatric otolaryngologist.

Allergies may also manifest themselves in a child with the development of severe laryngeal stenosis. In most cases, this condition is caused by airborne allergens.

Food and chemicals become a common cause of the development of pronounced narrowing of the glottis in a child. To improve breathing in this case, it is necessary to completely exclude the entry of allergens into the child’s body and prescribe antihistamines or hormonal drugs. Allergic pathologies, according to statistics, most often develop in children aged 5-12 years.

Purulent formations, which appear in the neck area can also spread to the internal parts of the larynx, thereby causing severe inflammation there. This leads to the fact that the child’s glottis narrows and breathing is significantly impaired. The course of purulent diseases, as a rule, is quite severe and occurs with the development of the most unfavorable symptoms.

In some cases, surgical treatment is required to eliminate ulcers on the neck.

Species

In their practice, doctors use a variety of classifications, which include a huge variety of different clinical variants of the disease.

According to the time of onset of adverse symptoms, all stenoses can be acute and chronic. The first narrowing of the glottis in a baby as a result of various causes is called acute. Usually its course is the most dangerous and is quite often complicated by the development of acute respiratory failure.

A subacute process is considered if unfavorable symptoms persist for 1-3 months. The prognosis for this clinical type of disease is usually more favorable. With proper treatment, all symptoms usually disappear completely. In some cases, the inflammatory process may become chronic.

If the pathological narrowing of the glottis in a baby persists for more than three months, then in this case doctors talk about a chronic process. Typically, this clinical variant of the disease appears in children who have some congenital anomalies in the structure of the respiratory tract.

Secondary pathology, which contributes to the preservation of the narrowed lumen of the glottis, can also lead to the development of a chronic variant of laryngeal stenosis in the child.

Pediatric otolaryngologists also identify several clinical forms of the disease. Each of them has its own characteristics in the development and degree of manifestation of adverse symptoms.

In their practice, doctors use a wide variety of tables, which list the main features of the development of each form of this pathological condition.

Taking into account the reason that led to the appearance of narrowing of the glottis, all stenoses can be divided into the following groups:

• Paralytic. They occur in children somewhat more often than in adults. As a rule, they develop in children who have undergone surgery on the thyroid gland or in the area of ​​other formations in the neck. Pathological narrowing in this case occurs due to damage to the vocal nerve during surgical treatment.

Some babies may develop postintubation stenosis, which occurs after improper tracheal intubation.

• Scarring. They can occur both after traumatic impacts and after operations performed on the neck. Traumatic damage to the mucous membranes during surgical incisions leads to the formation of a lot of scar tissue. Such scars tighten the glottis, which contributes to a change in its diameter. Long-term infectious diseases can also lead to the development of scar changes in a child.

• Tumor. They are an extremely unfavorable option for the development of the disease. The narrowing of the glottis in this case develops due to the proliferation of tumor tissue. Severe papillomatosis of the larynx is also a provoking cause of the development of large neoplasms, which, during their growth, cause changes in the lumen of the glottis.

• Allergic. They appear in children who have individual sensitivity to the development of allergies. A wide variety of allergens can provoke laryngeal stenosis. The most common in children include: bites of various insects, inhalation of plant pollen, certain chemicals and foods.

Symptoms

The intensity of symptoms increases as the lumen of the glottis narrows. So, doctors highlight There are several stages of development of this pathological condition:

• 1st degree. With stage 1 narrowing, the baby’s breathing becomes impaired. This clinical variant of the disease is also called compensated, as it has a very good prognosis. At this stage of the disease, the baby’s voice production is impaired. The child's voice becomes more hoarse.

• 2nd degree. Narrowing of the 2nd degree is accompanied by more pronounced adverse symptoms. This variant of the disease is called subcompensated. The baby becomes overly excited, breathes more often, and his skin becomes bright red. In this case, breathing movements become clearly visible from the outside.

The baby’s chest “sinks” in some areas, which are located between the ribs.

• 3rd degree. The most unfavorable variant of the development of this pathological condition is a 3rd degree narrowing. This form of the disease is also called decompensated. In this state, the child can be either extremely excited or completely inhibited. The skin begins to turn very pale, and the area of ​​the nasolabial triangle and lips acquire a blue tint. In the most severe cases, the child may even lose consciousness completely.

Asphyxia

The most extreme stage of the disease is called asphyxia. This is the most dangerous condition, especially for children. This pathology is characterized by complete cessation of breathing. Without oxygen, brain cells begin to die.

If emergency assistance is not provided, the baby may die from acute respiratory and heart failure.

Urgent Care

Parents should remember that the appearance of signs of breathing problems in a child is an emergency indication for to call an emergency ambulance. This must be done before making any attempts and actions to quickly relieve the attack that has occurred.

After calling an ambulance, parents should first of all try to calm down and under no circumstances panic! A “cold” mind is a necessary condition for helping your baby in such a difficult situation.

While waiting for the doctor, try to calm the baby. To do this, you can take the child in your arms. Constantly monitor your baby's condition. Open all the windows and doors in the children's room to ensure a flow of fresh air and oxygen into the room. During the cold season, dress your child in a warm blouse and pants to prevent him from catching a cold.

First aid from parents consists only of carrying out non-specific actions that will be aimed at slightly improving the child’s well-being.

Children who have developed laryngeal stenosis due to severe infectious diseases accompanied by high fever can be given antipyretic and anti-inflammatory drugs. Such first aid is used only for persistent fever.

Used to reduce swelling of the airways and improve breathing antihistamines. These drugs include: “Claritin”, “Suprastin”, “Loratadine”, “Zyrtec” and many others. They are usually used for 5-7 days. Longer use of drugs must be discussed with your doctor.

Treatment

Treatment of laryngeal stenosis is carried out only by the attending physician. In most cases, this pathological condition is treated in an inpatient setting. For this, a whole range of different medicines is used.

If the disease is more severe, the baby will be hospitalized to the intensive care and resuscitation department. If the cause of the pathological narrowing of the glottis is a bacterial infection, then the treatment regimen must include antibacterial agents with a wide spectrum of action.

The frequency of use, daily dosage, route of administration and duration of the course of antibiotic therapy are chosen by the attending physician.

In some chronic forms of stenosis, to improve breathing in sick children, special inhalations. For this, as a rule, alkaline preparations or isotonic sodium chloride solution are used. The number of procedures required may vary greatly. Typically, 12-15 inhalations are performed to achieve a positive effect.

In severe cases of laryngeal stenosis, glucocorticosteroids have a positive effect. The dosage of dexamethasone is selected individually, taking into account the age and weight of the sick baby.

For milder cases, they may be prescribed hormonal agents in the form of inhalations and aerosols. "Pulmicort" allows you to improve external respiration and improve the overall well-being of the child.

During the acute period of the disease, all sick children are recommended follow a special diet. The basis of such therapeutic nutrition is fermented milk products, as well as vegetables and fruits. All dishes are steamed, baked or boiled. Fatty and difficult to digest foods are completely excluded from the children's menu.

After an acute period of illness, a complex of rehabilitation measures is carried out. It is necessary to eliminate residual symptoms and improve the overall well-being of the baby.

Hiking to a salt cave, various physiotherapeutic procedures and hardening are excellent methods to restore breathing and strengthen the baby’s immunity.

You can find out more information regarding this issue in the following video.

Diseases

Narrowing or blockage of various structures and channels in the body is commonly called stenosis. It can occur in the vertebral area, blood vessels and arteries, larynx, heart and other cavities. Such a pathological change is quite dangerous, because in some cases it can affect the functioning of the entire body. Diagnosis of the disease in children and infants is difficult because they cannot tell what and where it hurts. Therefore, a large share of responsibility falls on the shoulders of the parents: they must carefully monitor the child’s condition, especially when the baby is sick or feels unwell.

Symptoms

The disease can develop in children and adults, while the latter are much more likely to seek medical help in the early stages of the disease. Since newborns cannot express how they feel with virtually anything other than crying, their stenosis is diagnosed much later. The manifestation of the clinical picture of the disease directly depends on the location of the narrowing or blockage of the hollow canal. However, there are a number of signs that allow you to determine that a child requires urgent medical intervention. Parents can observe this condition of the baby:

• severe shortness of breath;
• difficult, noisy breathing;
• belching, vomiting;
• intense crying;
• moodiness or lethargy;
• violation of motor skills, coordination of movements;
• lack of response to some manipulations.

At the first signs of stenosis in children, you need to call an ambulance or go to the nearest hospital department. They appear when short-term ischemia of the affected organ occurs. Repeated and prolonged course of symptoms may mean the transition of the disease to an extreme stage, when there is a risk of death.

Children and adults have different causes of the disease. In children, this pathology is usually congenital, but there are cases of exposure to external factors. It is worth understanding that in infancy there are several types of stenosis that occur most often. This damages the spine, arteries and blood vessels, and the larynx. In the first case, the disease may occur due to:

• congenital deformation of the vertebrae;
• hernia surgery;
• other surgical interventions.

The occurrence of disease in blood vessels and arteries carries the greatest danger, since in case of late diagnosis it has the highest mortality rate. The disease is explained by intrauterine anomaly of fetal development and is quite rare in medical practice. Damage to the larynx or trachea can occur for reasons such as:

The causes of stenosis in children partly determine the manifestation of symptoms. Before treatment of the disease begins, the necessary studies are carried out to determine the factor that provoked it. Depending on the organ affected, the child requires observation by an appropriate specialist.

From the moment a child is born, his health is primarily taken care of by one doctor, until the baby reaches a certain age. Therefore, if you notice that your child is capricious, crying, has difficulty breathing, or does not always respond to your words and gestures, seek advice from:

It will help determine why the child began to behave strangely. After a thorough examination, the specialist may refer you to one of such specialists as a neurologist, cardiologist, orthopedist, otolaryngologist, or ophthalmologist. If a child is suspected of having a certain organ, the doctor usually asks the parents what symptoms they observed in the baby. During the appointment, he may also clarify:

1. How long ago did the first signs appear?
2. How often does the baby cry?
3. Does he have random lacrimation?
4. How does he breathe? Are there wheezing or noises?
5. How active is the child?
6. Does he have a tendency to stay in one position?
7. How well does gastrointestinal motility work?

After listening to complaints about the baby’s well-being, examining and taking a full history, the doctor determines the type and location of the disease, and then begins to develop a treatment regimen.

Complications of the disease

The disease consists not only in the narrowing of the lumen of various channels and structures, but also in the complete blocking of the passage. If symptoms of stenosis appear in children and treatment is not started, there is a high probability of complications, including death. Moreover, each type of disease can be deadly. With prolonged damage to the larynx, the following may develop:

• chronic acid starvation;
• disruption of the central nervous system;
• inability to fight infections.

Damage to arteries and blood vessels can be no less complex. In this case, there is a risk of stopping the functioning of a vital organ - the heart. This type of disease can lead to:

• heart failure;
• arrhythmias;
• chest pain;
• impaired blood circulation;
• cardiac arrest.

In cases of spinal stenosis, there is a risk of developing serious neurological diseases, pinched nerves and damage to the spinal cord. Regardless of the type of disease, its complications involve disruption of the most important organs in the child’s body, which can lead to death. The only way to protect your baby from such terrible consequences is to seek medical help in a timely manner.

Treatment of stenosis in children

Despite all the complications that this disease can cause, it is highly treatable, especially if diagnosed early. A fragile child's body endures the disease much more severely than an adult, but at the same time he does not have a more vivid clinical picture. General treatment of pathology such as stenosis in children can be carried out using:

It is worth noting that the choice of one therapy or another largely depends on the stage of the disease. There are several of them:

• the first one passes almost unnoticed;
• the second, manifests itself symptomatically;
• third, irreversible complications are possible.

Drug treatment is effective for some types of stenosis in the first and uncomplicated second stages. Also, a developed disease can be overcome with the help of combination therapy: medications and physical procedures. If complications arise, as well as at the third stage of the disease, surgery may be indicated for the baby. Each method is effective in its own way and is prescribed by a doctor based on the complexity of the disease, the cause of its occurrence, and the age of the patient.

What to do if there are signs of stenosis in a baby?

Considering the danger of this disease, it is appropriate to talk about providing emergency care for a small child. If you notice difficulty breathing, wheezing and shortness of breath, accompanied by lethargy, you need to call an ambulance. If the condition is not so acute, the child is simply capricious, whiny, you need to contact your local doctor as soon as possible or call him at home. What you definitely can’t do is wait and hope that everything will go away by itself. Newborns are most vulnerable to various diseases because they do not have a strong immune system to fight them, nor the ability to talk about what worries them. If stenosis is suspected, it is also not recommended:

• try to provide assistance yourself;
• give medications without first consulting a doctor;
• apply traditional medicine methods;
• listen to treatment advice from friends;
• delay visiting a specialist.

After a medical professional has examined the child and diagnosed stenosis, all treatment measures must be followed, as well as the recommendations given by him. If the doctor insists on surgery, then you should not refuse it, it could cost the child’s life. In any case, you can ask the opinion of a specialist from another clinic.

Prognosis for the disease

It is impossible to say for sure what the prognosis is for stenosis in children. It all depends on the location of the disease and the stage it has reached. We can only say with certainty that in the vast majority of cases, damage to the larynx ends favorably. Spinal stenosis in the presence of nerve damage significantly reduces the chances of full recovery and sometimes has a poor prognosis. Vascular damage can also lead to death, so when diagnosing the disease by ultrasound during pregnancy, the following measures can be applied.

Everyone is accustomed to the fact that children often cough and suffer from a runny nose during the cold season. Children's immunity is imperfect and cannot provide adequate protection against respiratory infections. But you shouldn’t take these symptoms lightly, as they can be harbingers of laryngeal stenosis in children.

This serious condition is a complication of seemingly banal diseases. Therefore, every parent should know how to help their child in case of stenosis.

Description of the pathology

Laryngeal spasm in children is a significant narrowing of the airway. Because of it, babies first show signs of difficulty breathing, and then suffocation.

This condition is also called croup. Translated, this word means to croak. A croaking cough precedes severe constriction of the larynx.

The term croup is obsolete. Modern doctors use it less and less to refer to laryngeal stenosis. Increasingly, the term “stenotic laryngitis” is being used instead.

Children have a special structure of the larynx and trachea:

• The mucous membranes of the child's larynx and trachea are saturated with fatty tissue mixed with lymphoid tissue. In addition, it is densely permeated with capillaries. With the development of the inflammatory process, this contributes to tissue swelling and the development of edema. As a result, a rapid narrowing of the lumen of the larynx occurs.
• The child's airways have a small diameter. The length of the larynx is much shorter than that of an adult. In addition, it is shaped like a funnel. The vocal cords are located higher than in adults. All this contributes to the rapid spread of inflammation.
• The nervous system in a child’s body is not yet fully formed. Because of this, parasympathetic mechanisms of transmission of nerve impulses come first. In addition, this causes the presence of additional reflex areas in the respiratory organs and increased tissue excitability. Because of this, any irritants can provoke the development of laryngeal stenosis in children.

Komarovsky believes that when the first signs of pathology appear, first aid should be provided immediately. The fact is that this pathology disrupts several important functions at once: vocal, respiratory and protective.

Classification of stenosis

At one time, doctors developed several classifications of this pathology. Each of them is based on one of the characteristics of the disease.

Taking into account the speed of development and duration of the course, the following types of stenosis are distinguished:

The rate of development of pathology largely depends on how quickly the adults around the child notice the presence of a problem, and the promptness of the assistance provided.

Laryngeal stenosis is also divided into stages. The onset of one or another stage is determined by the symptoms of laryngeal stenosis in children:

At each of these stages, a sick baby needs emergency care. Parents cannot provide it on their own. They can only provide first aid, and then they must call an ambulance.

Reasons for the development of the pathological condition

Doctors divide all causes of the development of stenosis into 2 large groups: infectious and non-infectious. Infectious causes include:

• Diseases of viral etiology: influenza, adenoviral and respiratory infections.
• Diseases of bacterial origin: diphtheria, scarlet fever, measles, etc.

There are much more non-infectious causes. The most common of them include:

• Allergic reaction. The allergic agent can be food, pollen, medications, household chemicals, etc. This is a common cause of throat spasms.
• Inflammatory processes occurring outside the respiratory system. For example, in the esophagus or stomach.
• Congenital pathologies of the trachea, causing a narrowing of its lumen.
• Purulent processes involving the neck and the areas of the head closest to it. Due to the close proximity of the respiratory organs, inflammation can spread to them.
• Tumors in the trachea and larynx.
• Violation of tissue innervation. This can happen either after an injury or due to a strong emotional outburst. The latter is typical for teenage girls.
• Injuries to the larynx obtained in various ways: burns from hot food, foreign bodies entering the trachea, damage from chemicals, blows to the neck, etc.
• Acute liver failure. This disease is accompanied by the penetration of urea into the mucous membranes of the larynx, which, when interacting with microflora, is converted into a poison that can provoke the appearance of foci of necrosis.
• Inflammatory processes in the respiratory organs. For example, laryngotracheitis.

For any form and stage of pathology, it is important to quickly identify the causes of its development. You can get rid of the symptoms of the disease only by eliminating negative factors.

If the attack develops at lightning speed, then diagnosis is not needed. The main thing here is to have time to help the child. Things are different when the pathology develops gradually. Doctors have time to find out the cause and get rid of it.

Diagnosis begins with an examination. The doctor examines the oral cavity, pharynx and larynx with trachea. Allergy tests are required to rule out the possibility of allergies. If a neuroparalytic process is suspected, a neurologist is involved in the examination. If signs of a tumor are detected, the child is referred to an oncologist.

Additional research methods are used:

• Radiography. It allows you to assess the degree of narrowing of the trachea and larynx.
• Ultrasound of the thyroid gland. An enlarged organ can compress the larynx.
• Computed tomography of the neck organs.
• Bacteriological cultures to identify an infectious agent.

General blood and urine tests are required. They allow, by indirect signs, to identify the presence of a hidden inflammatory process that can cause laryngeal stenosis in children.

Acute attacks of croup can develop very quickly. For this reason, it is very important that parents know how to provide emergency assistance to their child. This can save the baby's life until doctors arrive.

When the first signs of stenosis appear, parents should take the following steps:

It is very useful to have Prednisolone in your home medicine cabinet. This drug can help when the pathology begins to enter the third stage. The medicine has a lot of side effects, but if the child’s life is at risk, there is no choice. It quickly eliminates swelling and signs of allergies. Small children can be injected with no more than half an ampoule. Teenagers can administer the whole ampoule.

To eliminate the pathological condition, drug therapy and surgical treatment can be used. The choice of treatment technique is determined by the severity of the symptoms and the cause of the stenosis.

Conservative therapy

This treatment is prescribed exclusively in the initial stages of the disease. Doctors are trying to get rid of the causes of narrowing of the larynx with the help of medications. Their set is determined by the causes of the pathology.

In some cases, the doctor may allow the child to be treated at home. This usually occurs when the pathology is caused by laryngitis. But even at home, bed rest must be observed.

Parents should not provoke their child to talk. Excessive stress on the cords can have a negative impact on the formation of inflamed vocal cords.

It is necessary to regularly ventilate the room. If the pathology is complicated by allergies, then you should avoid compotes and foods that can provoke an allergic reaction.

You can do inhalations with medicines and infusions of medicinal herbs.

In a hospital setting, conservative Treatment is carried out using the following groups of drugs:

• Antiviral agents: Grippferon, Viferon, Alfaron, Tsitovir, Kagocel.
• Antibacterial drugs for acute inflammatory processes: Amoxicillin, Augmentin, Zinacef, Summed, Hemotsin.
• Antiallergic medications: Xizal, Zodak-Express, Erius, Dezal, Fexadin.
• Decongestants: Naphthyzin, Galazolin, Tizin, Delufen, Furosemide.

All medications are prescribed by a doctor. Parents should not treat their child at their own discretion.

For grades 3 and 4 stenosis, there is no point in using medications. They simply do not have time to exert their effect before death occurs, so doctors resort to surgical intervention.

Today, when treating airway stenosis, doctors practice the following types of operations:

To restore respiratory function, doctors may intubate the child. We are talking about placing a special tube into the trachea through the mouth.

Intubation is performed only in cases where doctors are confident that they can eliminate the spasm with medication.

Fortunately, not all parents know what laryngeal stenosis in children is. But this is only partly pleasing, because this disease is not only dangerous for the baby’s life, but also very “insidious”, as it can manifest itself at any moment. Therefore, every parent should have information about what this disease is, what its symptoms are and the rules for providing first aid to a child affected by this disease.

What is the danger?

Today, the most complex sections of pediatrics, otolaryngology and surgery are those that specialize in the treatment of children with various obstructions of the larynx (stenoses). How dangerous the disease is for the health and life of the baby can be judged even by the fact that ambulances respond to such calls many times faster than to patients with heart attacks. After all, the “insidiousness” of laryngeal stenosis lies in its rapid development. And if the child is not provided with qualified medical care in a timely manner, asphyxia may occur.

General information

Laryngeal stenosis is a patient’s condition in which there is a complete or partial narrowing of the already narrowest part of the respiratory system - the larynx. At the same time, the passage of air into the lungs becomes difficult, as a result of which the patient begins to experience hypoxia. This condition can develop against the background of any respiratory tract disease or as a reaction of the body to irritants (allergies). That is why laryngeal stenosis in children and adults in medicine is not classified as a separate disease, but is called a concomitant symptom or condition.

Forms of stenosis

Depending on the causes of occurrence and the rate of progression, the disease is divided into acute and chronic forms. In the first case, narrowing of the lumen of the larynx develops in a very short period of time and threatens the health and life of the patient. The condition usually occurs against the background of diseases such as laryngotracheobronchitis, false and true croup, phlegmonous laryngitis, as well as swelling of the respiratory tract. Acute laryngeal stenosis in children can also develop due to a foreign body entering the trachea, chondroperichondritis, or injury.

The chronic form of the disease is characterized by slow development against the background of diphtheria, formations and tumors of the larynx after injuries and other diseases of the respiratory tract. In general, this disease does not pose a threat to the health and life of the patient. However, it is worth remembering that the chronic form of the disease can transform into an acute form due to injury or inflammation in just a couple of hours.

Why does stenosis develop?

There are many reasons for narrowing of the larynx, and in medical practice they are divided into two groups: infectious and non-infectious. The first includes diseases caused by RSV, influenza, parainfluenza and adenovirus viruses. Also, quite often the causes of stenosis are infectious diseases of bacterial origin, such as diphtheria, epiglottitis, peritonsillar and retropharyngeal abscess.

Before considering non-infectious causes of laryngeal stenosis in children, it is worth saying that they provoke the disease much less often than viral diseases. But, despite this, the consequences of non-infectious stenosis can be many times more complicated, since a narrowing of the larynx develops due to the entry of a foreign body into the respiratory tract, an allergic reaction or injury.

Symptoms of stenosis

The first signs of illness in a baby may not be noticed even by the most attentive parents. This is explained by the fact that the symptoms of stenosis are very similar to the clinical manifestations of a common acute respiratory infection. The baby may have a slight increase in body temperature and a runny nose. In addition, do not forget that each baby is individual, so if laryngeal stenosis begins, the symptoms in children may vary.

The next stage of development of stenosis, which is characterized by a strong paroxysmal cough, hoarse voice and rapid noisy breathing, cannot leave adults indifferent. Parents should also be concerned that the child’s condition is rapidly deteriorating, he becomes lethargic and irritable, which indicates the onset of hypoxia.

In such a situation, it is important not to panic, to immediately call an ambulance, and to provide first aid to your baby before the team of professionals arrives.

Degrees of stenosis

In order to provide effective assistance to a sick child, it is necessary to assess the stage of development of the disease. Not only doctors, but also parents should know how to do this. By navigating the situation, they will be able to help their baby before the ambulance arrives, preserving his health and life.

1. So, the first degree of the disease - compensated - appears only under strong emotional and physical stress. In this case, there are completely no signs of hypoxia. The baby's breathing becomes rapid and a little noisy.
2. As for the second (subcompensated) degree of laryngeal stenosis in children, its signs can be noticed even when the baby is at rest. He usually shows anxiety due to discomfort that he does not understand. In addition, when examining the patient, pronounced signs of the work of auxiliary muscles are observed. In other words, on the back of the baby you can see the retraction of the supraclavicular and subclavian fossae, as well as the intercostal spaces.
3. The clinical picture of the third (decompensated) degree of the disease is characterized by pronounced signs of hypoxia, such as pallor of the skin, blue discoloration of the fingertips and lips. The baby’s heart rate and irregular breathing also increase. If a patient in this condition is not provided with medical assistance, asphyxia occurs.
4. The fourth (terminal) degree is characterized by severe unconsciousness. In this case, the child can hear shallow, rapid breathing. In some cases, it may even seem that the baby is better, since he does not have noisy breathing, barking paroxysmal cough and shortness of breath.

Diagnosis of stenosis

If one of the parents suspects that laryngeal stenosis is developing in children, photos of the visible manifestations of the disease on the stands of an otolaryngologist or local physician will help dispel doubts. But only a professional doctor can confirm or refute this diagnosis.

The specialist’s conclusion in the acute form of the disease is based on the clinical picture, medical history and examination of the child’s larynx. The pediatrician clarifies in detail with the patient and parents the sequence of symptoms, as well as the circumstances and time when they appeared. Then the doctor, based on the data obtained, assesses the dynamics and nature of the development of the disease. The last stage of diagnosis is listening to breathing and assessing the visible external manifestations of the disease.

Features of the disease

The acute form of stenosis, especially in children under 7 years of age, is characterized by rapid development, as a result of which signs of hypoxia appear after a couple of hours or even minutes. This peculiarity of the course of the disease is explained by the anatomical features of the structure of the larynx in children.

The upper part of this unpaired respiratory organ is covered from above by a soft epiglottis, but in its subglottic section there is connective tissue with many blood vessels. It is this area that can swell greatly due to inflammatory processes, allergies and mechanical injuries.

As for the lumen of the larynx in children, it has the shape of a narrow funnel. In adults, this organ is cylindrical in shape and wider. It is precisely this anatomical feature of the structure of the respiratory tract that explains the fact that laryngeal stenosis in children under 7 years of age occurs much more often than in representatives of other age categories.

What should parents know?

If a child, due to an illness or after an injury, has the first symptoms of an illness, for example, difficulty breathing, pale skin or blue lips and fingertips, you should not hesitate.

The first thing household members should do is overcome their own panic and call an ambulance. It is advisable not to leave the child alone during the call and begin to provide him with first aid. To do this, the baby should be calmed down, while his need for oxygen will decrease slightly and he will feel a little better. The child can be picked up or allowed to take a position that is comfortable for him, for example, on the sofa. The main thing at this moment is that adults themselves do not give in to panic; the baby may feel it and get scared.

It is also worth noting that treatment of laryngeal stenosis in children is best done in a hospital. After all, the baby’s condition can quickly deteriorate, and even if the attack was stopped completely, it can happen again. Therefore, it is better not to refuse the recommendations of emergency doctors to hospitalize a patient.

First aid for stenosis

If, with the first degree of stenosis, it is enough to calm the child before the ambulance arrives, then with degrees 2-4, you need to act in accordance with a clear algorithm. In other words, if the baby shows signs of hypoxia and is suffocating, you urgently need to moisten the airways. This can be done by inhalation or humidifying the air in the room. At the same time, the baby should not be nervous and cry.

It is strictly forbidden to give the patient various antitussive syrups and tablets during an attack, as this can serve as an additional impetus for the development of swelling. You should also not rub it with ointments or gels; a foot bath with warm water and drinking plenty of fluids will be more effective.

Inhalations for stenosis

The ideal option would be to have a compressor inhaler and pharmaceutical saline solution at home. After just 2-5 minutes of the procedure, the baby’s condition will improve significantly. But, unfortunately, not everyone can boast of having such an expensive device in their home medicine cabinet. Therefore, you should not panic and think that this is the only way to relieve laryngeal stenosis in children. Inhalation with sodium chloride is only one option to alleviate the baby’s condition.

If there is no inhaler in the house, the child should be taken to the bathroom and turn on the hot water. Increased humidity in a small room will allow the baby to breathe a little more freely until the ambulance arrives.

Treatment of the disease

Before considering the groups of medications that a child may need for recovery, it is worth noting that treatment of laryngeal stenosis in children should only be carried out in a hospital. This can be either a surgical or otolaryngological department of a children's hospital, where there is all the necessary equipment to stop an attack and completely cure the disease.

As for the necessary medications, their list depends on the disease against which the stenosis manifested itself. These can be antibacterial, decongestant and anti-inflammatory drugs, as well as antiallergic and hormonal. The drugs Dexamethasone, Prednisolone or Aminazine can be used directly to relieve laryngeal edema.

In cases where drug therapy does not produce results, and the condition of a small patient is rapidly deteriorating, doctors may resort to a surgical treatment method - tracheotomy.

How to prevent stenosis?

To prevent laryngeal stenosis in children, prevention should be aimed at preventing diseases that cause swelling of the airways. To do this, parents must pay due attention to hardening their children, prevent their children from getting hypothermic while walking in the fresh air, and also strengthen their children’s immune system with vitamin complexes.

If the disease still turns out to be stronger, you should not take the risk and wait until laryngeal stenosis appears in children. Help should be provided immediately. To do this, it is enough to include antiallergic drugs in the course of treatment, but first you should consult with a pediatrician.

Is laryngeal stenosis dangerous or not?

Laryngeal stenosis (laryngotracheitis) is dangerous because of its suddenness. Even during the day, a pediatrician can diagnose a child with laryngitis, and at night, usually an hour and a half after falling asleep, the baby may develop laryngotracheitis. Let's try to figure out why this happens.

Laryngitis is an inflammation of the larynx, but if the inflammatory process spreads to the trachea, swelling and narrowing (stenosis) of the trachea develops, then they talk about the occurrence of laryngotracheitis. The narrowing of the tracheal space and thick mucus prevent air circulation, and the child begins to choke. Typically, inflammation of the larynx and trachea is accompanied by an elevated body temperature of the child (from 38–39 degrees Celsius), lethargic behavior, and drowsiness.

3 symptoms of false croup that parents should always remember!

If parents notice that:

1. The child breathes abruptly, tries to breathe and succeeds with difficulty. The abdomen and chest are sunken. The baby is worried and crying.

2. The baby exhales with a whistle, bubbling audible breathing (stridor) is visible. The stronger the inflammation and swelling of the larynx and trachea, the more powerful and noisy the baby’s breathing becomes.

3. Hoarseness of voice and sharp cough. Laryngeal swelling affects the vocal cords and prevents them from functioning normally. The voice may completely disappear or become hoarse. In this case, the cough resembles a jerky bark (barking croupy cough). It seems that the baby is trying and cannot clear his throat.

All three of these symptoms together indicate the need for urgent hospitalization of the child. Usually the condition worsens, so self-medication is unacceptable.

Parents' actions before the ambulance arrives

The child’s life depends on how correct and coordinated the parents’ actions are with false croup. While the ambulance is on its way, the following measures must be taken:

1. Calm the child so that laryngeal spasms do not increase from crying or fear.

2. Humidify the air in the room or go with the child to the bathroom, where, turning on the water, create humid air.

3. Ventilate the room after covering the baby.

4. Give your child an alkaline drink (warm mineral water without gas).

5. If the temperature is high, then give paracetamol in an age-appropriate dosage.

Do not give syrups, mucolytics or expectorants. Remember, now the baby needs fresh, humidified air to expel mucus, antihistamines and hormonal agents to relieve swelling of the larynx. All this will be brought by the ambulance team. Children diagnosed with stenosing laryngotracheitis require mandatory hospitalization in a children's hospital under the supervision of doctors to relieve the attack.