Pediatric emergency medicine trisk 1494 1494

with developmental delays There may be a history of choking on food or a small object Physical examination varies, depending on the location of the foreign body (see Chapter 32 Foreign Body: Ingestion and Aspiration ) Both ingestion and inhalation of caustic or thermally damaging substances may result in injury to the airway or hypopharynx (see Chapter 104 Burns ) Symptoms of airway compromise may be delayed for as long as hours Blind finger sweeps have also been reported rarely to result in stridor Other causes to consider include spasmodic croup, anaphylaxis, angioneurotic edema, and trauma Chronic Stridor The differential diagnosis of chronic stridor varies with patient age Stridor noted shortly after birth is most likely caused by an anatomical defect This type of stridor tends to slowly worsen and is severe when the infant is crying or agitated Laryngomalacia is the most common cause of congenital stridor accounting for up to 75% of chronic stridor in children younger than year Stridor associated with laryngomalacia is positional and may be relieved by placing the child in the prone position It frequently disappears when the child cries Other congenital causes of stridor include laryngeal webs, laryngeal diverticula, vocal cord paralysis, subglottic stenosis, tracheomalacia, and vascular anomalies such as a double aortic arch or a vascular sling Stridor in infants has also been reported to be associated with gastroesophageal reflux, possibly related to associated laryngomalacia, or acutely secondary to partial laryngospasm