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with airway obstruction at or above the level of the larynx often hyperextend the neck and lean forward (“sniffing” position) in an effort to straighten the upper airway and maximize air entry Finally, response to therapies, such as nebulized racemic epinephrine, should be noted FIGURE 75.2 Inspiratory (A ) and expiratory (B ) lateral neck radiographs of a child with upper airway obstruction secondary to a granuloma (arrow ) in the upper trachea Note ballooning of the pharynx during inspiration (A ) and narrowing of the trachea (arrowheads ) below the level of obstruction On expiration (B ), note the normal pharyngeal lumen and dilation (arrowheads ) of the trachea distal to the obstruction The “bunching up” of the pharyngeal tissues (PT ) and the buckling of the trachea (B ) are normal findings on expiratory films Emergency management of the child with stridor depends on its severity and its likely cause Oxygen, nebulized epinephrine, corticosteroids, laryngoscopy, intubation, and even emergency cricothyroidotomy or tracheostomy all have specific roles in the emergency department (ED) management of stridor, depending on its cause (see Chapters 106 ENT Trauma and 118 ENT Emergencies ) Febrile Child In the febrile child with stridor, the onset is generally acute with croup being the most common cause Other diagnostic possibilities to consider include bacterial tracheitis, supraglottitis, and much less likely retropharyngeal abscess The child whose clinical picture is consistent with mild to moderate croup needs no further evaluation History and physical examination alone are the most important