Noisy breathing in children is a common condition, usually caused by a blockage in the air passages.
Noisy breathing is generally caused when a blockage somewhere in the breathing passages creates abnormal airflow. The blockage can be anywhere from the mouth to deep inside the lungs. Noisy breathing may be harmless or a life-threatening condition.
When parents complain that a child has noisy breathing, the healthcare professional will want to know: what the breathing sounds likewhen the noisy breathing startedwhether it is constant or only occurs sometimeswhether it goes away during sleepwhether the breathing is affected by changes in positionwhether symptoms get worse with feedingif there are any signs of an infection, such as a cough, fever, or runny nosewhether the child snores during sleepif there is a family history of noisy breathingwhat other medical conditions the child has, if any
Other questions may also be asked, depending on the history and the results of the physical examination.
There are many causes of noisy breathing in children. The many possibilities include: small objects into the mouth that have been unintentionally inhaled into the windpipea structural defect such as a deviated nasal septum, which divides the two nostrils unequallyrespiratory infections, such as croup, influenza, pertussis, epiglottitis, pneumonia, respiratory syncytial virus (RSV) infection, bronchiolitis, and the common cold.metabolic conditions, such as cystic fibrosis, an inherited condition that affects the lungsasthma, which results in reversible narrowing of the airwaysgastroesophageal reflux disease, which occurs when stomach contents and acid flow backward all the way up into the throat and mouth and affect breathing.sleep apnea, a condition that results in a blockage of the airway in the throat during sleepcancers or other tumors that partially or fully block the airwaysnervous system problems or damage that affect the ability to breathe, such as cerebral palsy paralysis of a vocal cordheart conditions, such as congestive heart failure that can cause fluid to collect in the lungs
Most cases cannot be prevented. Small objects should be kept away from young children to who might unintentionally inhale them. Children should receive routine vaccines to prevent some cases due to an infection, such as pertussis.
In some cases, the diagnosis is obvious to the healthcare professional from the history and physical exam. In other cases, further tests are needed, depending on the suspected cause. A chest x-ray is commonly done to look for infections, tumors, and lung or heart diseases. Special x-rays such as a chest CT scan will look for tumors, or a cranial MRI can look for nervous system damage. A test of the sweat called a chloride sweat test may be done if cystic fibrosis is suspected.
In some cases, a procedure called endoscopy or bronchoscopy may be used. A small tube is inserted through the mouth and into the throat and windpipe. The tube has a light and camera on the end of it. This allows the healthcare professional to see the inside of the throat and airway. This test is useful to detect conditions such as vocal cord paralysis, or a tumor or cancer in the throat or lungs.
Long-term effects are related to the cause. For example, cases due to infection often go away and have no long-term effects. Cancer can result in death. Noisy breathing caused by nervous system conditions may sometimes be permanent.
Noisy breathing itself is not contagious. If the cause is an infection, which is often the case, the infection can often be transmitted to others.
Treatment is directed at the cause. A child with a bacterial infection needs to be given antibiotics. Cases due to anatomic defects, such as deviated nasal septum, can often be corrected with surgery. Foreign bodies can often be removed during endoscopy. Gastroesophageal reflux disease can be treated with medications to reduce stomach acid.
Side effects are related to the treatments used. Antibiotics may cause allergic reactions or stomach upset. Surgery can be complicated by bleeding, infection, or reactions to the anesthesia. Endoscopy may cause throat or windpipe irritation or, rarely, tissue damage.
A child with asthma may have occasional "flare-ups" and need treatment for many years. A child with an infection usually gets better and needs no further treatment. Someone with cancer may die if treatment is not successful.
Any new or worsening symptoms should be reported to the healthcare professional. Other monitoring is related to the cause. For example, a child with cancer may need repeated blood tests or x-rays to monitor the effects of treatment.
Rudolph's fundamentals of Pediatrics, 1998, Rudolph et al.