Noisy breathing in children can be concerning for both parents and clinicians. The aetiology may not be easily apparent on office assessment. Having a systematic approach and understanding potential pathologies can help differentiate which children require referral.
- Most children breathe comfortably and quietly both awake and asleep. If present, airway noise can indicate the presence of either a static or dynamic obstruction.
- Assessment of noisy breathing in children begins with questions about the onset, severity and progression of the noise, associated features, history of previous intubation and the possibility of a foreign body.
- General inspection, listening to the sound and how it correlates with respiration, and examining the nose, oral cavity, neck and chest can help localise the region of pathology.
- The nasal cavity, oral cavity, larynx and trachea are potential sources of various airway noises and presentations. Correlating the site with age, acuity of onset and associated symptoms narrows the differential diagnosis.
- Consider referral to an ENT surgeon for anatomical assessment and potential intervention if there is persistent noisy breathing, especially if associated with parental anxiety, difficulty feeding, slow weight gain or increased work of breathing.
- Refer to the emergency department if there are prolonged apnoeas, dusky episodes or blue spells when the child is awake or asleep, or if there is concern about a foreign body, especially a button battery.