38
Table 2.2 (continued)
Short case scenarios
A 2-year-old child presents with recurrent
attacks of sudden-onset stridor, barking cough,
hoarse voice, and respiratory distress. The
symptoms are usually worse at night. There are
no cold symptoms, and the child is afebrile
A 3-year-old female child presents with acute
onset of stridor, sore throat, drooling, high-grade
fever, muffled voice, difficulty swallowing, and
inability to speak or lie flat. She sits upright with
her mouth open and neck extended
A 4-year-old male child presents with a brassy
cough, stridor, respiratory distress, and high
fever, preceded by a viral respiratory infection.
He does not drool and he is able to lie flat
A 1-year-old previously well male child presents
with sudden onset of stridor, respiratory distress,
and severe cough after a history of choking
A 2-month-old child presents with intermittent
stridor that worsens (or may only be present) on
crying, exertion, or lying flat. It is improved by
neck extension
A 2-year-old male child presents with stridor,
respiratory distress, fever, irritability, drooling,
muffled voice, difficulty swallowing, neck pain,
and decreased oral intake. The child has a recent
history of ear infection
History Station 2.5: Stridor
• Identity: Age
• Chief complaint(s): Crowing noise, noisy breathing, or difficulty breathing
• History of present illness:
1. Onset: Sudden or gradual
2 History Taking of Common Pediatric Cases
Diagnosis and special points in favor
Spasmodic croup
 – This usually occurs in children
1–3 years of age
 – It usually occurs at night
 – Cold symptoms are often absent and
the child has no fever
 – Attacks are severe and recurrent, but
usually last for a short period
Epiglottitis
 – This usually occurs in children
2–7 years old who did not receive
Hib vaccine
 – The cough is usually absent or slight
 – The child with epiglottitis is usually
toxic and unwell
Bacterial tracheitis (pseudomembranous
croup)
 – The usual age is between 3 and
10 years, with a slight male
predominance
 – It is often preceded by a viral
respiratory infection
Foreign-body aspiration
 – Focal wheeze may be present
 – There is a history of sudden choking
 – There is no response to medication
Laryngomalacia
 – This is characterized by intermittent
stridor that worsens (or may only be
present) on crying, exertion, or lying
flat
 – It often develops in the first 6 weeks
of life
 – It often improves with age and
resolves at the age of 2 years
Retropharyngeal abscess
 – This occurs in children aged less than
4 years
 – About two-thirds of patients have a
recent history of throat, ear, or nose
infection
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