The management of acute upper airway obstruction in children

Abstract The child with upper airway obstruction is one of the most challenging emergencies in paediatric practice. Rapid assessment of the child and an understanding of the epidemiology of the condition will allow the underlying pathology and its treatment to be defined. This article reviews the most common causes of upper airway obstruction and analyses the optimal management. Viral croup is the most frequent cause of paediatric upper airway obstruction. Prompt management with nebulized adrenaline and corticosteroids avoids the need for tracheal intubation in all but a fraction of cases. Sub-glottic stenosis and bacterial tracheitis are less common problems but their management is more complex. Laryngomalacia, foreign body aspiration, mediastinal tumours and lymphadenopathy are uncommon and management is directed towards the underlying lesion. Epiglottitis has become much less prevalent since the introduction of mass immunization, but should be considered in the unvaccinated child.