Failure to thrive is common in neonates and occurs most often due to inadequate caloric intake; however, it also can be caused by systemic disease associated with inadequate gastrointestinal absorption or increased caloric expenditure, such as congenital heart disease, renal disease (eg, renal tubular acidosis), chronic pulmonary disease (eg, cystic fibrosis), laryngomalacia
, malignancy, immunodeficiency, or thyroid disease.
A few days later she was projectile vomiting and gasping for air, so we rushed to the Emergency Department where she was admitted and diagnosed her with severe laryngomalacia
, a condition that would require surgery to correct.
In young children, enlarged tongue, laryngomalacia
, and congenital goiter syndrome are other causes of stridor (5).
Differential diagnosis of wheeze in children <5 years of age* Category Disease entity Congenital upper airway Complete tracheal rings Tracheomalacia Laryngomalacia
Vocal cord palsy/paresis Subglottic stenosis/post-intubation/ congenital Congenital lower airway Vascular rings/slings Bronchomalacia Aspiration Gastroesophageal reflux disease Swallowing inco-ordination Laryngeal cleft Tracheo-oesophageal fistula Bronchiectasis Cystic fibrosis Primary ciliary dyskinesia Persistent bacterial bronchitis Primary immunodeficiency HIV Endobronchial lesions Foreign body Tuberculosis granuloma Malignancies Cardiac Enlarged heart Congenital heart disease (left-to-right shunts) * Adapted from White et al.
In contrast to infantile VC--which is recognized as a distinct entity and often occurs with laryngomalacia
, leading to choking during feeding, cyanotic spells, failure to thrive, and a feeling of airway obstruction--adult VC is usually asymptomatic.
Episodes of nasal chondritis can lead to a collapse of the nasal septum with saddle-nose deformity, and laryngo-tracheal involvement can cause hoarseness dyspnea and stridor and may lead to subglottic stenosis due to recurrent laryngeal inflammation and laryngomalacia
The adorable four-month-old suffers from laryngomalacia
, a condition better known as floppy voicebox.
There was no evidence of laryngomalacia
. The baby was ventilated for four days and weaned to nasal continuous positive airway pressure.
Stridor in children may be due to congenital anomalies like laryngomalacia
, laryngeal web or vocal cords paralysis or acquired causes like infections2.
These categories included conditions with neurological involvement (such as asphyxia and convulsions), anatomical and structural impairments (including laryngomalacia
), genetic and chromosomal disorders (including trisomy 21), dysphagia secondary to systemic illness (including pneumonia), psychosocial factors (including oral deprivation) as well as dysphagia secondary to resolved medical conditions (including hospital-acquired infections).