Laryngeal stenosis in children
There are many reasons for the development of laryngeal stenosis in pediatrics. These include congenital malformations, acquired stenoses. What is stenosis itself? This is a narrowing of the lumen of the larynx, leading to the fact that air can hardly pass through the airways. Acquired stenoses are acute and chronic. Chronic stenosis develops slowly, because of this, the body has time to adapt to hypoxia, and its manifestations are not so noticeable.
In acute stenosis, the narrowing of the larynx occurs very quickly, immediately signs of hypoxia occur. This condition in children can be associated with the peculiarities of the anatomical structure of the larynx. From above it is covered with a soft epiglottis, in the subglottic region it is very developed, prone to edema and having many blood vessels, connective tissue. The larynx itself is very narrow and has the shape of a funnel. In an adult, the larynx is in the form of a cylinder, wider. It should be remembered that the younger the child, the more severe the disease.
Laryngeal stenosis can be caused by:
Diphtheria (true croup), Acute laryngotracheitis (false croup), Epiglottitis (inflammatory disease of the epiglottis), · Foreign body of the larynx.
Most often, pediatricians in their practice are faced with acute laryngotracheitis. It is believed that false croup is a complication of a viral infectious disease (ARVI, flu). Why did the division of false and true croup arise, what is their difference? With true croup, the lumen of the larynx is blocked by specific films. With false croup, the symptoms are the same, but the reason is different. Here, the lack of air occurs due to an instant spasm of the larynx due to edema.
You will not meet an adult diagnosed with false croup. More often children from six months to three years old are ill, less often children of a different age category.
What are the main manifestations of acute laryngotracheitis? Usually the disease develops 2-3 days after the onset of the underlying disease, hoarseness appears. Then a ringing barking cough and noisy breathing join. All these three signs are characterized as a triad of symptoms. Croup develops usually at night or in the morning, unexpectedly. In addition to the main symptoms, the child will have anxiety, fear, excitement. With physical activity and anxiety, the condition can worsen. In severe cases, the child begins to turn blue, suffocate, and may lose consciousness.
There are four degrees of laryngeal stenosis:
1. First degree (compensated) - symptoms appear only with physical exertion and strong emotions. There is no hypoxia.
2. Second degree (subcompensated) - symptoms appear at rest. The baby's anxiety is noted, upon examination, there are signs of the participation of the auxiliary muscles in the act of breathing (retraction of the intercostal spaces, sub- and supraclavicular fossae).
3. Third degree (decompensated) - all the symptoms are pronounced, there are signs of hypoxia (blue lips and fingertips, pale skin, increased heart rate). Arrhythmic breathing appears, asphyxia may occur.
4. Fourth degree (terminal). At this stage, the baby's condition is very difficult, the child is unconscious, breathing is frequent, shallow. The heart rate is already decreasing until the heart stops working. Although sometimes it may seem that the child is better due to the fact that there is no shortness of breath, barking cough and noisy breathing.
Diagnosis of acute laryngotracheitis is based on clinic data, direct laryngoscopy is performed. There is no need for laboratory research. Fluoroscopy in this disease plays an auxiliary role in the differential diagnosis of possible complications (pneumonia).
What to do with acute laryngeal stenosis? The main thing is not to get confused. Call an ambulance right away. Answer the dispatcher's questions correctly and clearly. Thus, you will be able to send a specialized team and help you faster. Before the ambulance arrives, try to help the baby yourself. First of all, you need to calm down and calm the child yourself. Become an example for the baby, with your tantrum, the child will also worry. At rest, it will become much easier for him.
Your actions:
1. In the absence of allergies, you can give a natural sedative (tincture of motherwort, valerian).
2. Give more warm alkaline drink to thin the mucus in the respiratory tract (milk or tea with honey, mineral water without gas).
3. If you are prone to allergies, give any antihistamine. It should be in the home of those parents whose children are prone to allergic reactions.
4. Open the window (window), hang wet towels or sheets in the room. These activities will humidify the air, the child will breathe easier.
5. For hands or feet, you can make a warm bath.
All your actions will help blood outflow, relieve laryngeal edema. Upon the arrival of an ambulance, the baby will be provided with emergency medical assistance, hospitalization in a medical institution will be offered. It is advisable not to give it up, since the child will be under the supervision of a doctor for some time, the necessary diagnostic measures will be carried out in the department. And most importantly, they will make a swab from the throat and nose to exclude such a formidable disease as diphtheria.
Pulmonary artery stenosis in children and newborns
With this disease, the child will also have manifestations of hypoxia and shortness of breath. Especially in advanced and severe cases. The extent of symptoms will depend on the extent of the stenosis. If the narrowing is small, then there will be practically no manifestations. This disease is relatively rare. Due to the narrowing of the lumen of the pulmonary artery, it becomes difficult for blood to pass into the pulmonary artery from the right ventricle. Over time, it increases in size due to muscle tissue, since each time the blood needs to be distilled with more and more force.
In newborns, pulmonary artery stenosis is manifested by symptoms of congestive heart failure (dyspnea at rest, cyanosis).
For diagnostics, the following research methods are used:
ECG - right ventricular hypertrophy is detected;
PCG - a study of heart murmurs (with stenosis of the pulmonary artery in children, rhomboid or fusiform murmurs are noted;
· Radiography - reveals an increase in the size of the heart.
If the stenosis is not very pronounced and there are practically no symptoms, then no special treatment is required, only symptomatic. With the progression of the disease, an increase in the degree of stenosis, the child undergoes surgical treatment. The optimal age for treatment is 5-10 years.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
