1. Background

• lack of airway support leads to a functional tracheal stenosis and stridor particularly on expiration although both inspiratory and expiratory stridor can occur
• a self-resolving disorder as cartilagenous development will eventually support the airway
• when a similar process involves the:
  • larynx - laryngomalacia
  • bronchus - congenital lobar emphysema

2. Types

1. Congenital Stridor

• begins within the first few days of life
• worse with an upper respiratory tract infection, forceful breathing (crying, exertion), lying on back
• better with sleep, shallow breathing, prone position
• may be accompanied by wheezing, dyspnea, tachypnea, and chronic cough

2. Complications

• respiratory distress
• opisthotonus
• thoracic deformities (if retractions severe)
• failure to thrive (if difficulty nursing)
• laryngomalacia
• absent ear cartilage

1. Imaging Studies

2. Bronchoscopy

• diagnostic
• collapse of tracheal walls usually during expiration

1. Supportive

• natural history is worsening in first few months with persistence up to 6-12 months then resolution
• respiratory distress:
  • intubation and ventilation
  • control of infection and secretions with antibiotics and humidification, respectively
• feeding difficulties:
  • slow and careful feedings
  • may use dropper or gavage feedings

2. Surgery

• tracheostomy rarely needed