Worried About Wheezing?

Parents naturally worry about their children. The smallest departure from the norm can send them into a frenzy. Noisy breathing – either while sleeping or awake – is one of those things. However, noisy breathing can have a variety of causes, some of which are not as serious as others. 

Pediatric otolaryngologist Roy Rajan, MD, with LVPG Pediatric Ear, Nose and Throat–1210 Cedar Crest and Lehigh Valley Reilly Children’s Hospital, part of Jefferson Health, says a first step for parents is to consult their pediatrician to distinguish where the noise is coming from. If needed, a multidisciplinary team comprising specialists from pulmonology, gastroenterology and otolaryngology (ear, nose and throat) come together to evaluate each case. 

“These problems are not always clear cut,” Dr. Rajan says. “It’s valuable to have the diagnostic abilities of these three specialties to arrive at the best possible course of action.”   

A common cause of noisy breathing in infants is laryngomalacia. This is where the tissues above the vocal cords are floppy and move inward when the child breathes, creating noise. Children are born with the condition. As they grow and their muscle tone gets stronger, it usually goes away.  

“Laryngomalacia shows up as noisy breathing at night or during feeding; or parents will see the child’s neck suck in when breathing or they may be spitting up a lot,” Dr. Rajan says. “A visit to the pediatrician’s office will give them reassurance that their child will grow out of it. If in doubt or it gets worse, the pediatrician would refer the child to us.” 

A similar condition is tracheomalacia, when cartilage in the windpipe is weak and floppy, causing it to collapse during breathing. It can result in noisy, high-pitched breathing, a barky cough and feeding issues. Like laryngomalacia, as the child develops, the condition goes away – usually by age 2 or 3.  

In rare cases, laryngomalacia is severe enough to make breathing and gaining weight difficult. “In these cases, we will surgically trim some of the floppy tissue,” Dr. Rajan says.

Still another benign cause of noisy breathing that sounds like snoring (stertor), is the common cold, which can cause congestion in the nose.  This is typically short term and resolves as the illness passes. 

There are some noisy breathing issues that parents are wise to be concerned about. Here are a few:

• Croup: If your child has croup, which causes inflammation of the airway, their breathing will be high-pitched and turbulent (stridor). Dr. Rajan advises going to the emergency room (ER) for medication and possibly admission to the hospital, especially if croup is new.
• Growths: While commonly noncancerous, tumors can grow in the airway and can cause stridor. LVHN’s otolaryngology team uses a tiny camera to examine the throat and help with diagnosis.  The otolaryngology team sometimes removes them under anesthesia.
• Vocal cord problems: Problems with the vocal cords can originate from a viral infection and often cause hoarseness and noisy breathing.
• Compression of airway: This can often be identified through imaging, along with an evaluation of how the child is breathing. The condition may or may not have been present since birth and sometimes requires surgical repair depending on the degree of compression. 

If a child has swallowed a foreign object, noisy breathing is usually not a symptom. They would more likely have swallowing issues, drooling or, if lodged lower, coughing. Asthma in children can cause wheezing and is usually controlled with medication. The most important thing for all noisy breathing issues, according to Dr. Rajan, is to know when to go to the ER. 

“The ER is for life-threatening emergencies,” he says. “If your child is struggling to breathe and their lips are turning a pale blue, go to the ER immediately. However, if your child has noisy breathing but is comfortable and doesn’t turn color or stop breathing, it’s not usually an emergency. In this case, call your pediatrician – or for situations somewhere in between – go to ExpressCARE or JeffExpress.” 

Dr. Rajan says that noisy breathing is usually not serious, and parents can take a deep (quiet) breath before panicking. 

“Fortunately, most kids do not have significant, long-standing problems,” he says. “A lot of noisy breathing is related to respiratory illnesses, and it goes away when the child gets better.”