Laryngospasm in children

Laryngospasm, or sharp spasmodic contraction of the vocal cleft, occupies a special place among many painful conditions that require emergency care. Laryngospasm in children often develops during severe crying, stress, fright. Its main manifestations are a pronounced wheezing inhalation with further breath-holding: the baby becomes pale, then - cyanotic, consciousness is disturbed. The end of the attack occurs with a deep loud breath, and after a few minutes the child's well-being normalizes. Severe course of laryngospasm can lead to death due to cardiac arrest.

Epidemiology

Laryngospasm can develop at absolutely any age, but more often it is diagnosed in young children, starting from six months of age and up to 2-3 years old.

Newborns do not suffer from laryngospasm. Specialists point to the physiological impossibility of attacks in children under six months of age, which is explained by the immature state of their nervous system.

Statistically, laryngospasms occur in 5% of children between the ages of six months and three years.

Causes of the laryngospasm in children

Laryngospasm in childhood develops for a variety of reasons:

• Calcium deficiency, associated with low intake of calcium in the body, or with a violation of its absorption;
• weak immune response;
• birth trauma;
• foreign body in the larynx, trachea (small parts from toys, fruit bones, etc.);
• metabolic disorders;
• congenital defects in the development of the respiratory system, in particular - laryngeal, tracheal, bronchial sections;
• taking strong vasoconstrictors;
• choreic hyperkinesis;
• severe stress, fright, any strong displays of emotion, tantrums;
• rachitogenic tetany, spasmophilia;
• rickets;
• bronchitis, bronchial asthma, pneumonia;
• a severe, prolonged cough.

Risk factors

Laryngospasm is more likely to occur in children belonging to certain risk groups:

• premature babies;
• infants with some physical developmental delays;
• children who are initially artificially fed with non-adapted milk products;
• Babies who have been injured during the birthing process;
• kids with hyperactive behavior;
• children suffering from allergic processes (allergorhinitis, conjunctivitis, dermatitis, bronchial asthma), tendency to rickets;
• babies with intestinal disorders, enzyme deficiencies, and those who do not get enough vitamins and minerals from food.

Pathogenesis

Some children are predisposed to laryngospasms due to the physiological characteristics of the respiratory system. There are dangerous and sensitive areas in the pediatric larynx. One of them is located above the vocal cords and is called the subclavian space. And the second is at the level with the vocal cords. In small children in these areas there is unformed fibrous connective and lymphoid tissue. Due to the lack of density, these tissues quickly swell and block the respiratory system: this can happen under the influence of increased temperature, allergic reaction, smoke, infectious process and so on. If these areas have genetic defects, anatomical and physiological changes, then such a child has a significantly increased chance of developing laryngitis and laryngospasm.

Fortunately, as the child grows older, this factor becomes less important.

Symptoms of the laryngospasm in children

Laryngospasm can occur in patients of any age category, but this pathological condition is most often recorded in children in the first two years of life.

The first signs of increasing laryngospasm are a difficult attempt to inhale, accompanied by noise. At the same time, the pallor of the skin increases, turning into cyanosis, which is especially noticeable in the area of the nasolabial triangle. Tension of the neck muscles is visible.

The immediate attack is characterized by such symptomatology:

• the child opens his mouth wide;
• there's an increase in sweat production;
• pulse becomes thready.

Since with the onset of an attack of laryngospasm in the blood increases the concentration of carbon dioxide in the blood, there is irritation of the respiratory center, so breathing is quickly stabilized.

What does laryngospasm look like from the laryngoscopy angle? The vocal cords are tightly pressed together. Attacks tend to recur several times a day, mainly during the daytime. The severe course is usually supplemented by other painful signs:

• semi-fainting and syncope;
• convulsive twitching of the limbs;
• foaming saliva from the mouth;
• involuntary urination and defecation;
• cardiac arrest.

Laryngospasm in an infant

Laryngospasm in young children appears suddenly, without early warning signs, so it is almost impossible to predict the attack in advance. It can start in the middle of the night, when the baby is sleeping, or in the middle of the day and even during play. The baby has too noisy breathing, followed by attempts to cough. The baby becomes restless, tilts his head back. Tension of the neck muscles is noticeable, the mouth is wide open, the frontal surface is covered with sweat, the skin is pale. Convulsions and thready pulse are possible.

The attacks are of varying duration and may recur with varying frequency. In many infants who have experienced laryngospasm once, the problem tends to recur with almost every cold or viral illness.

In some cases, laryngospasm is atypical and in its manifestations resembles an epileptic seizure, as it is accompanied by convulsions of the arms and legs, pharynx and esophagus.

Stages

In its development, laryngospasm in children can go through several stages, which is strongly reflected in the clinical picture of pathology.

• The first stage is characterized by a small laryngeal stenosis, which occurs only during physical or mental impact, stress. Examination and listening to the child is sufficient to make a diagnosis.
• The second stage is manifested by difficulty breathing even in a calm state, without certain stimuli. During inhalation, the baby has a hesitation inside the jugular fossa, there are dry wheezes. There may be signs of oxygen deficiency in the body (blueing of the nasolabial triangle, increased heart rate, general agitation).
• At the third stage, inspiratory dyspnea with retraction of intercostal zones and epigastrium joins. There is a ringing cough with dysphonia, breathing changes. The child is overexcited, but sometimes sharply becomes sleepy, lethargic.
• The fourth stage is the disappearance of the ringing cough and respiratory noises. Inhalation becomes arrhythmic and shallow. Slow heartbeat may be noted. In severe cases, without assistance, hypoxic coma, asphyxia, and death may occur.

Forms

Four degrees of laryngospasm are also known:

• The first degree is called compensated laryngospasm, for which it is typical to have difficulty breathing against the background of physical exertion or stress.
• The second degree is subcompensated and is characterized by difficulty breathing even at rest.
• The third decompensated degree is the presence of severe paradoxical breathing, severely labored breathing.
• The fourth degree is terminal and may end in the death of the patient.

Acute laryngospasm in children always begins unexpectedly and for others, and for the child himself. Its development is sometimes associated with other pathologies, mental trauma, allergic processes, taking high doses of medications. Depending on this, laryngospasm can be allergic, stress, medication, etc.

Complications and consequences

In most young patients, attacks of laryngospasm pass without a trace and do not recur. However, if the disease is severe, complications in the form of such painful conditions are possible:

• muscle cramps;
• respiratory failure;
• heart failure;
• loss of consciousness.

With prolonged laryngospasm, asphyxia, coma, up to death of the patient may develop.

If the diagnosis is timely, if the doctor prescribes competent complex treatment, then you can count on a favorable course of the disease: laryngospasms will disappear as the baby grows and develops.

Diagnostics of the laryngospasm in children

The diagnosis of laryngospasm can be made by a pediatric ENT doctor (otorhinolaryngologist) already after collecting anamnestic information and assessing the clinical signs of the disease. Usually the doctor collects data on the course of the perinatal period, the first signs of malfunction, the sequence of expansion of the clinical picture. Information about other existing pathologies in the baby, about the treatment taken, about the individual characteristics of the organism is important.

Examination of the oral and laryngeal cavity becomes mandatory.

Tests are general in nature and are prescribed to assess the condition of the body as a whole or to diagnose the underlying disease. Usually we are talking about general blood and urine tests. Sometimes it is recommended to take a biochemical blood test, coagulogram, coprogram. During laryngoscopy, a swab is taken from the pharynx with further microscopy and sowing on nutrient media (to identify the pathogen). If it is necessary to determine the degree of oxygen deprivation, then analyze the blood gas composition and acid-base balance.

If necessary, additional instrumental diagnostics is performed: ultrasound examination of the head (neurosonography), radiography of the sinuses and chest, electroencephalography, sometimes assess the work of the heart (electrocardiography, ultrasound).

Differential diagnosis

Differential diagnosis is mandatory: laryngospasm should be distinguished from true diphtheria croup, pharyngeal abscess, acute inflammation of the epiglottis, foreign body in the larynx, acute bronchial obstruction.

Treatment of the laryngospasm in children

If a child has an attack of laryngospasm, the first thing to do is to calm him or her down. To improve air circulation, open a window, unbutton the baby's clothes. Washing the baby with cold water or other irritating action - for example, the child can be pinched, tickled, patted, etc. - has a good effect.

You can give a sniff absorbent cotton soaked in alcoholic ammonia solution, or administer as an enema chloral hydrate in the amount of 0.3-0.5 g per 200 ml of water. In prolonged attacks help warm baths, oral intake of potassium bromide solution twice a day.

In severe cases, tracheal intubation or tracheostomy is performed.

In all cases of laryngospasm in children, even if its course is mild, it is necessary to consult a doctor. General recovery of the child's body, strengthening treatment, hardening is recommended. It is mandatory to prescribe calcium-containing medications, vitamin D, multivitamin preparations, UVB sessions. In nutrition, the emphasis is placed on dairy and vegetable products.

Emergency treatment for laryngospasm in children

The emergency physician must assess the degree of laryngospasm and the general condition of the child, after which he or she prescribes treatment. If the attack is severe, the baby must be taken to an inpatient unit.

For mild laryngospasm, treatment may be as follows:

• ensuring air access;
• Providing sufficient warm fluids (tea, water, compote);
• applying hot compresses or mustard plasters to the calf muscles;
• inhaler administration of baking soda, vitamin A, Hydrocortisone, Eufillin;
• administration of antispasmodics (Papaverine, Atropine);
• taking antihistamines and sedatives (Dimedrol, Pipolfen);
• administration of vitamins (particularly vitamin D).

With a strong attack and lack of the necessary effect of treatment, a novocaine blockade is performed, with which it is possible to relieve the swelling of mucous tissues and reflex compression of muscles.

Severe laryngospasm in children may also require the administration of additional medications:

• hormonal agents (Prednisolone, Hydrocortisone);
• cardiac glycosides (Strophanthin, Corglycone);
• neuroleptics (Aminazine, Promazine);
• hypertonic solutions of calcium gluconate or glucose.

What should not be done for laryngospasm in children?

• Potential allergens such as bee products, citrus drinks, chocolate, etc. Should not be given to the child.
• Essential oils should not be attempted so as not to aggravate the spasm.
• Cough medicines should not be given without a doctor's recommendation.

How to relieve laryngospasm in a child at home

How can you help a child with laryngospasm - for example, before the ambulance arrives? There are several options that can usually help relieve the attack and get your baby breathing normally:

• The baby should be held, soothed, and brought to a window or balcony to get fresh air. If the infant is warmly clothed or wrapped in a diaper, the baby should be removed so that he or she can breathe fully.
• You can put a cotton pad soaked in ammonia solution to the spout.
• It helps to wash the face with cold water, or other distracting actions (you can tickle, pinch the child, slap the palm of the hand on the back, press a spoon on the base of the tongue to trigger the gag reflex).

To prevent an attack, it is necessary to well humidify and ventilate the room in which the baby stays.

In prolonged and severe laryngospasm, artificial ventilation (mouth-to-mouth technique) and indirect cardiac massage may be required. Hospitalization in such situations is mandatory.

Medicines that your doctor can prescribe

Fencarol	An antihistamine systemic drug that is taken orally immediately after meals. The average dosage of the drug is 10 mg twice a day for 10-14 days. Fencarol side effects: dizziness, headache, nausea, drowsiness, bitterness in the mouth.
Dexamethasone	Semisynthetic glucocorticoid drug with anti-inflammatory, immunosuppressive, antihistamine action. The dosage is calculated from the ratio of 0.6 mg per kilogram of body weight of the baby. The route of administration is determined by the doctor: it can be intravenous or intramuscular infusions. Possible side effects: allergies, weight gain, pancreatitis, suppression of adrenal function.
Pulmicort	Glucocorticosteroid drug based on budesonide, available in a convenient multi-dose inhaler. The dose for laryngospasm, the doctor determines individually, depending on the severity of the course of the disease and the age of the baby. Pulmicort is allowed to mix with saline and other nebulizing liquids that include terbutaline, fenoterol, salbutamol, acetylcysteine (such a mixture is used for half an hour). The drug is used for the treatment of children, starting from six months of age. Probable side effects: oral and pharyngeal candidiasis, pharyngeal irritation, sleep disorders, allergies.
Papaverine	An antispasmodic drug that is administered intramuscularly at a rate of 0.1 ml per year of life of the baby, together with antihistamines (e.g., with dimedrol, pipolphen). In some cases, the drug can cause allergies, tachycardia, low blood pressure, impaired visual function.
Motherwort tincture	Sedative, reducing emotional excitability, improving the cardiovascular system. The drug is taken orally after meals at the rate of 1 drop per one year of life of the baby. The duration of treatment is determined by the doctor. Possible side effects: dizziness, drowsiness, apathy.

Berodual for laryngospasm in children

One of the common remedies for laryngospasm attacks in children is Berodual, which is a combination medication consisting of a couple of ingredients with bronchodilator properties. One of the ingredients is ipratropium bromide, a well-known anticholinergic drug, and phenoterol hydrobromide, a sympathomimetic.

Berodual promotes relaxation of smooth muscle fibers of bronchi and vessels, stops the development of bronchospasm.

In laryngospasm, this drug acts somewhat weaker than the popular Pulmicort, but it is safer, has a smaller list of side effects.

Berodual is used in individual dosages depending on age, method of inhalation administration and quality of nebulization. The duration of inhalation is controlled depending on the flow rate of the solution.

The dissolved drug is used in various models of nebulizers or in a breathing oxygen machine. In the latter case, it is used at a flow rate of six to eight liters per minute.

The use of Berodual, if necessary, is repeated at intervals of at least four hours. It is allowed to alternate the drug with Pulmicort.

Vitamins

A particularly important vitamin that can positively affect the course of laryngospasm in children is considered to be vitamin D. This vitamin is synthesized in the skin under the influence of ultraviolet light, but in addition, it can also enter the body with food. Experts consider the optimal amount of vitamin D in the bloodstream to be 30 ng/mL: this is enough to maintain adequate levels of calcium and parathyroid hormone. In general, the main properties of this vitamin are considered to be:

• supporting calcium metabolism in the body;
• stabilizing hormone secretion;
• activation of immune system functions;
• regulation of cell proliferation and differentiation processes.

The "sunshine" vitamin is present in fish oil, eggs. Some products (in particular, infant formulae and juices) are often specially enriched with it to prevent many diseases - in particular, rickets, seizures, bronchial asthma and laryngospasm. However, doctors also prescribe additional preparations that contain in their composition a useful supplement. In most cases, these are liquid vitamin _D3 drops, which can be used for both preventive and therapeutic purposes.

Physiotherapy treatment

Physiotherapy to get rid of attacks of laryngospasm in children involves a number of general strengthening measures aimed at improving the immune response of the child's body, optimizing the work of all vital organs and systems.

First of all, the child is recommended hardening procedures, balneotherapy, resort therapy. It is necessary to walk often in the fresh air, you can go to the sea or to a sanatorium located among coniferous forests. It is also shown hydrotherapy, which is the external effects of water in the form of warm baths, contrast showers, dousing, rubbing, cool wraps. Hydromassage has a powerful effect.

Obligatory becomes physical activity: depending on the age and capabilities of the body, the doctor will select the optimal set of exercises, recommend the necessary in this case the type of sport.

A separate sheet is prescribed diet therapy. The child's diet is maximally saturated with vegetable food, fermented milk products. For infants, breastfeeding with mother's milk is preferable.

Most patients with laryngospasm are prescribed UVO procedures: they are performed with a special lamp device, which is usually available in the arsenal of physiotherapy room doctors. The duration of irradiation and its power are determined individually by the specialist.

Once the laryngospasm attacks are over, it is useful to undergo a course of oxygen treatment.

Folk treatment

Cure of laryngospasm is promoted by means of folk medicine. This can be internal use of infusions and decoctions, inhalations, compresses, distraction procedures, etc.

If the child does not suffer from allergies, he can be offered such a therapeutic decoction. One tablespoon of crushed calamus berries pour one glass of water, put on the fire and bring to a boil with constant stirring. Decoction is cooled, strained, add 1 tbsp. Of honey. The remedy should be drunk a little at a time during the day - for example, take a small sip every 2 hours. Similar useful effect also has a juice from calanium berries. It is drunk every one and a half or two hours by one tablespoon.

Treatment with aloe leaves has a good effect:

• Collect, wash and pass through a meat grinder 300 g of leaves, put in a glass jar with a capacity of 1 liter;
• add 300 ml of honey (if there is no allergy) and 1 tbsp. Badger fat, stir and insist for a day in the refrigerator;
• give at attacks of laryngospasm 1 tsp. Of the remedy with warm tea or water.

Herbal treatment

In laryngospasm in children are particularly effective infusions based on herbal collections, for example:

• Take half a tablespoon of crushed burdock leaf, the same amount of aspen leaves, one teaspoon of fir needles, half a teaspoon of baking soda, 200 ml of water;
• raw materials are mixed, pour boiling water, insist until cool;
• add baking soda, cover and place the mixture in the refrigerator for one week;
• infusion filtered, take 1 tbsp. In the morning and evening, as well as at each attack of laryngospasm.

In addition, during the day you should drink at least 3 cups of hot tea made with lingonberry leaves or berries.

You can make a remedy like this:

• prepare a mixture of birch leaves, oregano and raspberry (5 tablespoons each);
• Pour 500 ml of boiling water, insist under a lid for two hours;
• filtered;
• add 200 ml of honey and the same amount of butter or ghee, stir.

The mixture is stored in the refrigerator, taking daily 1 tbsp. Before breakfast, lunch and dinner.

Homeopathy

Homeopathic remedies to get rid of laryngospasm in children are prescribed by a homeopathic physician: the frequency of administration and dose depends on the severity of the condition, on the number and depth of recurrences, as well as on the individual characteristics of the child. During the treatment of chronic attacks of laryngospasm, at first there may be an exacerbation of the disease. In such cases, it is necessary to suspend the administration of the remedy and return to it again after 3-4 days.

Homeopathic medicines are practically devoid of negative side effects, they do not have an addictive effect and do not have an adverse effect on other organs and systems.

In laryngospasm in children are recommended to take such homeopathic remedies:

• Tartefedrel
• Bronchalis heel
• Galium heel
• Engistol H
• Spaccuprel

If laryngospasms are seasonal, it is recommended to conduct a preventive homeopathic course for about a month and a half before the expected onset of attacks. Allergy, Rhinosennai, EDAS-118 are good relievers of mucous membrane swelling, spasm and increased glandular secretion.

Surgical treatment

If no drug therapeutic measures have not brought the necessary result, then surgical intervention may be required to stop laryngospasm, which is a more complex and radical measure.

Two types of surgery are used to treat laryngospasm in children:

• tracheotomy;
• tracheal intubation.

Intubation is performed to provide airflow by placing an endotracheal tube. The airway becomes passable, oxygen enters the pulmonary system, and respiratory function is restored.

Tracheotomy is performed in the hospital, using anesthesia. The surgeon dissects the front wall of the trachea and then inserts a tube into it or sews the wall to the skin.

Any of the above procedures is an extreme method that is appropriate only in terminal conditions when other methods are pointless or futile.

Prevention

Preventive measures to prevent the development of laryngospasm in children are the exclusion and elimination of possible causes of the pathological condition. Doctors give the following recommendations in this regard:

• it is necessary to temper the child's body from a young age;
• It is important to make sure that children's immunity is strong;
• Provide complete vitaminized and balanced nutrition;
• avoid hypothermia and overheating;
• walk more often in the fresh air, ventilate the apartment, pay enough attention to moisturizing the room;
• to observe the rules of hygiene, to teach these rules to the child;
• keep the apartment clean, clean it regularly, dust it, wash the floors.

If the child is prone to allergic processes, it is necessary to avoid contact with likely allergens. If laryngospasm has already occurred once, it makes sense to consult a doctor about the necessary medicines in the first aid kit and to try to determine the cause of the disorder in order to try to eliminate it.

Forecast

A severe attack of laryngospasm without emergency treatment may result in the patient's death. Severe and prolonged spasticity can adversely affect the central nervous system, which in the long term can lead to mental retardation.

Fortunately, in the vast majority of cases, the prognosis of the disease is favorable: laryngospasm in children with age ceases to bother them.