Swelling of the throat in children

With various infectious diseases of the upper respiratory tract, as well as some common infectious diseases, edema of the throat in the child can develop - pathological fluid exudation into the intercellular space of the mucous and submucosal tissues caused by their inflammation.

[1], [2]

Causes of the swelling of the throat in the child

Otolaryngologists note that the swelling of the throat in a child - in comparison with adults - occurs more often because of the morphological peculiarities of the pharynx and larynx and its mucous tissues peculiar to children, in particular, the smaller size of the pharynx; the continuing formation of the lymphatic pharyngeal ring, palatine and pharyngeal tonsils in the early years of life (which explains the accumulation of lymphoid tissue in the throat); less dense structure of the mucosa and underlying connective tissue; developed capillary network and a significant number of serous glands in the throat.

The most common causes of edema of the throat in a child who have an infectious inflammatory etiology include:

• Inflammation of the throat caused by respiratory viruses;
• bacterial inflammation of the larynx - laryngitis (see - Laryngitis in children );
• acute laryngotracheitis or laryngotraheobronchitis (false croup). Read more - Acute laryngotrahebronchitis of young children;
• pharyngitis and tonsillitis (angina or streptococcal tonsillopharyngitis);
• measles, whooping cough, scarlet fever (see - Koryova laryngitis, as well as Scarlet fever in children );
• adenoiditis (inflammation of the pharyngeal tonsil);
• epiglottitis (bacterial or fungal inflammation located behind the root of the tongue of the epiglottis cartilage and covering its mucous tissues);
• gullet abscess (purulent inflammation of retrofaringealnyh lymph nodes);

Also, the causes of swelling in the child's throat may be associated with allergies. In this case, an allergic swelling of the throat in a child is an asphyxial variant of an anaphylactic reaction to the effect of allergenic substances on mast cells and basophils.

Edema is considered one of the signs of inflammation, and is a natural reaction of the body to inflammation in the affected area. And the pathogenesis of edema of the throat is associated with a violation of the integrity of cytoplasmic membranes by infectious agents, as well as with an increase in the degree of permeability of the walls of blood microvessels caused by the action of cellular-tissue mediators of inflammation (cytokines, prostaglandins, leukotrienes, histamine, etc.).

[3], [4], [5]

Symptoms of the swelling of the throat in the child

The first signs of swelling of the throat in children are manifested against the background of the main symptoms of the existing disease. With acute respiratory viral infection and influenza it is a fever, malaise, headache, cough, redness and sore throat. Usually, in these infections, the symptoms of swelling of the throat in the child are not very pronounced, and catarrhal edema occurs as they recover.

Other situation with false croup (laryngotracheitis): with a strong paroxysmal coughing barking character and a pronounced hoarseness of the voice, the swelling of the throat and larynx rapidly under the vocal folds, as well as the swelling of the vocal cords themselves. For more details see - Acute laryngitis (false cereal) in children.

Developed such symptoms of a child's throat swelling as:

• hoarse breathing with whistling, while on inhalation there is a swelling of the nostrils and more intensive work of the musculature of the thorax;
• anxiety and increased arousal;
• pallor of the skin;
• light blue lips;
• heart palpitations (tachycardia).

Continuing to progress the swelling of the throat in a child can cause complications in the form of a subcompensated narrowing of the laryngeal (stenosis), which is indicated by such signs:

• pallor of the skin and cold sweat;
• breathing remains hoarse, but becomes superficial, with difficulty in inhaling and exhaling and shortening of pauses between them (this is called dyspnea or shortness of breath);
• blue lips will spread to the nasolabial area of the face, ears and fingers;
• Increasing heart rate is combined with muffling of cardiac tones.

And from this moment - in the absence of emergency medical care - the swelling of the throat in the child and the narrowing of the larynx caused by it lead to insufficient intake of air, a decrease in the frequency of heartbeats (bradycardia) and arterial pressure. The consequences of an increasing shortage of air - loss of consciousness, suffocation (asphyxia) and cardiac arrest.

It should be borne in mind that with edema due to epiglottitis, the child has a very high fever, severe pain in the throat, noisy breathing, but there is no cough and hoarseness. And for the retropharyngeal abscess is also characterized by loss of voice and increased production of saliva with hypersalivation. If a child has a swelling of the tongue in the throat, then this also indicates an inflammatory process or an allergic reaction; inflammation of only the palatal tongue (uvulitis) in children occurs rarely and, as a rule, accompanies the same tonsillitis or pharyngitis.

With swelling of the throat of an allergic nature, the child's voice disappears, the head turns, breathing with wheezing and labored exhalation, the skin pales, sometimes the lips become blue; In addition, there are abdominal pain, nausea and vomiting.

Diagnostics of the swelling of the throat in the child

With the examination of the throat and larynx in young children, difficulties may arise, since instrumental diagnosis using indirect laryngoscopy is not performed for children, and direct laryngoscopy is extremely difficult and, moreover, simply contraindicated in the presence of acute inflammation in the throat.

Therefore, the diagnosis of edema of the throat in a child is performed by examining the child's throat with an otolaryngological head mirror (lor-reflector) or a laryngeal mirror, and also on the basis of clinical symptoms. Required tests may include a general blood test and a smear from the mucous membrane. It is also very important for the doctor to know whether there was any allergy in a child's history.

If necessary, specialists use radiography and bronchoscopy. More in this article - Diagnosis of acute laryngitis.

[6], [7], [8],

Differential diagnosis

Given the multifactority of this pathology in children, differential diagnosis is necessary to determine the true cause of throat edema and apply adequate therapeutic agents.

[9], [10]

Treatment of the swelling of the throat in the child

Parents should be aware that only a doctor can cope with the swelling of the throat in children, so calling an emergency care (by phone 103) is mandatory.

Prior to the arrival of medical personnel, the child must receive first aid. You do not know what to do if the child has a sore throat? For your help to really help in this situation, carefully read the article devoted to this issue - What to do with swelling of the throat.

A medical treatment for edema of the throat in a child from the beginning of the stage of sub- or decompensated stenosis of the larynx consists in the introduction of glucocorticosteroids (Prednisolon, Hydrocortisone or Dexamethasone), antispasmodics (Aminophylline) and antihistamines (Dimedrol, Suprastin).

Medicines group corticosteroids (hormones of the adrenal cortex) have strong anti-edematous, anti-inflammatory and anti-allergenic properties. They are practically indispensable in acute conditions and in anti-shock therapy.

Thus, a slow intravenous infusion of a solution of Prednisolone is carried out: for children up to a year 2-3 mg per kilogram of body weight, from year to 14 years - 1-2 mg per kilogram. The drug is administered 2 to 4 times a day for two to three days. The most common side effects of this medication are: weakness and increased drowsiness.

In addition, Prednisolone and all corticosteroids cause immunosuppressive effects, that is, suppress the body's defenses, and in acute viral and bacterial infections are contraindicated. Therefore, in the presence of severe infectious diseases, they can be used in emergency situations only with the continuation of a specific treatment, i.e., etiotropic therapy of the disease that caused the edema. So in cases of bacterial infections in the child, antibiotics are mandatory.

Aminophylline refers to adenosinergic agents against asthma; it relaxes the smooth muscles of the bronchi, increases the frequency and strength of the heart contractions and muscles of the diaphragm, acts as a stimulant of the respiratory center. That is why Aminophylline is used in complex emergency therapy for children with increasing throat swelling and decompensated stenosis of the larynx (by intravenous injection, in accordance with the scheme of pediatric dosing).

Obviously, the benefit of this medication when rescuing a child from suffocation is much greater than that among its contraindications (indicated in the official instruction) are fever and ENT infections.

And with swelling of the throat that have arisen in a child who is sick with flu or measles, interferon and immunoglobulins should be used. Interferon should be instilled in the nose in the form of a solution, which is prepared from one ampoule of this drug (2 ml) and 2 ml of boiled water, heated to normal body temperature. The solution is injected 4-5 drops into each nostril up to five times a day. The course of treatment lasts three days.

Also do not forget that vitamins, especially vitamin C, increase the resistance of children to infections and contribute to a faster recovery.

With swelling of the throat in cases of severe stenosis and inadequate efficacy of the medicamentous effect, urgent surgical treatment is performed in the form of a tracheotomy. With this surgical intervention, the throat is cut at the level of the cricoid cartilage of the larynx and a tracheotomy tube (cannula) is inserted into the formed hole in the trachea, fixing it with a bandage. Thanks to this, a child with a strong swelling of the throat and a narrowing of the larynx can breathe.

Used for throat swelling, physiotherapeutic treatment can be performed with the help of procedures such as inhalation of aerosols of corticosteroids, as well as solutions of epinephrine and ephedrine. It should be borne in mind that the recommended for inhalation broncholytics Terbutalin is allowed to be used for children after three years, GS Fluticasone for children over 4 years old, and Budesonide is effective only for allergic edema and is contraindicated in bacterial, viral and fungal infections of the respiratory tract.

Otolaryngologists warn that alternative treatment is possible only in cases of cough, sore throat and minor swelling in ARVI or tonsillitis - with the throat rinse with decoctions of medicinal plants known to all (sage, marigold, chamomile or eucalyptus leaves). With symptoms indicating a narrowing of the larynx, there is a real threat to the life of the child, so it is unacceptable to rely on alternative methods.

Read also - How is acute laryngitis treated (false croup)?

Prevention

Is it possible to prevent throat swelling in children? Pediatricians and ENT doctors recommend parents to direct efforts to strengthen the immunity of the child and carefully follow the recommendations of doctors in the treatment of diseases of the upper respiratory tract.

[11], [12], [13], [14]

Forecast

Often, airway obstruction in the swelling of the throat in a child is a very difficult, life-threatening condition, in which the only salvation is emergency medical care. And the forecast will be positive if this assistance is provided in a timely and correct manner.

[15], [16]