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Laryngitis in Children – Symptoms & Treatment
Laryngitis in children is an inflammation of the larynx often causing hoarseness, a barking cough, and breathing difficulties. Learn about causes, symptoms, and treatment options.
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Laryngitis in children is an inflammation of the larynx often causing hoarseness, a barking cough, and breathing difficulties. Learn about causes, symptoms, and treatment options.
What is Laryngitis in Children?
Laryngitis is an inflammation of the mucous membrane lining the larynx (voice box). In children, it commonly occurs as part of a respiratory infection and can develop more rapidly into a serious condition than in adults, due to the naturally narrower airways of children. A well-known form is croup (also called stenosing laryngotracheitis or pseudo-croup), which primarily affects toddlers between one and five years of age.
Causes
The most common causes of laryngitis in children include:
- Viral infections: The vast majority of cases are caused by viruses, most notably parainfluenza viruses (the leading cause of croup), rhinoviruses, the respiratory syncytial virus (RSV), and influenza viruses.
- Bacterial infections: Less frequently, bacteria such as streptococci or Haemophilus influenzae may be responsible. Severe bacterial infections, such as epiglottitis (inflammation of the epiglottis), can be life-threatening.
- Allergens and irritants: Exposure to allergens, cigarette smoke, or dry indoor air can irritate the laryngeal mucosa and contribute to inflammation.
- Vocal strain: Excessive shouting or singing can also irritate the larynx and lead to temporary inflammation.
Symptoms
Typical symptoms of laryngitis in children include:
- Hoarseness or complete loss of voice
- Barking cough (characteristic of croup)
- Sore throat and difficulty swallowing
- Inspiratory stridor: a high-pitched, wheezing or whistling sound when breathing in, indicating airway narrowing
- Mild fever (particularly in infectious cases)
- Breathing difficulties in severe cases (medical emergency)
Croup: Warning Signs to Watch For
Croup often begins suddenly at night with a distinctive barking cough and labored breathing. Parents should call emergency services (911 or the local emergency number) immediately if the child shows signs of severe breathing difficulty, bluish lips, or extreme agitation.
Diagnosis
A pediatrician typically diagnoses laryngitis based on the characteristic symptoms and a physical examination. The diagnostic process may include:
- Medical history: Questions about the onset of symptoms, progression, and potential triggers
- Inspection of the throat and neck
- Auscultation of the lungs to assess breath sounds
- If a bacterial infection is suspected: laboratory tests (complete blood count, CRP levels) or a throat swab
- In severe cases: laryngoscopy (direct or indirect examination of the larynx) by an ENT specialist
Treatment
General Measures
In mild cases, supportive care is the primary approach:
- Fresh, cool, moist air: Opening a window or standing near an open refrigerator can help soothe the airways.
- Humidifying the room: A cool-mist humidifier or damp towels on a radiator can add moisture to the air.
- Rest and voice care: The child should rest the voice and get adequate sleep.
- Adequate fluid intake: Water and lukewarm herbal teas are recommended.
- Avoid whispering: Whispering actually places more strain on the vocal cords than speaking quietly in a normal voice.
Medical Treatment
- Corticosteroids (e.g., dexamethasone, budesonide): For croup, inhaled or oral corticosteroids are the treatment of choice, as they quickly reduce airway swelling.
- Nebulized epinephrine (adrenaline): In severe cases with significant breathing difficulties, nebulized epinephrine can rapidly open up the airways (typically administered in a hospital setting).
- Antipyretics (e.g., paracetamol or ibuprofen) to manage fever and pain.
- Antibiotics are only indicated when a bacterial infection has been confirmed.
When to Seek Emergency Care
Immediate medical attention is required if the child shows:
- Severe breathing difficulty or bluish discoloration of the lips
- Loud stridor (high-pitched breathing sounds)
- High fever above 39 °C (102.2 °F)
- Significantly impaired general condition
- Any infant (under 12 months) with laryngitis symptoms
Prevention
While laryngitis cannot always be prevented, the following measures can help reduce the risk:
- Regular handwashing to reduce the spread of viruses
- Vaccinations as recommended by health authorities (e.g., influenza vaccine, Haemophilus influenzae type b vaccine)
- Avoiding exposure to secondhand smoke
- Ensuring adequate fluid intake and a balanced diet to support the immune system
References
- Johnson, D. W. – Croup. BMJ Clinical Evidence, 2014. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4178184/
- Zoorob, R., Sidani, M. A., Fremont, R. D., Kihlberg, C. – Antibiotic use in acute upper respiratory tract infections. American Family Physician, 2012; 86(9): 817-822.
- World Health Organization (WHO) – Acute respiratory infections in children: case management in small hospitals in developing countries. WHO/ARI/90.5.
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