Abnormal Breathing Sounds in Ill or Injured Children

Infants and children can make a variety of sounds when they inhale and exhale. Children may have audible stridor or wheezing, or may make gurgling or grunting sounds when breathing. Abnormal sounds that arise from the lungs and airways of children can represent a number of medical concerns.

Stridor:

Stridor is a breathing sound that is usually heard during inspiration. Stridor is often high-pitched and coarse sounding and is an indication of upper airway obstruction. This may be caused by a foreign body that the child has inhaled, by infection such as croup, by congenital airway abnormalities such as laryngomalacia, or by acquired abnormalities such as tumors or cysts obstructing the airway.

Stridor can also result from edema (swelling) of the upper airway that results from an allergic reaction, medical procedures or the irritation of endotracheal intubation. In some cases stridor indicates a critical airway obstruction that requires immediate intervention from a healthcare provider.

Wheezing:

Wheezing is a whistling sound heard during expiration. Wheezing may be high-pitched or low-pitched and sometimes is heard as more of a sighing sound. This abnormal airway sound in children is a sign of lower airway obstruction. Bronchiolitis and asthma are common causes of wheezing in infants and children.

Occasionally, wheezing sounds may be heard during inspiration. If this occurs it suggests there is a foreign body or other obstruction in the trachea or upper airway, rather than a medical issue with the small airways of the lungs themselves.

Gurgling

Gurgling is a bubbling sound. Infants may make gurgling sounds as a normal part of attempted speech. However, gurgling that occurs during the inhalation or exhalation of normal breathing is medically concerning. Gurgling sounds in children may result from obstruction of the upper airway with a liquid such as vomit, mucous or blood.

Grunting

Grunting is a brief, low-pitched sound that is heard when an infant or child exhales. The grunting sound occurs when the child exhales against a partially closed glottis (the tissue folds of the vocal cords). Grunting may be a response to the discomfort of pain or fever, however it may also represent dangerous lung disease.

A child or infant often grunts to keep the small airways and alveoli of the lungs open in order to improve oxygenation and ventilation. This is often an indication of diseased lung tissue and collapse of small airways and/or alveoli. Grunting in infants and children is often a sign of severe respiratory distress or respiratory failure and should be addressed by a healthcare provider immediately.

Infants, toddlers and children may make abnormal lung and airways sounds when breathing. It is important for parents and health care providers to recognize and understanding the medical implications of abnormal breathing sounds in children.

Source: Pediatric Advanced Life Support. American Heart Association. 2006.