Diagnostic approach to upper airway obstruction in children

* The following findings suggest upper airway obstruction:

• Inspiratory stridor, wheezing, or stertor
• Suprasternal or supraclavicular retractions
• Prolonged inspiratory phase
• Oral mucosa or tongue swelling
• Drooling
• Dysphagia

Positions of comfort to help maintain airway patency in patients with severe obstruction:

• "Sniffing" position (neck is mildly flexed and head is mildly extended)
• Tripod position (leaning forward while bracing on the arms with neck hyperextended and chin thrust forward)

¶ Given the risk of sudden decompensation, patients with significant laryngotracheal injury, thermal or chemical epiglottitis, or symptomatic upper airway obstruction warrant emergency consultation with an anesthesiologist or pediatric intensivist and an otolaryngologist to help secure the airway.