Upper Airway Obstruction
A child’s upper airway is small, so a little swelling or a small object causes a big obstruction. Upper airway obstruction is one of the four respiratory types taught on the PALS course.
Recognising it
Inspiratory stridor, a hoarse voice or barking cough, drooling or difficulty swallowing, and increased effort. Keep the child calm and in a position of comfort — agitation can worsen the obstruction.
A viral illness causing a barking cough and stridor, usually in young children. Treatment taught includes dexamethasone and, for moderate or severe cases, nebulised adrenaline, with oxygen as needed.
Sudden choking in a previously well child. A responsive child who cannot cough effectively needs back slaps and chest thrusts (infant) or abdominal thrusts (child) — see choking relief. Avoid anything that makes a partially obstructed child distressed.
Swelling of the lips, tongue and airway after an allergen, often with rash and wheeze. Intramuscular adrenaline is the key treatment, with oxygen and fluids for associated shock — see distributive shock.
Rarer since vaccination, but a drooling, toxic-looking child sitting forward is an emergency. Avoid examining the throat or upsetting the child; call for senior airway help. Retropharyngeal abscess and airway trauma are other causes.
This guide summarises what the PALS course teaches, for education only. It is not a clinical protocol: follow the current American Heart Association guidelines, linked below, and your institution’s paediatric policies.
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Inspiratory stridor.
Dexamethasone, and nebulised adrenaline for moderate or severe cases, as taught in PALS.
Intramuscular adrenaline.
Crying and agitation can worsen upper airway obstruction.
Yes, as part of infant and child BLS.
Paediatric emergencies are learned by doing. Safety First Medical Services is an American Heart Association training centre on Al Reem Island, Abu Dhabi, with HeartCode, classroom and on-site PALS and a two-year AHA PALS Provider eCard.
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What we teach follows the awarding body and the UAE health authorities. For the definitive position on a course or licensing question, these are the places to check.
Last reviewed by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.