What are the Common Causes of Upper Airway Obstruction in PALS?

Upper airway obstruction is a critical condition where airflow is blocked in the upper part of the airway, including the nose, mouth, throat, and voice box. This condition is hazardous in pediatric patients, as their smaller airways can become obstructed more easily, leading to breathing difficulties. 

If not addressed quickly, upper airway obstruction can escalate into severe complications such as respiratory distress and even cardiac arrest. In such a situation, immediate action is crucial. Understanding the common causes of upper airway obstruction in children is key to recognizing and treating this life-threatening condition. In this blog, we’ll take a closer look at what causes upper airway obstruction in children, how to spot the signs, and what can be done to manage it, so you’re better prepared in case of an emergency. 

Common Causes of Upper Airway Obstruction

Foreign Body Obstruction

Foreign body obstruction is a frequent cause of airway blockage in young children, as they often put small objects like toys, food, or coins in their mouths. These objects can easily get lodged in the airway, causing sudden difficulty in breathing. Immediate action is crucial to prevent severe breathing complications or choking. 

Airway Swelling

Swelling in the upper airway can occur due to allergic reactions, infections like croup, or inflammatory conditions. When the tissues around the airway swell, it narrows the passage, making it harder for air to pass through, which can lead to respiratory distress. Quick medical intervention is necessary to reduce the swelling and restore normal breathing.

Trauma

Injury to the neck or throat, such as from a car accident or physical trauma, can lead to swelling, bruising, or structural damage, blocking the airway. In such cases, the swelling can compress the airway, restricting airflow and making breathing difficult. Immediate evaluation and treatment are essential in these situations.

Tongue Obstruction

When a child is unconscious or severely ill, the tongue may relax and fall back into the throat and constrict the airway. This is a common concern in emergency situations, particularly if the child is unresponsive. Simple repositioning techniques, such as tilting the head or lifting the chin, can help ease the obstruction. 

Congenital Abnormalities

Some children are born with conditions like laryngomalacia or tracheomalacia, where the airway is softer or not fully developed. This can make it easier for their airway to collapse or become blocked, especially when they are breathing or feeding. These conditions can make them more prone to airway obstructions, particularly during feeding or illness. Special care and medical management are often required to ensure proper breathing in these children. 

Secretions

Excessive secretions such as mucus, saliva, or blood, especially in cases of respiratory infections or injury, can block the airway and interfere with normal breathing. Suctioning or clearing these secretions is often necessary to maintain an open airway and ensure that air can flow freely.

Airway Malposition

Improper positioning of the head or neck can also obstruct the airway, particularly in infants or during medical procedures. In such cases, ensuring the proper alignment of the head and neck is critical to prevent airway blockage and allow normal breathing. Simple adjustments can often resolve this issue quickly.

Signs and Symptoms of Upper Airway Obstruction

• Noisy breathing such as wheezing or stridor( a high-pitched sound)
• Difficulty breathing with visible chest retractions or use of accessory muscles
• Cyanosis(bluish tint around the lips or face)
• Altered mental status or lethargy
• Difficulty speaking or making sounds
• Choking or gagging, especially with foreign body obstruction

How airway obstruction can lead to respiratory distress and cardiac arrest

When the airway is blocked, the body can’t get enough oxygen, leading to respiratory distress. As the obstruction continues, the oxygen levels in the bloodstream drop, causing hypoxia (low oxygen levels). If this condition isn’t quickly resolved, it can lead to respiratory failure, where the lungs can no longer provide sufficient oxygen to the body. In severe cases, this lack of oxygen can cause the heart to stop functioning properly, resulting in cardiac arrest.

For pediatric patients, this progression can happen alarmingly fast due to their smaller airways and higher metabolic rates. Children may become lethargic, show signs of confusion, or exhibit a bluish tint to their skin (cyanosis) as oxygen deprivation worsens. Without immediate intervention, the situation can escalate rapidly, leading to irreversible damage to vital organs and, ultimately, death.

Recognizing the signs of airway obstruction and acting quickly can mean the difference between life and death. This highlights the importance of training in CPR and first aid. Being prepared to respond effectively in these situations can help prevent the dire consequences associated with airway obstructions in children. 

The role of CPR in managing pediatric patients with airway obstruction

If a child becomes unresponsive due to an airway obstruction, immediate CPR is very much essential. While trying to clear the obstruction, chest compressions, and rescue breaths can help maintain oxygen flow to the body. In cases of foreign body obstruction, back blows and abdominal thrusts(in older children) or chest thrusts ( in infants) are used to attempt to clear the blockage. Knowing how to perform CPR and being trained in first aid for airway obstructions can be life-saving, especially in pediatric emergencies. 

Your CPR skills can help you respond to emergencies and empower caregivers and bystanders to respond quickly. CPR teaches you to remain calm and focused in such situations. So, it is better to learn it and use the skills in pediatric emergencies. At Heart Start CPR, we offer Infant CPR classes to laypersons and advanced PALS classes for pediatric healthcare professionals. You can join and learn the skills to save the life of a child in pediatric emergencies.