Stridor: Croup vs Epiglottitis vs FBAO
Objective: Sort stridor into croup-like, epiglottitis-like, and choking. Keep the child calm in a position they choose. Do not look in the throat. Go to a hospital that can secure the airway.
Why this matters
The toddler has a barking cough, and the parent wants you to look in the throat. Keep the child in a position they choose. A forced look can complete the blockage. Croup, epiglottitis, bacterial tracheitis, choking, and anaphylaxis can all cause stridor. You do not need the exact name before you support the airway and move.
- They stay comfortable, usually in a parent’s lap. I do not lay them flat to get a better look or a better sat.
- I give oxygen if they will accept it. Oxygen blown past the face is better than a fight that closes the airway.
- I do not put a tongue blade in a drooling child who is sitting forward.
Clinical sequence
- Look as you walk in. Keep them in the position they chose. Do not lay them flat.
- Give oxygen the way they will accept it. Get a sat only if it does not make them fight.
- Sort the picture, then move. A bark and a playful child after a cold is croup-like. A sick, drooling child sitting forward, with little cough and a muffled voice, is epiglottitis-like. Sudden silence at dinner, with no fever, is choking until you prove otherwise. Stridor plus hives, wheeze, or shock is anaphylaxis.
- If this might be epiglottitis or bacterial tracheitis, go to a pediatric hospital that can secure the airway. Do not go to a clinic. Do not put anything in the mouth. Leave early, and do not upset them.
- If they tire, go quiet, or stop moving air, that is a ventilation emergency. Open the airway. Suction only what you can see. Bag with a two-person seal. A two-handed jaw-thrust seal beats a one-handed E-C clamp. If this started as a witnessed choke, use the choking lesson, not a nebulizer.
Teaching points
- Croup-like. A viral illness comes first, then a barking cough, with stridor that is worse when they are upset. Keep them calm. Steroids and nebulizers belong to your protocol. Most of these children can sit up during transport.
- Epiglottitis-like. They look very sick, drool, sit forward and brace, have little cough, and have a muffled voice. Do not examine the throat.
- Choking. The onset is sudden, there is no fever, and someone saw them choke. That is not a nebulizer.
- Anaphylaxis. Stridor plus hives, wheeze, or shock gets intramuscular epinephrine first. See the anaphylaxis lesson. Do not call every bark “just croup” when the child looks very sick and is silent.
Common errors
- Using a tongue blade on a drooling child who is sitting forward.
- Laying them flat to get a better sat.
- Calling every bark just croup when the child looks very sick and is silent.
Practice
One-minute check
Partner gives three cases. (1) A 2-year-old with a bark, playful, and stridor only when crying. (2) A 4-year-old who is drooling, sitting forward, and has no cough. (3) An 18-month-old who suddenly goes silent while choking at dinner. For each, say the first move and what you will not do.
Related: FBAO, Pediatric airway.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; follow your protocol
- AHA/AAP 2025 Pediatric BLS — keep the airway patent; do not delay oxygenation
- AHA/AAP 2025 Part 8: Pediatric ALS — position of comfort; do not agitate a threatened pediatric airway
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.