Have you ever heard a cough that sounds like barking? It’s not just a strange noise — it’s stridor, an abnormal breathing sound that is usually heard during inhalation. Not only does it wake parents at night, it signals that something is happening inside the airways.
The word stridor may be new to some of you, but in practice this phenomenon is quite common among infants and children, and may also appear in adults in certain situations. It is a sound produced when air has difficulty passing through the upper airways, usually in the throat or the area of the trachea, creating a sharp, “barking” noise.
What causes stridor?
To understand what lies behind this unusual sound, it’s important to know that it is not a disease in itself, but rather a symptom that points to an obstruction or narrowing in the airways. Causes that can lead to stridor include:
Viral infection — illnesses such as croup (laryngotracheitis) cause swelling around the vocal cords and produce a noisy sound during inhalation.
A foreign object in the airways — especially in curious children who put objects into their mouth or nose.
Congenital abnormalities — such as laryngomalacia (softness of the larynx), which appears from birth and sometimes persists for months.
Allergic reactions or edema — which can create sudden airway obstruction.
Not only general guidelines stand behind the clinical understanding of stridor. There is also scientific evidence that deepens the picture. A retrospective study published on PubMed examined 67 cases of stridor in children and found that the most common cause was a foreign body in the trachea (38.8%), and that in very young ages (infants) the most common cause was laryngomalacia (47.4%). In later childhood, the study also identified deeper infections such as peritonsillar abscess.
Another study published in the Journal of Child (August 15, 2024) found that among chronic cases of stridor in infants, laryngomalacia was the most common cause (69.1%), and also identified other rare conditions such as subglottic narrowing (about 9.3%).
These findings sharpen the need not to settle for a superficial understanding of a “strange cough,” but to evaluate each case according to age, medical history, and additional possible factors.
How do you identify stridor and what is the difference between a sound and a ‘cough’?
It’s important to distinguish: Stridor does not only cause coughing, but is an abnormal breathing sound created during inhalation. It may sound like whistling or a “barking” sound, and sometimes other sounds appear before it, such as hoarseness or shortness of breath. It is not always accompanied by a cough with a clear beginning and end; sometimes it appears only during specific actions, such as crying, laughing, or exertion — which adds difficulty to making an accurate diagnosis without professional observation.
When should you see a doctor?
Many parents tend to delay seeking care when it comes to a “severe” cough, but stridor requires different attention:
Clear breathing difficulty, rapid or labored breathing
A change in skin color to blue around the lips
Stridor that worsens rapidly
High fever or lack of improvement within a few days
Even if it is a one-time occurrence, it is important to share full details with the doctor to rule out dangerous conditions.
Treatment and support at home — what really helps?
In most cases of viral stridor in children, supportive relief is possible: Rest, maintaining adequate humidity in the home environment, lifting the infant into a position that makes breathing easier (sitting or holding them upright), and light ventilation. But none of this replaces a professional diagnosis, as the cause can vary from case to case.
In severe cases, there may be a need for steroid medications, breathing-improving inhalations, or — if a foreign body is identified — its immediate removal. Understanding the source is what determines the correct treatment.
Many parents ask whether stridor always means a dangerous illness. The answer is: Not always, but it is a signal that calls for attention and seriousness. Often it is a transient phenomenon, especially among toddlers, but early professional evaluation can distinguish between a temporary condition and one that requires urgent treatment.
Stridor is more than an unusual sound; it is a symptom that tells us about the airflow in the child’s or adult’s airways. It is important to recognize it, notice it, and seek professional evaluation when signs of distress, breathing difficulty, or rapid worsening appear. Proper treatment begins with understanding the cause, and up-to-date research continues to shed light on its common and unique factors.
Dr. Kay Alkara is a family physician in the Northern District of Maccabi Healthcare Services.