What is the recommended treatment for acute laryngitis in children?

Treatment of Acute Laryngitis in Children

Acute laryngitis in children should be managed primarily with supportive care, with corticosteroids and nebulized epinephrine reserved for moderate to severe cases with respiratory distress. 1, 2

Etiology and Clinical Presentation

• The most common causative agents of acute laryngitis in children are parainfluenza viruses, typically affecting children between 6 months and 3 years of age 2
• Typical symptoms include dry, barking cough, inspiratory difficulty, wheezing, and stridor 2, 3
• In children under one year of age, structural and functional anomalies causing symptoms resembling laryngitis should be considered 2

First-Line Treatment Recommendations

Supportive Care

• Most patients with mild laryngitis can be managed at home with supportive care 2
• Maintain adequate hydration to help thin secretions 1
• A supported sitting position may help expand lungs and improve respiratory symptoms in children with respiratory distress 1
• Antipyretics and analgesics (acetaminophen or ibuprofen) can be used to keep the child comfortable and reduce fever 1
• Aspirin should be avoided in children due to the risk of Reye syndrome 1

Medication Recommendations for Moderate to Severe Cases

• For moderate to severe laryngitis with respiratory distress:

  • Nebulized epinephrine is effective for emergency treatment of acute laryngitis with significant respiratory distress 1, 2
  • Oral or parenteral corticosteroids (dexamethasone) are effective for reducing subglottic edema 1, 3, 4
  • The effectiveness of epinephrine nebulization is quick (30 minutes) but transient (2 hours), requiring monitoring 1

• Corticosteroid dosing:

  • Dexamethasone at a dose higher than 0.3 mg/kg for 48 hours, followed by oral corticosteroids for severe cases 5
  • Nebulized budesonide can be used as a safe and effective alternative treatment in children with moderate to severe subglottic laryngitis 3

What NOT to Use

• Antibiotics should not be routinely prescribed to treat laryngitis 1

  • There is overwhelming evidence showing ineffectiveness of antibiotic therapy and a preponderance of harm over benefit 1
  • Acute laryngitis is typically viral in origin and self-limited, with patients showing improvement in 7-10 days with supportive treatment alone 1

• Routine use of systemic corticosteroids is not recommended for mild cases 1

  • Corticosteroids should be reserved for moderate to severe cases with respiratory distress 1, 3

• Chest physiotherapy is not beneficial and should not be performed 1

  • Evidence suggests physiotherapy may be counterproductive, potentially leading to a longer duration of fever 1

Monitoring and Follow-up

• The frequency of monitoring (heart rate, temperature, respiratory rate, oxygen saturation) should be determined by the child's condition 1
• Children receiving oxygen therapy should have at least 4-hourly observations including oxygen saturation 1
• Patients should begin to improve within 24-48 hours of starting appropriate treatment 6
• If symptoms worsen or fail to improve within 48-72 hours, reassessment is necessary 6

Special Considerations

• In children with severe respiratory distress, hospital admission may be necessary for close monitoring and treatment 2, 3
• For children with post-extubation laryngitis, airway endoscopy is recommended for definitive diagnosis if symptoms persist 4
• Avoid desflurane anesthesia in children with upper respiratory tract infections due to increased airway resistance 1

When to Consider Alternative Diagnoses

• In children under one year of age with recurrent or severe symptoms, consider structural abnormalities 2
• If symptoms persist beyond the expected recovery period (7-10 days), further evaluation is warranted 1
• Epiglottitis (supraglottic laryngitis) is typically bacterial in origin and requires antibiotics in combination with corticosteroids, unlike typical viral subglottic laryngitis 5