Management of Spasm Due to Sudden Sneezing in a Child
For a child experiencing spasm triggered by sudden sneezing, immediately assess airway patency and breathing, position the child appropriately with head tilt/chin lift, administer high-flow oxygen, and evaluate for signs of respiratory distress including stridor, accessory muscle use, and chest retractions.
Initial Assessment and Positioning
The immediate priority is airway assessment using the "Safety, Stimulate, Shout for help" approach 1.
Key positioning strategies:
- For children under 2 years: Use a neutral head position with a pillow or rolled towel under the shoulders to optimize airway patency 1
- For older children: Apply chin lift ("sniffing the morning air") with or without jaw thrust 1
- Lateral positioning may benefit children with known upper airway obstruction, though this limits access to the anterior neck 1
Airway Patency Evaluation
Assess breathing by looking, listening, and feeling for airflow at both the mouth/nose, supplemented by waveform capnography where available 1.
Critical signs of respiratory distress to identify:
- Stridor
- Accessory muscle use
- Tracheal tug
- Sternal, sub-costal, and intercostal recession
- Agitation, restlessness, or obvious distress (may indicate airway obstruction) 1
Oxygen Administration
Deliver high-flow oxygen immediately to the patient's face 1. If only one oxygen supply is available, apply it to the airway from which spontaneous breathing is detected 1.
Management of Laryngospasm
If the spasm represents laryngospasm (which can occur with sudden sneezing and respiratory irritation):
- Reposition the airway with appropriate head positioning 1
- Administer 100% oxygen with positive pressure if needed 1
- Laryngospasm is usually reversible with oxygen administration, repositioning of the airway, and brief positive-pressure ventilation 1
- Rarely, treatment with a muscle relaxant may be required 1
Bronchospasm Considerations
If the child develops bronchospasm following the sneeze:
For children under 6 years with respiratory symptoms:
- Administer nebulized salbutamol: 2.5 mg for children <20 kg, 5 mg for children >20 kg 1
- This can reduce perioperative cough and bronchospasm by approximately 50% 1
When to Escalate Care
Summon additional help immediately if:
- Signs of respiratory distress persist 1
- No signs of breathing are detected 1
- The child becomes unresponsive 1
Call for advanced airway specialists (anesthetists, ENT surgeons) and ensure emergency equipment is available 1.
Rescue Interventions
If the child is not breathing or spontaneous ventilation is inadequate:
- Attempt five rescue breaths using high-flow oxygen 1
- Deliver via facemask if upper airway is patent 1
- Assess effectiveness clinically and with waveform capnography 1
Important Caveats
- Avoid blind finger sweeps of the pharynx, as these can impact foreign bodies in the larynx 1
- Monitor for complications: Sneezing with closed airway can result in over 20 times normal airway pressures, potentially causing various injuries 2
- Consider underlying conditions: If spasms are recurrent, evaluate for upper respiratory infection, laryngomalacia, or other structural airway abnormalities 1, 3
- The sneeze reflex involves complex trigeminal and olfactory nerve pathways, and spasm may represent protective airway reflexes 4, 5