INTRODUCTIONStridor is one of the life threatening symptoms presenting to the Emergency Department. 1 The word stridor is derived from the Latin word "Stridulus", which means creaking, whistling or grating. Stridor is harsh, vibratory sound of variable pitch caused by partial obstruction of the respiratory passages that results in turbulent airflow through the airway. Stridor is a sign of airway obstruction, so it demands immediate attention and thorough evaluation to uncover the precise underlying cause. 2 This study on paediatric stridor is to suggest an approach to evaluate and manage the underlying cause.Aims of the study 1. To find the causes of stridor in paediatric age group of newborn -to 12 years.2. Early identification of the cause to initiate treatment of stridor. ABSTRACTBackground: Stridor is one of the life threatening symptoms presenting to the Emergency Department. Stridor is a sign of airway obstruction, so it demands immediate attention and thorough evaluation to uncover the precise underlying cause. This study on paediatric stridor is to find the causes of stridor in paediatric age group are to identify the cause to initiate treatment of stridor, suggest an approach to evaluate and manage the underlying cause. Methods: Retrospective study of series 515 cases in paediatric age group, below 12 years of age presenting with respiratory distress to the Emergency department/ENT department. The primary management was to maintain the airway in all cases. Intravenous line established intravenous fluid/antibiotics /steroids/racemic adrenaline, followed by history of the respiratory distress from the parents/ caretakers. Then according to the provisional diagnosis evaluation is done by radiological investigation/ endoscopy. Results: Laryngomalacia was the most common cause of infant stridor in less than one year of age in 348 cases, while Foreign body aspiration is the most common cause of stridor in age group one to 12 years in 122 cases. 358 cases (69%) were treated conservatively and cause related management was done in 157 (31%). Endoscopy and imaging offers the best methods in evaluating and treatment of pediatric stridor. Conclusions:The management of stridor in pediatric age group is a team work of ENT surgeons, Pediatrician, Pediatric surgeons, anaesthetist. The airway maintenance is the main management followed by ENT examination, evaluation by imaging, endoscopy and treatment of the cause. We follow the airway management algorithm in order to evaluate the child for diagnosis of the cause for treatment and successful outcomes of stridulous pediatric patients.