Onset of stridor shortly after birth suggests vocal cord paralysis. In contrast, laryngomalacia is typically noted after 4 weeks of life. Previous airway manipulation, such as prolonged endotracheal intubation, predisposes to subglottic stenosis. Associated feeding difficulties, coughing during or shortly after feeds, and poor weight gain may indicate gastroesophageal reflux, poor pharyngeal tone (e.g., developmental delay, neuromuscular disorder), laryngeal cleft, tracheoesophageal fistula, or vascular ring. A hoarse cry with or without mild stridor may occur with unilateral vocal cord paralysis; bilateral vocal cord paralysis often results in severe obstruction. In older children, fever, cough, respiratory distress, drooling, and symptoms of upper respiratory tract infection, such as rhinorrhea or sore throat suggest croup, epiglottitis, or parapharyngeal abscess. Pain with neck extension also suggests parapharyngeal abscess.