Laryngomalacia is a condition most common in young babies. It’s an abnormality in which the tissue just above the vocal cords is especially soft. This softness causes it to flop into to the airway when taking a breath. This can cause partial blockage of the airway, leading to noisy breathing, especially when a child is on their back.
The vocal cords are a pair of folds in the larynx, also known as the voice box. The larynx allows air to pass into the lungs, and it also helps make vocal sounds. The larynx contains the epiglottis, which works with the rest of the larynx to keep food or liquids from entering the lungs.
Laryngomalacia is a congenital condition, meaning it’s something babies are born with, rather than a condition or disease that develops later on. About 90 percent of laryngomalacia cases resolve without any treatment. But for some children, medication or surgery may be necessary.
The main symptom of laryngomalacia is noisy breathing, also known as stridor. It’s a high-pitched sound heard when your child inhales. For a child born with laryngomalacia, stridor may be obvious at birth. On average, the condition first appears when babies are two weeks old. The problem may worsen when the child is on their back or when upset and crying. The noisy breathing tends to get louder in the first several months after birth. Babies with laryngomalacia may also pull in around the neck or chest when inhaling (called retractions).
A common associated condition is gastroesophageal reflux disorder (GERD), which can cause a young child considerable distress. GERD, which can affect anyone at any age, occurs when digestive acid moves up from the stomach into the esophagus causing pain. The burning, irritating sensation is known more commonly as heartburn. GERD may cause a child to regurgitate and vomit and have trouble gaining weight.
Other symptoms of more severe laryngomalacia include:
- difficulty feeding or nursing
- slow weight gain, or even weight loss
- choking when swallowing
- aspiration (when food or liquids enter the lungs)
- pausing while breathing, also known as apnea
- turning blue, or cyanosis (caused by low oxygen levels in the blood)
If you notice symptoms of cyanosis or if your child stops breathing for more than 10 seconds at a time, get to a hospital immediately. Also, if you notice your child straining to breathe — for example, pulling in their chest and neck — treat the situation as urgent and get help. If other symptoms are present, make an appointment with your child’s pediatrician.
It’s unclear exactly why some children develop laryngomalacia. The condition is thought of as abnormal development of the cartilage of the larynx or any other part of the voice box. That may be the result of a neurological condition affecting the nerves of the vocal cords. If GERD is present, it may make the noisy breathing of laryngomalacia worse.
Laryngomalacia may be an inherited trait, though the evidence isn’t strong for this theory. Laryngomalacia is occasionally associated with certain inherited conditions, such as gonadal dysgenesis and Costello syndrome, among others. However, family members who have a particular syndrome don’t necessarily have the same symptoms, nor do they all have laryngomalacia.
Identifying symptoms, such as stridor, and noting when they happen can help your child’s doctor make a diagnosis. In mild cases, an exam and close follow-up may be all that is necessary. For babies with more symptoms, certain tests may be required to officially identify the condition.
The primary test for laryngomalacia is a nasopharyngolaryngoscopy (NPL). An NPL uses a very thin scope fitted with a tiny camera. The scope is gently guided down one of your child’s nostrils to the throat. The doctor can get a good look at the health and structure of the larynx.
If your child appears to have laryngomalacia, the doctor may order other tests, such as neck and chest X-rays and another test that uses a thin, lighted scope, called airway fluoroscopy. Another test, called a functional endoscopic evaluation of swallow (FEES), is sometimes done if there are significant swallowing problems along with aspiration.
Laryngomalacia can be diagnosed as mild, moderate, or severe. About 99 percent of infants born with laryngomalacia have mild or moderate types. Mild laryngomalacia involves noisy breathing, but no other health problems. It’s usually outgrown within 18 months. Moderate laryngomalacia usually means there are some problems with feeding, regurgitation, GERD, and mild or moderate chest retractions. Severe laryngomalacia can include trouble feeding, as well as apnea and cyanosis.
Most children will outgrow laryngomalacia without any treatment before their second birthday, according to the Children’s Hospital of Philadelphia.
However, if your child’s laryngomalacia is causing feeding problems that are preventing weight gain or if cyanosis occurs, surgery may be required. The standard surgical treatment often starts with a procedure called a direct laryngoscopy and bronchoscopy. It’s done in the operating room and involves the doctor using special scopes that provide a close look at the larynx and trachea. The next step is an operation called a supraglottoplasty. It can be done with scissors or a laser or one of a few other ways. The surgery involves dividing the cartilage of the larynx and the epiglottis, the tissue in the throat that covers the windpipe when you eat. The operation also involves slightly reducing the amount of tissue just above the vocal cords.
If GERD is a problem, your doctor may prescribe a reflux medication to help control stomach acid production.
In mild or moderate cases of laryngomalacia, you and your child may not have to make any major changes in feeding, sleeping, or any other activity. You’ll need to watch your child carefully to make sure they’re feeding well and not experiencing any serious symptoms of laryngomalacia. If feeding is a challenge, you may need to do it more frequently, since your child may not be getting many calories and nutrients with each feeding.
You may also need to raise the head of your baby’s mattress slightly to help them breathe easier at night. Even with laryngomalacia, babies are still safest sleeping on their backs unless otherwise recommended by your pediatrician.
While you can’t prevent laryngomalacia, you may be able to help prevent medical emergencies related to the condition. Consider the following strategies:
- Know what signs to look for when it comes to feeding, weight gain, and breathing.
- In the uncommon case that your baby has apnea associated with their laryngomalacia, talk with your pediatrician about using continuous positive airway pressure (CPAP) therapy or other specific treatment for apnea.
- If your baby’s laryngomalacia is causing symptoms that may warrant treatment, find a specialist with experience treating laryngomalacia. You may need to go online to find support groups that can help or try a nearby university’s medical school. A specialist living far from you may be able to consult with your pediatrician remotely.
Until your child’s larynx matures and the problem disappears, you’ll need to be on the lookout for any changes in your child’s health. While many children do outgrow laryngomalacia, others require surgery, and that is often done before a child’s first birthday. Apnea and cyanosis can be life-threatening, so don’t hesitate to call 911 if your child is ever in distress.
Fortunately, most cases of laryngomalacia don’t require surgery or anything other than patience and extra care for your child. The noisy breathing can be a little upsetting and stress-inducing until you know what’s going on, but knowing the issue should resolve itself may make it easier.