Definition

Laryngomalacia is a condition in which the tissues of the entrance of the larynx collapse into the airway when the child breathes in. This gives rise to noisy breathing.

Incidence/Age

Laryngomalacia is the commonest cause of noisy breathing in early life. It usually starts during the first two weeks of life and gradually recovers. It can go on to the age of 2 or even older in some cases.

Causes

The precise cause is unknown. Most children with laryngomalacia have no other health problems but do have a rather slit-like laryngeal entrance which is susceptible to getting sucked in as air passes through.

Signs & Symptoms

Infants with LM have intermittent noisy breathing when breathing in. It becomes worse with agitation, crying, excitement, feeding or position / sleeping on their back. These symptoms are often present at birth and are usually apparent within the first 10 days of life. However, noisy breathing may be present in babies up to 1 year of age.

Symptoms will often increase or get worse over the first few months after diagnosis, usually between 4-8 months of age. Most children outgrow the noisy breathing (stridor) by 12-18 months of age.

Other associated symptoms include:

•     Poor weight gain
•     Difficulty with feeding
•     Vomiting or spitting up
•     Choking on food
•     Stops breathing
•     Chest and / or neck retractions (chest and / or neck sinking in with each breath)
•     Turning blue
•     Gastroesophageal reflux (GERD) (spitting up of acid from the stomach)

Treatment

• Do nothing
• Most cases of laryngomalacia are mild and will get better on their own.
• A hard cervical collar which supports the neck will often help to improve the airway.

Outcome

Laryngomalacia is a self limiting condition which most children grow out of within a few months. The noisy breathing may become louder for a few months as the child becomes bigger and stronger but then starts to diminish. Laryngomalacia is much less common after the age of one year although it is not rare for it to persist to the age of two or even longer.

When to call your child’s doctor:

Take your child to the hospital for:

•     Stops breathing for longer than 10 seconds
•     Dusky or blue color around lips associated with noisy breathing
•     Chest or neck retractions that do not stop with repositioning your child or waking your child up

Inform your child’s doctor about:

•     Child has difficulty keeping food down and constantly spits it up
•     Child is losing weight or is not gaining weight
•     Child begins to feed less and tires easily in the middle of feeding
•     Child begins to choke on food
•     Child struggles between eating and breathing