Laryngomalacia is the most common cause of chronic stridor in infancy, in which the soft, immature cartilage of the upper larynx collapses inward during inhalation, causing airway obstruction.
Is laryngomalacia life threatening? Despite the associated noisy breathing, laryngomalacia is usually not dangerous, as most babies with the condition are still able to breathe. While most infants outgrow laryngomalacia, a few cases will require surgery to correct the issue.
The exact cause of laryngomalacia is not known. Relaxation or a lack of muscle tone in the upper airway may be a factor. The malformation is usually present at birth or appears within the first month of life. Gastroesophageal reflux (GE reflux) may contribute to the severity of the symptoms.
In particular, signs that indicate more severe conditions include: irritability, poor feeding, pulling in of the skin at the collar bone, between the ribs, or under the ribs, flaring of the nose, increasing effort to breathe, and poor weight gain or weight loss, especially in infants.
What Is Laryngomalacia? Stridor is a high pitched, noisy or squeaky sound that occurs during inspiration (breathing in). Laryngomalacia is the most common cause of chronic stridor in infants. The stridor from laryngomalacia is generally mild but it becomes louder when babies cry or get excited.
Laryngomalacia: a cause for early near miss for SIDS.
Babies with laryngomalacia make a harsh, squeaky sound when breathing in. This sound, called stridor, can start as soon as the baby is born or, more often, in the first few weeks after birth. Symptoms usually get worse over several months.
Noisy breathing that seems to worsen with feeding or while supine is suspicious for laryngomalacia. The clinician should explore feeding habits and note any weight loss or failure to thrive. A physical examination focuses mainly on the head and neck.
While most cases of laryngomalacia resolve over time without surgery, more severe cases require a treatment called supraglottoplasty. This surgery involves cutting the folds of tissue to open the supraglottic airway (the area above the vocal chords). During this procedure, your child will be under general anesthesia.
Laryngomalacia has been related to the sleep state,6 brain injury,12 and neurologic disorders including seizure disorder and cerebral palsy. Several authors have noted poorer results of therapeutic intervention when a history of associated neurologic conditions is present.
Infants with laryngomalacia classically have worsening of stridor associated with increased effort of breathing during feeding, as well as often being reported to have frequent interruption of feeding caused by coughing and choking episodes.
Symptoms of laryngomalacia tend to be worse during periods of activity and are less obvious during sleep. However, rapid eye movement (REM) sleep is associated with reduced upper airway tone and is therefore a time of increased susceptibility to airway obstruction.
Children with laryngomalacia will do better resting at a 30-degree angle, or by positioning their heads to relieve or reduce the obstruction. The child should also be held in an upright position for 30 minutes after feeding and should never be fed lying down.
Hold your child in an upright position during feeding and at least 30 minutes after feeding. This helps keep food from coming back up. Burp your child gently and often during feeding. Don't give your child juices or foods such as orange juice or oranges that can upset your child's stomach.
Common Signs and Symptoms of Laryngomalacia
If you notice that your baby is breathing faster than normal, it is likely that they will be diagnosed with laryngomalacia.
The incidence of laryngomalacia was seen in 66% of all children less than 2 years of age who presented with stridor. The finding was similar to a study by Richter et al which showed a prevalence of 45-75%.
Moderate-severe laryngomalacia can result in sleeping difficulties and pauses in the breathing (apneic spells).
There are a handful of cases of people inheriting laryngomalacia and of multiple siblings developing laryngomalacia, but in general, the condition does not appear to have a genetic cause.
The noise may be more high pitched, crowing stridor. Noise is often increased when the baby is supine, during sleep, during agitation, during upper respiratory infection episodes, and, in some cases, during and after feeding. The baby's cry is usually normal, unless concomitant reflux laryngitis is present.
In type 1 laryngomalacia, the aryepiglottic folds are tightened or foreshortened. Type 2 is marked by redundant soft tissue in any area of the supraglottic region. Type 3 is associated with other disorders, such as neuromuscular disease and gastroesophageal reflux.
Indeed, patients with laryngomalacia can have coughing and choking during feeding, feeding difficulty, dysphagia, aspiration, failure to thrive, or worsening of stridor during feeding.
In the pediatric population, laryngomalacia is one of the most common causes of airway distress. It typically presents as inspiratory stridor, coughing, choking, or regurgitation.
SIDS is less common after 8 months of age, but parents and caregivers should continue to follow safe sleep practices to reduce the risk of SIDS and other sleep-related causes of infant death until baby's first birthday. More than 90% of all SIDS deaths occur before 6 months of age.