Laryngomalacia

What is Laryngomalacia

Laryngomalacia is a condition in which the larynx, commonly called the voice box, stays soft and lacks its normal firmness. This condition is the most common cause of abnormally noisy breathing (stridor) in infants.

What are the causes?

The cause of this condition is not known. It may be a birth defect (congenitaldefect) that involves a delay in the maturing of the larynx.

What are the signs or symptoms?

Symptoms of this condition include:

  • High-pitched breathing sounds.
  • Harsh, noisy breathing sounds.
  • Swallowed foods or liquids coming back up into the throat (regurgitation) during feedings.
  • Coughing, choking, or turning blue during feedings.
  • Snoring.

Symptoms are often more noticeable when your child:

  • Has a cold.
  • Is lying on his or her back.
  • Is crying, feeding, or excited.

As your child grows, the force of his or her breathing increases. Because of this, symptoms may get worse over the first few months of your child’s life.

How is this diagnosed?

This condition is diagnosed with a procedure in which a flexible tube with a light is passed through the nose into the larynx (flexible fiberoptic laryngoscopy). This procedure allows the child’s health care provider to look at the larynx.

Your child may also have other tests and procedures, such as:

  • A procedure to look at the larynx and the airway below (flexible bronchoscopy).
  • A test to check whether your child is getting enough oxygen when breathing.
  • Tests to check whether your child has other conditions that can be present with laryngomalacia, such as stomach acid reflux.

Your child may be referred to a specialist.

How is this treated?

Usually, this condition does not need treatment. Most children improve by the time they are 12–18 months old. If treatment is needed, it may include:

  • Oxygen therapy. This may be done if your child is not getting enough oxygen while breathing.
  • Surgery to tighten structures that support the larynx and to remove extra tissue (supraglottoplasty). This may be done if the problem interferes with breathing, eating, growth, and development.
  • Medicine. This may be suggested if acid reflux causes the condition to get worse.
  • Using thickeners for foods and liquids.

If your child’s symptoms are mild, they may be managed by a primary health care provider. If your child’s symptoms are moderate to severe, they may be managed by a specialist.

Follow these instructions at home:

Feedings

  • Allow your child to have brief breaks during feedings.
  • If your baby has reflux, hold your baby upright for 15–30 minutes after feedings before laying him or her down to sleep.
  • If your child’s health care provider instructs you to thicken food or liquids, follow his or her instructions to do this correctly.
  • Watch your child during feedings for problems such as choking, regurgitation, bluish color of the skin, pauses in breathing, and difficulty breathing.

General instructions

  • Watch to see if your child wets fewer diapers than usual. This may indicate that your child is not getting enough with feedings.
  • Give over-the-counter and prescription medicines only as told by your child’s health care provider.
  • Keep all follow-up visits as told by your child’s health care provider. This is important. Symptoms can get worse, and your child’s health care provider needs to watch for this.

Contact a health care provider if:

  • Your child’s symptoms get worse.
  • Your child is uncomfortable when asleep.
  • There is a problem with the way your child is feeding.
  • Your child has half the number of wet diapers that he or she normally has in a 24-hour period.

Get help right away if:

  • Your baby’s breathing suddenly gets worse.
  • Your baby stops breathing for periods of time.
  • Your baby’s skin appears gray or blue in color.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

Summary

  • Laryngomalacia is a condition in which the larynx stays soft and lacks its normal firmness.
  • It is the most common cause of abnormally noisy breathing (stridor).
  • The cause of this condition is not known.
  • Usually, this condition does not need treatment. Most children improve by the time they are 12–18 months old.
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