Laryngomalacia is a common congenital condition affecting a baby’s airway. It involves the softening of tissues above the vocal cords, which can partially block the airway when a baby breathes in. This condition is the most frequent reason for noisy breathing in infants.
Understanding Laryngomalacia in Babies
Laryngomalacia occurs when laryngeal tissues above the vocal cords are softer than typically expected, causing them to collapse inward during inspiration, particularly in the supraglottic area. The exact cause is not fully known, but theories include atypical cartilage or muscle development, or neuromuscular issues. Symptoms, most commonly noisy breathing (stridor), often appear within the first few weeks of life.
Stridor sounds like a high-pitched squeak and typically worsens when the baby is agitated, crying, feeding, or lying on their back. Babies might also experience feeding difficulties, such as choking or slow feedings, and gastroesophageal reflux (GER). Symptoms become more noticeable and may peak around 4 to 8 months of age.
Supporting Natural Resolution at Home
For most infants, laryngomalacia resolves as laryngeal structures mature, typically without medical intervention. Parents can implement several strategies at home to help manage symptoms. Positioning changes can help: keeping the baby upright during and after feedings, or elevating the head of their mattress slightly, may help open the airway and reduce reflux. Avoid placing the baby flat on their back if symptoms worsen.
Feeding adjustments also aid symptom management. Offer smaller, more frequent feedings to prevent reflux and reduce the effort associated with coordinating breathing and swallowing. Burp the baby frequently to prevent gas buildup. If reflux is a concern, consider avoiding certain foods for nursing mothers or thickening formula with infant cereal, if advised by a healthcare provider.
When Medical Treatment is Necessary
Medical intervention becomes necessary when symptoms are severe or impact a baby’s overall health and development. Signs indicating a need for medical attention include significant feeding difficulties leading to poor weight gain (failure to thrive). Severe breathing issues, such as prolonged pauses in breathing (apnea), a bluish tint to the skin (cyanosis), or significant pulling in of the neck and chest with each breath (retractions), also warrant immediate evaluation.
Medical treatments vary based on the severity of the condition. For severe reflux that worsens laryngomalacia symptoms, healthcare providers may prescribe anti-reflux medications. In cases where conservative measures are insufficient, surgical intervention, specifically supraglottoplasty, may be recommended. This procedure involves trimming or reshaping the excess, floppy tissue above the vocal cords to create a more stable and open airway. Supraglottoplasty is typically performed through the mouth using a microscope, laser, or other surgical instruments, and aims to improve breathing, feeding, and overall quality of life.
What to Expect as Your Baby Grows
The outlook for most babies with laryngomalacia is positive, with symptoms generally improving over time. Stridor often peaks around 6 to 8 months of age and then gradually resolves. The majority of infants outgrow the condition completely by 12 to 18 months, though for some, symptoms may persist until they are around 2 years old. In over 90% of cases, no surgical treatment is necessary, and the noisy breathing disappears as the child matures.
Ongoing monitoring by a pediatrician and an ear, nose, and throat (ENT) specialist is important to ensure proper growth and symptom resolution. While the condition typically resolves, a small percentage of children might experience mild, lingering symptoms or require continued follow-up into childhood. This continued oversight helps address any persistent issues and supports the child’s development.