Laryngomalacia is a common condition in infants that causes noisy breathing. This occurs because the tissues above the voice box are softer than typical and can temporarily fall into the airway when a baby inhales. Many infants outgrow this condition, but understanding how sleep positions can help manage symptoms is helpful for parents.
Understanding Laryngomalacia and Sleep
Laryngomalacia involves a floppiness of the larynx, or voice box, which can partially obstruct the airway. When an infant breathes in, negative pressure is created in the larynx, causing these soft structures to collapse inward and narrow the breathing passage.
Sleep positions are important for infants with laryngomalacia because gravity influences the degree of airway obstruction. Lying flat on the back can worsen symptoms by allowing the floppy tissues to fall further into the airway. Conversely, certain positions can improve airflow by using gravity to pull these tissues away from the airway. Stridor may be louder during sleep.
Optimal Sleep Positions
Placing an infant on their side or stomach can reduce the collapse of laryngeal structures. Side sleeping may reduce the frequency of obstructive events and lessen breathing effort compared to back sleeping.
Elevating the head of the mattress is also beneficial, as this position helps open the airway. This can be achieved by placing a wedge under the mattress, creating an incline of approximately 30 degrees. It is important to emphasize that wedges or pillows should never be placed directly inside the crib with the infant due to safety concerns. Discuss these positional changes with a pediatrician to ensure they are appropriate and safely implemented for your child’s specific condition.
Positions to Avoid and Precautions
Infants with laryngomalacia should generally avoid sleeping flat on their back, as this position can worsen symptoms by allowing the floppy laryngeal tissues to collapse more easily into the airway. This can increase the noisy breathing and potentially make breathing more difficult. While back sleeping is generally recommended for all infants to reduce the risk of Sudden Infant Death Syndrome (SIDS), a healthcare provider may suggest alternative positions for infants with laryngomalacia if symptoms are severe.
General safe sleep precautions apply to all babies. These include placing the infant on a firm, flat sleep surface, such as a crib mattress, free from loose bedding, blankets, pillows, or bumper pads. Co-sleeping or bed-sharing is also not recommended, as it increases the risk of accidental suffocation or strangulation.
Comprehensive Sleep Management and When to Seek Help
Managing sleep for an infant with laryngomalacia involves more than just sleep positions. Infants with laryngomalacia often experience gastroesophageal reflux (GERD), which can further irritate the airway and intensify noisy breathing. Holding the infant upright for about 30 minutes after feeding and avoiding feeding while lying down can help reduce reflux. Thickening formula with infant cereal or over-the-counter thickeners may also be recommended by a healthcare provider to reduce regurgitation.
Monitoring an infant’s overall well-being is also important. Parents should be aware of signs indicating a need for medical attention. Seek immediate medical evaluation if your baby experiences:
Prolonged pauses in breathing (apnea)
Blue discoloration around the lips or face (cyanosis)
Significant pulling in of the neck or chest with each breath that does not improve with repositioning or waking
Difficulty feeding
Poor weight gain
Increased irritability