Laryngomalacia is the most common congenital anomaly affecting the larynx structure in infants. This condition is present at birth, often becoming noticeable within the first few weeks of life. Laryngomalacia is typically a benign, self-resolving condition that usually improves without the need for medical intervention. The primary symptom is a characteristic, noticeable noise the infant makes while breathing.
The Distinctive Sound of Laryngomalacia
The sound associated with this condition is noisy breathing called inspiratory stridor. Stridor is a high-pitched, harsh sound that occurs specifically when the infant breathes air in. This distinct noise is caused by the turbulent flow of air through a partially blocked upper airway.
The stridor is highly dynamic, meaning its volume and intensity change based on the baby’s state and position. The sound is typically louder when the baby is agitated, crying, or actively feeding.
The stridor often worsens when the infant is lying flat on their back, as this position encourages the soft laryngeal tissues to fall into the airway. Conversely, the noise may lessen when the baby is calm or placed on their stomach. The noisy breathing usually becomes more pronounced over the first few months of life before gradually beginning to improve.
The Physiological Cause of the Breathing Sound
The underlying cause of the stridor is soft or “floppy” cartilage in the supraglottic larynx, the tissue above the vocal cords. This includes the epiglottis and arytenoids. Because of this soft cartilage, the condition is sometimes informally called a “floppy voice box.”
When the infant takes a breath, the negative pressure created in the chest pulls this soft tissue inward. This collapse temporarily narrows the airway opening, causing a partial obstruction of airflow.
The air rushing through this constricted space creates vibrations in the floppy tissue. Since the tissues are pushed back out of the way when the baby breathes out, the stridor is generally heard only during the inspiratory phase. This mechanical vibration is responsible for the noisy breathing.
Recognizing Severity and Seeking Medical Evaluation
While the noisy breathing of Laryngomalacia is usually a mild and temporary issue, it is important to distinguish typical cases from those requiring immediate attention. Mild Laryngomalacia is characterized by stridor without impacting the infant’s ability to breathe, eat, or grow. If an infant is thriving and gaining weight appropriately, the condition is likely to resolve on its own, usually by the time they are one to two years old.
However, certain “red flags” signal a more severe form of the condition that necessitates prompt medical evaluation. These signs indicate that the airway obstruction is more significant and is affecting the baby’s overall health. Severe symptoms include:
- Difficulty with feeding, such as choking, gagging, or poor endurance during meals.
- Failure to gain weight or weight loss, which is a major concern in infants.
- Increased work of breathing, manifesting as severe retractions (visible pulling-in of the skin at the neck, between the ribs, or below the rib cage).
- Episodes of apnea, which are long pauses in breathing.
- Cyanosis, a bluish or grayish tint to the skin, particularly around the lips or face, indicating insufficient oxygen.
Any sign of respiratory distress, such as severe retractions, color changes, or prolonged breathing pauses, requires an immediate trip to the emergency room. Consulting with a pediatrician or an Ear, Nose, and Throat (ENT) specialist is advisable for a definitive diagnosis. A medical professional can confirm Laryngomalacia and rule out other, potentially more serious, causes of stridor in infants.