Laryngomalacia is a common congenital condition that affects an infant’s airway. It occurs when the tissues of the larynx are softer than usual at birth. These soft tissues can temporarily fall back over the airway opening, partially blocking it. This partial blockage leads to noisy breathing, a sound often more noticeable during feeding.
Deciphering the Sound
The noisy breathing associated with laryngomalacia is called stridor. It is a high-pitched sound, often with a crowing quality. This sound happens because air passes through a partially obstructed airway.
In laryngomalacia, the stridor is heard when the baby breathes in (inspiratory stridor). The sound can become louder when the baby is agitated, crying, or excited. Most infants with laryngomalacia do not experience serious breathing or feeding difficulties.
Why Feeding Affects the Sound
The stridor associated with laryngomalacia becomes more pronounced during feeding. A change in body position, such as lying flat, can worsen the floppiness of the laryngeal tissues. The act of suckling during feeding increases respiratory effort and creates more negative pressure in the airway, causing soft tissues to collapse further.
Coordination between breathing and swallowing is another factor. Infants may struggle to coordinate these actions, leading to increased noise or swallowing difficulties. Gastroesophageal reflux (GER) is common in infants with laryngomalacia. Stomach acid reaching the voice box can irritate and swell tissues, making noisy breathing worse.
Supporting Feeding for Infants
Managing feeding for infants with laryngomalacia involves strategies to minimize noisy breathing and support comfortable intake. Feeding the infant in an upright position reduces the collapse of the soft laryngeal tissues. Gravity helps keep the airway more open in this position.
- Smaller, more frequent feeds prevent stomach fullness and reduce reflux.
- Paced bottle feeding for bottle-fed infants allows control of flow and coordination of breathing and swallowing.
- Frequent burping during and after feeds releases swallowed air and reduces stomach fullness.
- Ensuring a good latch for breastfeeding improves feeding efficiency and comfort.
- Creating a calm and quiet feeding environment helps regulate breathing and feeding.
Knowing When to Seek Help
While most cases of laryngomalacia are mild and resolve on their own, certain signs indicate a need for medical attention. Difficulty breathing is a primary concern, manifesting as retractions (skin pulling in at the neck or chest), nasal flaring, or a bluish tint around the lips (cyanosis). These symptoms suggest increased effort to breathe.
Poor weight gain or weight loss can signal inadequate feeding. Choking or gagging during feeds, significant feeding difficulties, or prolonged pauses in breathing (apnea) warrant medical evaluation. If the stridor is constant, loud, or significantly worsens even when the baby is calm, consulting a pediatrician is advisable for diagnosis and management.