Laryngomalacia
Nurture Information Hub
Evidence
https://pubmed.ncbi.nlm.nih.gov/23905826/
Allison M Dobbie , David R White
Laryngomalacia is the most common cause of stridor in infants. Stridor results from upper airway obstruction caused by collapse of supraglottic tissue into the airway. Most cases of laryngomalacia are mild and self-resolve, but severe symptoms require investigation and intervention. There is a strong association with gastroesophageal reflux disease in patients with laryngomalacia, and thus medical treatment with anti-reflux medications may be indicated. Supraglottoplasty is the preferred surgical treatment of laryngomalacia, reserved only for severe cases. Proper identification of those patients who require medical and surgical intervention is key to providing treatment with successful outcomes.
Education
What is Laryngomalacia?
Laryngomalacia is a type of voice box abnormality present in newborn babies. The condition occurs when the tissues located above the voice box are floppy and fall back over the airway. Laryngomalacia is the most common cause of noisy breathing in babies. Laryngomalacia is congenital, meaning it is present at birth.
What are the symptoms of laryngomalacia?
Babies with laryngomalacia may exhibit mild, moderate, or severe symptoms. The most common sign of laryngomalacia is stridor (loud, squeaky noises that occur when your baby breathes in). Stridor symptoms often worsen over the first several months but resolve themselves within one year. Even though stridor sounds concerning, most babies with laryngomalacia have no trouble breathing or feeding. In infants with mild laryngomalacia, breathing usually gets louder when lying down, sleeping, crying or feeding.
Though not as common, some babies may have severe laryngomalacia symptoms, which include:
- Loud, noisy breathing.
- Difficulty swallowing (dysphagia).
- Apnoea (long pauses in breathing).
- Cyanosis (a condition that causes the skin to develop a bluish hue).
- Aspiration (pulling food into the lungs).
- Poor weight gain.
- Gastro-oesophageal reflux disease (GORD)
- A tugging or “pulling in” at the neck or chest when breathing.
If your baby exhibits any of the symptoms listed above, call your healthcare provider right away.
How Is Laryngomalacia Diagnosed?
Doctors often suspect laryngomalacia at birth or soon after based on the baby's symptoms and an exam. To confirm the diagnosis, a paediatric ear, nose, and throat (ENT) specialist will do a procedure called flexible laryngoscopy. To do this, the doctor passes a thin tube through the baby's nose or mouth to look at the airway and vocal cords in the voice box.
The doctor may check oxygen levels and order other tests to check for swallowing problems or Gastro-oesophageal reflux disease (GORD). The baby's weight gain and growth are especially important.
When to seek help for Laryngomalacia?
I can be challenging if you're a parent or family member trying to figure out the seriousness of a breathing issue in a child with laryngomalacia. If you have concerns, seek immediate medical evaluation to ensure the best care for your child.
Signs that indicate more severe conditions include
- Irritability,
- Poor feeding,
- Pulling in of the skin at the collar bone, between the ribs, or under the ribs,
- Flaring of the nose,
- Increasing effort to breathe
- Poor weight gain or weight loss, especially in infants.
Symptoms that should trigger emergent evaluation include:
- Pauses in the breathing,
- Colour change of the skin (particularly if the lips, face, or hands are turning blue)
- Appearing lethargic or tired,
- Or any other sudden change from a child’s normal breathing pattern.
If any of these or other concerning signs develop, please call 000 immediately.
Empowerment
Most infants with laryngomalacia will get better on their own without needing any medical intervention. 70% of infants will have resolution of stridor by 1 year of age, and 90% by 2 years of age. Sometimes medications are recommended to help control associated symptoms like acid reflux from the stomach (GORD), as this condition may worsen the symptoms of laryngomalacia.
If a child with laryngomalacia experiences severe symptoms such as difficulty feeding, poor weight gain, pauses in breathing (apnoea), or turning blue (cyanosis), surgical treatment may be suggested. The recommended surgical procedure for laryngomalacia is Supraglottoplasty. This procedure uses laser or surgical instrument to remove the tissue that has blocked the larynx. In rare cases, more invasive procedures might be considered.
Useful Links
Northern Beaches Hospital
ENT Care
http://www.entcare.com.au/newborn-breathing-complex-airway-care-children-david-lowinger.html
Perth ENT Centre
https://www.perthentcentre.com.au/breathing-difficulties
The Royal Children’s Hospital, Melbourne
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Confirmation Content
Disclaimer: This publication by Miracle Babies Foundation is intended solely for general education and assistance and it is it is not medical advice or a healthcare recommendation. It should not be used for the purpose of medical diagnosis or treatment for any individual condition. This publication has been developed by our Parent Advisory Team (all who are parents of premature and sick babies) and has been reviewed and approved by a Clinical Advisory Team. This publication is not a substitute for professional medical advice. Miracle Babies Foundation recommends that professional medical advice and services be sought out from a qualified healthcare provider familiar with your personal circumstances.To the extent permitted by law, Miracle Babies Foundation excludes and disclaims any liability of any kind (directly or indirectly arising) to any reader of this publication who acts or does not act in reliance wholly or partly on the content of this general publication. If you would like to provide any feedback on the information please email [email protected].
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