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Laryngomalacia is the most common cause of "noisy breathing" in babies
after the newborn period. This disorder may become obvious as early as the
first two weeks of life, with noisy, raspy breathing while taking a breath
in . At first the noise simply sounds like nasal congestion, but it occurs
without nasal secretions. This type of "noisy breathing" is known as
stridor and has a high pitched, harsh quality. The stridor is usually
absent with the child is at rest and becomes more prominent when the infant
is lying on his/her back, crying, feeding,excited or has a cold. The stridor
usually is at it’s worst around six months and then gradually improves.
Most children are symptom free by 24 months.
The cause of laryngomalacia is not clearly understood. What is known about
the condition is that the epiglottits which protects the airway when the
child feeds also partially obstructs the airway during breathing. The partial
obstruction is the source of "noise" with breathing.
Children with laryngomalacia will do better at a 30 degree angle, or by
positioning their heads to relieve or reduce the obstruction. The child should
also be held in an upright position for 30 minutes after feeding and never
fed lying down. Crying exacerbates the obstruction and work of breathing;
a pacifier may be useful to calm an agitated infant.
Characteristics of laryngomalacia include:
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Starts in the first two months of life (but not at birth)
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Occurs when the child is breathing in
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Becomes worse with crying, upper respiratory tract infections, laying in
the supine (on back) position*
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Usually gets worse before it gets better
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Child may have retractions (sucking in of the skin above or below the ribs
when breathing in)
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There is no cyanosis (blue color of the skin)
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The baby is otherwise happy and thriving
Treatment is simple but nerve-racking -- waiting for the child to out grow
the condition while explaining to family, friends, and passerbys that there
is really nothing wrong with your noisy breathing baby. It is rare that this
abnormality causes any serious problems. The stress is on the parent listening
to this noisy breathing as the infant is experiencing little problems. In
time, the cartilage that supports tissues around the throat and airway become
stronger which helps resolve the problem. Most children grow out of
laryngomalacia by one year of age and nearly all children eventually outgrow
the condition.
Laryngomalacia a not a dangerous condition and will not interfere with the
child’s growth and development. No treatment is necessary, although
some parents have found that cool visit from a vaporizer helps eases the
child's noisy breathing. Only in very severe (are rare) cases, or when there
is a simultaneous upper respiratory infection, does the condition require
treatment. Holding the child in the prone position (stomach down) and comforting
and soothing him/her to slow the breathing are almost always sufficient to
handle an episode. The most important thing is to calm the child, in order
to stop the crying, as crying makes the problem much worse. If a parent is
in doubt about their child's noisy breathing, they should have him/her looked
at, but hospitalization for Laryngomalacia is very rare.
*In some instances, doctors may recommend that babies with
laryngomalacia be placed on their stomachs to sleep instead of their
backs, as long as the bedding is not soft. Parents of children with
laryngomalacia should always talk to the baby's doctor if they are unsure
about the best sleep position for their baby.
