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Quick reference medical handouts used by Pediatric offices


Laryngomalacia: A noisy problem!


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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:

  • Starts in the first two months of life (but not at birth)
  • Occurs when the child is breathing in
  • Becomes worse with crying, upper respiratory tract infections, laying in the supine (on back) position*
  • Usually gets worse before it gets better
  • Child may have retractions (sucking in of the skin above or below the ribs when breathing in)
  • There is no cyanosis (blue color of the skin)
  • 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.

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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