Infants with Laryngomalacia have intermittent noisy breathing, called stridor, when breathing in. It becomes worse with agitation, crying, excitement, feeding or position / sleeping on their back.

These symptoms are often present at birth and are usually apparent within the first 10 days of life. However, noisy breathing may be present in babies up to one year of age.

Symptoms will often increase or get worse over the first few months after diagnosis, usually between 4-8 months of age. Most children outgrow the noisy breathing (stridor) by 12-18 months of age.

Other associated symptoms include:

• Poor weight gain
• Difficulty with feeding
• Vomiting or spitting up
• Choking on food
• Stops breathing
• Chest and / or neck retractions (chest and / or neck sinking in with each breath)
• Turning blue
• Gastroesophageal reflux (GERD) (splitting up of acid from the stomach)

Doctors may also use the following tests procedures to help diagnose laryngomalacia:

Flexible laryngoscopy

This test involves placing of a lighted tube through the nose or mouth to look at the voice box. During the test, your child’s doctor will look at the position of the tissue above the voice box to determine if it is “floppy”. At the same time, he / she will look for any other throat / voice box problems that may contribute to the noisy breathing.

X-rays of the neck and chest

Some children may have an additional problem that may be contributing to the noisy breathing. The X-rays can screen for other potential causes of noisy breathing in the upper airway, windpipe, chest and lungs.

pH probe

The pH probe is a test that measures the acid in two places in the esophagus, just before the stomach and near the throat.

There is a high association between gastroesophageal reflux disease (GERD) and laryngomaacia. Your doctor may recommend this test if he / she is concerned about the degree of acid regurgitation (vomiting or spitting up) your baby may be having.

Microlaryngoscopy and Bronchoscopy

During this test, your child’s doctor will look at the voice box and windpipe with telescopes. Your doctor may recommend this test if the X-ray test shows something abnormal or if your doctor has a suspicion of additional airway problems.

Esophagogastroduodenoscopy (EGD)

During an EGD, the doctor will look at your child's esophagus and stomach with a lighted tube to look for signs of chronic inflammation from acid irritation.

Your doctor may recommend this if the pH probe is significantly abnormal or there is strong suspicion of significant GERD based on history and clinical examination.

Symptoms and treatment plans will often vary depending on the severity of your child’s laryngomalacia.

Laryngomalacia can range from mild to severe:

Mild laryngomalacia

Infants in this category have non-complicated laryngomalacia with typical noisy breathing when breathing in. These children do not have significant airway obstructive events, feeding issues or other symptoms associated with laryngomalacia.

These patients will usually outgrow the stridor by 12-18 months of age. Even though your child may have mild laryngomalacia, it is still important to watch for signs or symptoms of it worsening.

Moderate laryngomalacia:

Children with moderate laryngomalacia have typical noisy breathing when breathing in, in addition to the following symptoms:

• Vomiting or spitting up
• Airway obstruction (from floppy voice box tissue)
• Feeding difficulties without poor weight gain
• History of airway symptoms severe enough to warrant multiple visits to an emergency department or hospital
• Gastroesophageal reflux disease (GERD): These patients also will typically outgrow the stridor by 12-18 months of age but may require treatment for GERD.

With moderate laryngomalacia, it’s important to watch for changes in the frequency or severity of symptoms.

Severe laryngomalacia:

Infants and children with severe laryngomalacia often require surgery for treatment and to lessen the degree of symptoms. Your doctor may recommend surgery if your child has any of the following symptoms:

• Life-threatening apnea
• Significant blue spells
• Failure to thrive with feeding difficulty
• Significant chest wall and neck retractions with breathing
• Requires oxygen to breathe
• Heart or lung problems as a result of chronic oxygen depravation

Take your child to the hospital for:

• Stops breathing for longer than 10 seconds
• Dusky or blue color around lips associated with noisy breathing
• Chest or neck retractions that do not stop with repositioning your child or waking your child up

Inform your child’s doctor about:

• Child has difficulty keeping food down and constantly spits it up
• Child is losing weight or is not gaining weight
• Child begins to feed less and tires easily in the middle of feeding
• Child begins to choke on food
• Child struggles between eating and breathing

There are two operations for treatment. Your doctor will most likely recommend a supraglottoplasty. The unneeded floppy tissue of the larynx is trimmed in the operating room with your child under general anesthesia. Your child may have a breathing tube in the nose through the voice box after surgery for at least one night.

Your child may need to have this operation done more than once. Having the operation may not make the noisy breathing go away completely, but it should improve your child’s breathing and will likely decrease the noise.

The other surgical option is the placement of a tracheotomy tube into the windpipe to bypass the floppy tissue of the larynx. Rarely is this operation done for laryngomalacia. Your surgeon will try to do the supraglottoplasty if it is appropriate and feasible for your child before recommending a tracheotomy. There are occasions and other health issues that make a tracheotomy the recommended surgical option.

If your child has an operation, he / she may still require treatment for gastroesophageal reflux during and after the operation. It is also important to monitor your child for signs and symptoms of worsening LM.