Everything you need to know about laryngomalacia in infants

What is laryngomalacia?

Just after the mouth and before we reach the windpipe, there is a region that is referred to as the larynx. This is a structure that is made up of cartilage and muscles, see the image attached.
At a very young age, as you will learn below, the cartilage is soft and the muscles are weak, and therefore they can sometimes collapse during inspiration, when air is coming in. In the image here you can see an open larynx and one that has collapsed following inspiration. The sound that you hear is called stridor.

Who are the babies that suffer from laryngomalacia?

It happens young babies, starting in their second week of life, and it lasts up until 1.5-2 years. There is usually a gradual improvement with time.

What is special about stridor that occurs in children with laryngomalacia?

So yes, in most people, stridor simply improves with time. But those who specialize in the field know that the sound of stridor may differ depending on the cause. In children who present with stridor due to laryngomalacia, the sound appears during inspiration, and worsens when the child is crying, irritated, feeding or laying on their back.

How is the diagnosis of laryngomalacia made?

The symptoms usually raise clinical suspicion, without the need for invasive examinations.
Nonetheless, to confirm the diagnosis a laryngoscope (camera) is inserted through the nose so that the physician can look at the area directly. The procedure is performed at a pediatric ENT doctor’s office and takes about half a minute.
A chest x-ray or x-ray of the windpipe is not usually required.
In severe or persistent cases – a wider investigation is required including examination of the entire respiratory tree with the help of a camera (bronchoscopy).

What other findings can accompany laryngomalacia?

Sometimes, these children can present with difficulty feeding that is usually mild, causing long feedings and insufficient weight gain… that is why children with laryngomalacia have to be monitored rigorously by their pediatricians.

How can laryngomalacia be treated?

Most cases do not require any treatment and time simply helps it get better. As time passes, the respiratory tract grows and becomes stronger and the stridor improves and eventually disappears.
To improve the stridor you can place a baby on their tummy or on their back on a mattress that has been elevated at an angle of 30 degrees.
In severe cases (insufficient weight gain or loss of weight, cyanotic episodes when the baby turns blue), repair can be done through a surgical procedure.
In summary, we have learned about laryngomalacia. A diagnosis that is mostly likeable in pediatrics, requires a good explanation, reassurance and patience. Until it resolves.
Good luck!