Laryngomalacia: Is My Child’s Noisy Breathing Serious?

Baby laying in crib

Laryngomalacia. That’s a big word to explain a relatively common condition that occurs in infants. “Laryngo” means having to do with the larynx (the “voicebox”), which is located in the trachea where the vocal cords are. And “malacia” means a softening or floppiness of the tissue. So, in short, laryngomalacia is when the tissue above the vocal cords is floppy and falls into the airway when a child breathes in, which causes noisy breathing (called stridor).

For 80-85 percent of babies with the condition, it is mild to moderate. In these instances, the condition usually resolves on its own without us having to do any intervention.

The 15-20 percent of infants who experience severe laryngomalacia may need surgery to correct the problem in their airway. The condition is typically diagnosed by an otolaryngologist, also known as an ENT or ear, nose and throat specialist.

Most babies who have laryngomalacia start to show symptoms at or shortly after birth. The most common symptom is stridor, a high-pitched squeaking noise you hear when your baby breathes in. For most babies, the stridor worsens a bit during the first few weeks of life. Often it will level off for a period of time and then at 4-6 months old, a baby’s breathing may get noisier again. By about 9-18 months old, the stridor usually starts to diminish. In most babies the stridor is typically gone by about 18 months old, once the tissue in the larynx has grown stiffer. If a baby will require surgery to treat the laryngomalacia, we will usually know by the time the baby is about 12 months old—give or take a few months because each baby is different.

More About Stridor

Stridor can be alarming if you’ve not heard this type of noisy breathing before. (It can also occur when children have certain illnesses, such as croup.) Sometimes it sounds like a squeak or a wheeze. You may be concerned about your child’s ability to breathe. The underlying problem is that the tissues in the larynx are too floppy and they collapse on themselves. Even though the stridor can be scary to hear, we also have to consider how hard your baby has to work to breathe.

A couple of important points about stridor:

  • It can get worse when babies are eating and crying, because they’re working harder to breathe at these times.
  • Some babies are noisier when they’re asleep; others are noisier when awake.
  • The stridor itself is not the main cause for concern. The noisy breathing will not harm your child.

Questions Your Doctor Will Ask You

When your pediatrician is evaluating your baby, he or she will ask several questions to assess how serious your baby’s condition is. These are the types of questions you’ll want to be prepared to answer:

  1. Describe the noise you hear when your baby is breathing. When do you hear it (asleep, awake)? What makes it worse (feeding, sleeping, crying)?
  2. How is your baby feeding? Is he gaining weight?
  3. What is your baby’s breathing like when she sleeps? Does she gasp or choke? Does she stop breathing or have pauses in her breathing?
  4. Does he ever turn blue around his lips?

The answers to these questions help gauge further medical care your child might need, and when a referral to an ENT specialist is necessary.

What to Watch For

Even though your child’s laryngomalacia may be mild, it’s still important to watch for signs or symptoms of it worsening. Call your pediatrician if your baby:

  • Is having difficulty feeding and gasps or chokes during feeds.
  • Is having trouble gaining weight. It might be too difficult for your baby to eat and breathe at the same time.
  • Is working too hard to breathe. Watch for your baby’s skin between the ribs and in the neck being sucked in with every breath.
  • Starts to have pauses in breathing while sleeping.

While most parents get used to the sound of their baby’s stridor, it might cause concern in others. Share what you know about laryngomalacia with family members, daycare providers and babysitters. Assure them that the noise in and of itself isn’t scary. Educate them about the above signs you are watching for at home so they know what to keep an eye on as well.

I know how concerning it is for parents when their baby’s medical condition relates to breathing. I hope this information helps you feel empowered about what to watch for with laryngomalacia, so you feel confident caring for your child.

If you have questions, or would like to have your baby’s stridor assessed, please contact our Department of Otolaryngology.
Catherine Hart, MD

About the Author: Catherine Hart, MD

Dr. Catherine Hart is a pediatric otolaryngologist (ear, nose and throat specialist) at Cincinnati Children’s. Dr. Hart’s areas of interest include pediatric airway disorders and general ENT problems. Her research interests focus on improved outcomes in pediatric airway surgery.

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Comments

  1. M&M December 10, 05:32
    My baby has been diagnosed with laryngomalacia since birth, she is currently 3 and a half months old and yesterday I went to my ENT specialist for her and she is having difficulty with weight gain from feeding. Reading this article helped me understand more of what was indicated at my daughters evaluation yesterday. Thank you for all the information.
    • Sam August 12, 08:26
      Even my my baby is having difficulty gainibg weight. What did your doc tell about gaining weight?
  2. Brittany August 08, 22:05
    Dr. Hart, My daughter was diagnosed with severe laryngomalacia when she was two months old. We had surgery to correct it two weeks later. Her stridor, breathing and eating were much better for about a week and a half. Now, the stridor is back and accompanied by a wheezing sound. Her neck still caves in when breathing. She is taking short, frequent breaths as if to catch her breath. Sometimes it also sounds like she needs to clear her throat, or that some phlegm is caught. She does have severe reflux as well. She is on reflux medication twice daily. She still refluxes all the time, but doesn't seem to be in pain from it. I reached out to our pediatric ENT and he doesn't seem concerned. I, as well as my family, are still worried since the symptoms had disappeared and are now back and are continuing to worsen. She did not have the wheezing before. Should we seek out another doctor, or is this common?
    • Catherine Hart, MD
      Catherine Hart, MD Author August 14, 08:42
      Mrs. Cowan, Thanks for reaching out to us. Symptoms of laryngomalacia can continue after surgery or come back after surgery. If you are worried about your daughter’s breathing, it would be very reasonable to have her checked again either by your pediatric ENT or by another physician. If you’d like for me or one of our partners to see her, we’d be happy to do so. We can be reached through this phone number: 513-636-4355 or by email: ent@cchmc.org. Sincerely, Catherine Hart