Laryngomalacia & Stridor: Is My Child's Noisy Breathing Serious?

Laryngomalacia: Is My Child’s Noisy Breathing Serious?

infant lying in crib

What is Laryngomalacia?

Laryngomalacia is a common condition that occurs 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 most infants, this condition is not serious and will resolve on its own. However, 15-20% of infants end up needing surgery. 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.

Signs and Symptoms

Most babies who have laryngomalacia start to show symptoms at or shortly after birth. Symptoms may worsen a bit during the first few weeks of life, usually around 4-6 months old. Most children outgrow laryngomalacia by about 9-18 months old, once the tissue in the larynx has grown stiffer.

Symptoms for laryngomalacia include:

  • Noisy breathing (stridor), a high-pitched squeaking noise you hear when your baby breathes in.
  • Difficulty feeding and gasps or chokes during feeds.
  • Trouble gaining weight.
  • Baby’s skin between the ribs and in the neck is being sucked in with every breath.
  • Pauses in breathing while sleeping.

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

More About Stridor

Stridor can be alarming if you’ve not heard this type of noisy breathing before. Sometimes it sounds like a squeak or a wheeze.

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.

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.

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.

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.

To speak to someone about how our ENT specialists care for patients with laryngomalacia, or to schedule an appointment, call 513-636-2371. 

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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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  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 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: Sincerely, Catherine Hart
    • Alex October 09, 02:56
      Hello my baby is a month old and has the same issue question does your baby choke on medication? Mine does and I stop giving it to her because I’m scared of losing her
      • Rachel Camper
        Rachel Camper October 09, 06:02
        Hi Alex, I would recommend following up with your baby's doctor, as it's difficult to fully understand what's going on with her via this format.
  3. Tee May 15, 17:54
    I have a 16mobth old with. Laryngomalacia and trachea malacia and this past 3 weeks has had to get stetiod shots to reduce airway swelling and decrease moderate retractions and is worse with eating. Especially liquids.HE IS ON A thickener for all liquids.I was just searching for more information on thia.He also may have oblong vocal cords the pulmonary doctor. Believes needs may be corrected to round.This problem has been ongoing since birth but seems to have worsened recently.we have strong steriod meds for every 3 hour aerosol treatments to try to keep him out of the hospital.5/15/2018.
  4. Jake y January 16, 00:50
    Hello! At 5 weeks old my girl had stridor and difficulty breathing which quickly landed us at TCH. She went pale and had 5-10 second pauses bw breaths and a very fast breathing rate. We were released after 4 days and the drs said probably a virus that caused croup or bronchialitis, however it presented very much at odds with classic cases- she never had fever, no cough, lungs sounded clear, etc. it was really just the stridor and respiratory distress. We ended up going back to the hospital for another stay a few days later. She’s now 8 weeks old and at home.... it hasn’t got as bad as when we went to the hospital the first two times but it’s still not good. She breathes very loud and it’s disturbing. Our ENT scoped her and said it was LM but again, it was not a classical case and he wasn’t 100% confident. Does LM result in severe resp distress that requires a hospital stay? Why does she recover and why wouldn’t her resp distress stay severe? If it’s LM, why aren’t different positions producing different breathing patterns? We have a brilliant pediatrician and ENT looking at her but they aren’t confident in the diagnosis. We live in a small town and the volume of infant respitory distress cases is low, so we want to find the right specialist who’s seen 1000 cases of each respitory distress issue- LM, subglottic hemogenia, heart rings, etc. Do you have any suggestions?
    • Catherine Hart, MD Author January 30, 15:10
      It would be best to discuss these concerns with your pediatrician at your baby’s next well child check. If you won’t be seeing the pediatrician anytime soon, you should schedule an appointment so a doctor can ask some more questions and get a bit more information about what is going on. If your pediatrician thinks it's necessary, he or she can refer you to our ENT office for evaluation.