Laryngomalacia is a congenital condition characterized by softness of the tissues of the larynx (voice box) located above the vocal cords. This condition is common in newborns and is the most common cause of stridor, a high-pitched sound that occurs when a child inhales. Although this condition can be worrying for parents, understanding laryngomalacia, its causes, symptoms, and available treatments through my medical guide, can help alleviate concerns appropriate care.

**What is laryngomalacia?**

 

Laryngomalacia is a condition characterized by sagging of the tissues of the larynx, causing it to collapse inward during inhalation, causing airway obstruction and the familiar stridor sound. This condition is congenital, meaning it is present from birth. In most cases, laryngomalacia is harmless and resolves on its own as the child grows and the structures of the larynx harden.

**Is laryngomalacia dangerous?**

 

In most cases, laryngomalacia is harmless, as it does not affect breathing or feeding, allowing the child to grow and develop normally. In very rare cases, surgery may be required, but the child then recovers completely without any health problems.

**What are the symptoms of laryngomalacia?**

 

Symptoms include loud breathing (stridor), especially during feeding or when the child is lying down, in addition to difficulty gaining weight.

How can laryngomalacia be prevented?

 

Laryngomalacia cannot be prevented because it is a congenital condition, but symptoms can be managed by following appropriate feeding techniques.

How can laryngomalacia be treated at home?

 

You can help your child burp gently and frequently during feeding. Avoid giving your child juices or foods such as orange juice, as they can upset his stomach. If your child suffers from frequent vomiting during feeding, it is preferable to consult a healthcare provider. It may be recommended to reduce the amount of milk given to the child to avoid reflux.

What are the causes of laryngomalacia?

 

Laryngomalacia occurs as a result of softening of the tissues above the vocal cords, which leads to partial obstruction of the airway in infants.

How is laryngomalacia treated?

 

Mild cases usually go away on their own, while more severe cases may require surgery to prevent breathing difficulties or feeding problems.

Is there a cure for laryngomalacia?

 

Treatment for laryngomalacia depends on the severity of the symptoms and their impact on the child’s overall health and development. Most cases of laryngomalacia are mild and go away without the need for any medical intervention.

When should parents be concerned about laryngomalacia in newborns?

 

If a newborn is having significant feeding difficulties, is failing to thrive, or is having severe breathing problems, seeking medical care is essential.

What is the prognosis?

 

To ensure that your child’s larynx matures and the problem is resolved, it is important to monitor any changes in their health. While many children outgrow laryngomalacia without medical intervention, others require surgery, often before the child turns one. Be careful, as breathing stops or cyanosis can be life-threatening, so don’t hesitate to call 911 if your child is experiencing any difficulty. Fortunately, most cases of laryngomalacia do not require surgery or other procedures, but rather require patience and care. Breathing loudly can be distressing, but knowing that this problem often resolves on its own can help reduce stress.

**Prevalence** Despite being a congenital defect, vocalizations do not begin until 4 to 6 weeks of age. Even then, the inspiratory flow rate may not be sufficient to produce the sounds. Symptoms peak at 6 to 8 months of age, and then begin to subside by the time the child is 2 years old. Late-onset laryngomalacia is a separate condition, with symptoms first appearing after the age of 2 years.

**Types of laryngomalacia**

Laryngomalacia can be classified into several types based on its severity and the anatomy involved. Understanding these types helps in evaluating the condition and determining the appropriate treatment.

**Type 1: Mucosal Recurrence** This type is characterized by an excess amount of soft tissue in the larynx, which can partially obstruct the airway. This excess tissue usually collapses during inhalation, causing a stridor.

**Type II: Short arylogenous folds** In this type, the folds that connect the side of the epiglottis to the larynx are shorter than normal. This shortening causes the epiglottis to be pulled inward during inspiration, causing a narrowing of the airway and a stridor sound.

**Type III: Posterior collapse** This type involves the collapse of the back of the larynx, often more severe, which can lead to significant airway obstruction. This type requires careful monitoring and may require surgery.

**Causes of laryngomalacia**

The exact cause of laryngomalacia is not fully understood, but it is thought to be the result of a combination of genetic and developmental factors. Some theories suggest that laryngomalacia may result from incomplete neuromuscular control of the larynx, which causes the airway tissues to sag.

**Genetic factors** Some evidence suggests that laryngomalacia may have a genetic basis. A family history of airway abnormalities or other congenital conditions may increase a child’s risk of developing laryngomalacia.

**Developmental factors** Immaturity of the laryngeal structures at birth is a major factor in laryngomalacia. As the child grows and the tissues mature, the condition often improves and goes away on its own.

**Diagnosis of laryngomalacia**

Diagnosis of laryngomalacia usually requires a comprehensive clinical evaluation, which may include a series of diagnostic tests to determine the condition and rule out other possible causes of stridor.

**Clinical evaluation** A pediatrician orAn otolaryngologist will perform a thorough medical examination and physical exam. The characteristic stridor sound and the absence of other worrisome symptoms often indicate laryngomalacia.

**Laryngoscopy** Flexible laryngoscopy is the most accurate diagnostic test for identifying laryngomalacia. This procedure involves inserting a thin, flexible tube with a camera (laryngoscope) through the nose to image the larynx. This allows the doctor to observe the movement of the laryngeal tissues during breathing and confirm the diagnosis.

**Imaging studies** In some cases, additional imaging studies such as X-rays or a barium swallow may be performed to rule out any other anatomical abnormalities or conditions that may be contributing to the airway obstruction.

**Symptoms of laryngomalacia**

The most prominent symptom is a snoring or whistling sound when the infant breathes, especially when sleeping, crying or screaming, or while feeding. This snoring begins in the first week of life, gets worse between 4 and 8 months, and then gradually improves and disappears on its own after about 18 to 20 months. There is no need to worry, as the child's health and growth will not be affected by laryngomalacia, but in rare cases other symptoms may appear, including:

- Very loud breathing sounds.

- Difficulty swallowing and breastfeeding.

- Risk of choking during breastfeeding.

- Breathing stops for seconds.

- Inhaling milk into the lungs.

- Poor growth and failure to gain weight.

- Gastroesophageal reflux.

- Blue color of the body.

- Protrusion of the rib cage during breathing.

**Possible changes at home**

In cases of mild or moderate laryngomalacia, you and your child may not need to make major changes in feeding, sleeping, or other activities. It is important to monitor your child carefully to ensure that he is feeding well and does not suffer from any serious symptoms associated with laryngomalacia. If you have difficulty feeding, you may need to offer food more frequently, as your child may not get enough calories and nutrients in each feeding. You can also raise the head of your child's bed slightly to help him breathe easier at night. Although laryngomalacia is present, sleeping on your back is the safest option for infants, unless your pediatrician recommends otherwise.

When should you be concerned?

 

Although laryngomalacia is often a harmless and temporary condition, there are some signs and symptoms that warrant more serious attention and intervention.

Serious symptoms??

- Severe stridor: Persistent, high-pitched stridor that interferes with the ability to feed or sleep.

- Difficulty feeding: Significant problems eating that lead to poor weight gain.

- Cyanosis: Episodes of bluish skin color, indicating a lack of oxygen.

- Apnea: Conditions in which an infant stops breathing.

Can it be prevented?

 

Although laryngomalacia cannot be completely prevented, you can take steps to help reduce the risk of medical emergencies associated with this condition. Here are some strategies you can follow:

- Be aware of signs to watch for regarding feeding, weight gain, and breathing.

- In the rare case that your child stops breathing due to laryngomalacia, it is best to discuss the possibility of using a continuous positive airway pressure (CPAP) device or other treatment options with your pediatrician.

- If your child’s laryngomalacia symptoms require treatment, seek out a specialist with expertise in this area.

**Treatment options for laryngomalacia**

 

The method of treating laryngomalacia is determined by the severity of the symptoms and their impact on the child’s overall health and development. In most cases, laryngomalacia symptoms are mild and resolve on their own without the need for medical intervention.

**Conservative management** In mild cases, conservative treatments are often sufficient, including:

- **Monitoring**: Regular follow-up appointments to monitor the child’s growth and development.

- **Position**: Keeping the child upright during feeding and sleeping can help reduce airway obstruction.

- **Feeding modifications**: Increasing feedings or using specialized feeding techniques to ensure the child receives adequate nutrition.

**Medical Treatment** In some cases, medications may be prescribed to control symptoms and improve the child's comfort, such as:

- **Anti-reflux medications**: Since gastroesophageal reflux can worsen the symptoms of laryngomalacia, anti-reflux medications may be prescribed.

- **Steroids**: In some cases, a short course of steroids may be used to reduce airway inflammation.

**Surgical intervention** In advanced cases of laryngomalacia that do not respond to conventional or medical treatments, surgical intervention may become necessary. The most common surgical procedure is a laryngectomy, which involves removing or reshaping excess tissue in the larynx to improve airflow.