Laryngomalacia is a common congenital condition where the soft tissues of the larynx (voice box) collapse inward during breathing, causing airway obstruction. It typically presents in infants with noisy breathing, known as stridor, which may worsen when the baby is upset or feeding. While it can be concerning, most cases improve as the child grows and the laryngeal tissues strengthen. In severe cases, medical intervention or surgery may be required to ensure proper airflow and prevent complications.
What Is Laryngomalacia?
Laryngomalacia is a common cause of noisy breathing in infants. It occurs when the larynx (voice box) is soft and floppy, causing part of it to collapse temporarily and block the baby’s airway when breathing in. Laryngomalacia (pronounced luh-ring-oh-muh-LAY-shuh) typically improves on its own by the time the baby is 1 year old.
Signs & Symptoms of Laryngomalacia
Babies with laryngomalacia make a harsh, squeaky sound when they breathe in, known as stridor. This can begin at birth or within the first few weeks. Symptoms often get worse over several months.
Most babies with laryngomalacia:
- Do not have trouble breathing or feeding despite noisy breathing.
- Have noisier breathing when crying, feeding, sleeping, lying down, or during upper respiratory infections.
However, more serious symptoms include:
- Difficulty breathing (with visible tugging at the neck or stomach)
- Feeding problems
- Poor weight gain
- Breathing pauses (apnea)
- Blue skin or lips (cyanosis)
If your baby shows these more serious symptoms or if their breathing worsens suddenly, call the doctor right away.
Babies with laryngomalacia often also have gastroesophageal reflux (GER), where food and acid flow back into the esophagus. If reflux affects the voice box, it can make breathing symptoms worse. Treating GER with special formulas or medications may improve symptoms.
What Causes Laryngomalacia?
The exact cause of laryngomalacia isn’t known, but it might be related to how the larynx forms before birth. The muscles that support the voice box may be weak or not properly coordinated with breathing. GER may also contribute to the condition.
How Is Laryngomalacia Diagnosed?
Doctors typically suspect laryngomalacia based on the baby’s symptoms and a physical exam. A pediatric ENT specialist (ear, nose, and throat doctor) will confirm the diagnosis using a procedure called flexible laryngoscopy. This involves passing a thin tube through the nose or mouth to view the airway and vocal cords.
Doctors may also check oxygen levels and conduct tests for swallowing issues or GER. Monitoring the baby’s weight and growth is critical.
How Is Laryngomalacia Treated?
Most cases of laryngomalacia improve on their own by the time the baby turns 1 year old. Doctors will monitor the baby’s breathing and weight gain during regular check-ups. Since many babies also have GER, anti-reflux medications are often prescribed.
In severe cases, where the baby has significant breathing difficulties or poor growth, surgery called supraglottoplasty may be necessary. This procedure tightens the floppy tissue above the voice box to improve feeding and breathing.
What Else Should I Know?
Laryngomalacia symptoms tend to worsen during the first few months of life but usually improve by 3–6 months and resolve completely in most children. Occasionally, older children who had laryngomalacia may experience noisy breathing during exercise, a viral infection, or while sleeping.
If you notice any concerning symptoms or your child’s condition doesn’t improve as expected, consult with your doctor for ongoing support and treatment.