What is Laryngomalacia & How is it Treated?

Infants or young children often breathe noisily. There are several reasons behind this noisy breathing. One of the most common reasons is Laryngomalacia. In this condition, the breathing is loud, but the child doesn’t choke. Laryngomalacia is only a condition in which breathing is loud. Let us see what laryngomalacia is, why it happens and how to treat it.

One of the most common causes behind stridor or noisy breathing in infants is Laryngomalacia. It is a common birth defect or congenital anomaly. The defect is associated with larynx or the voice box.

When the larynx or the upper part of the voice box, which is a soft and floppy tissue, falls into the path of breathing or the airway, it blocks the breathing. This creates the noise.

To understand the mechanism or functionality of the larynx, one must have a clear idea of the physiology. There are two arytenoids or paired pieces of cartilage and an epiglottis. The epiglottis prevents the food from entering the trachea or windpipe. In case of a congenital anomaly, this epiglottis and the arytenoids block the airway and this creates the noise while breathing.

The exact cause of Laryngomalacia is not clearly known. However, in some cases, it is found to be inherited, though no specific association with genetic deformity is found yet. A lack of muscle tone is also a cause behind this. One thing that can be said in this regard is that Laryngomalacia is not your or your caregiver’s fault.

Noisy breathing with a high-pitched sound is the basic characteristic or sign of Laryngomalacia. The sound is worse when the child lies on his or her back. Even when he or she has got a cold, the sound is too high-pitched. With other lying position, the sound may improve. The noise worsens with –

• Crying
• Agitation
• Feeding
• Excitement
• Sleeping position.

The noise worsens within the first four to eight months of diagnosis. However, noisy breathing isn’t the only symptom of this condition. The other symptoms are –

• Poor weight gain
• Difficulty in feeding the infant
• Choking while eating
• Vomiting up the food
• Chest and neck sinking while breathing
• Spitting up acid from stomach or Gastro-oesophageal reflux
• Pauses while breathing
• If the problem is severe, one can even turn blue.

The stridor or noisy breathing associated with Laryngomalacia will start almost within 10 days of birth. However, it can start at any time within the first year. From the first 4 to 6 weeks of age, the breathing is light and noisy breathing or stridor might not be diagnosed. However, from age 6 months to 8 months, the inspiratory flow rate is high enough to produce the high-pitched sound while breathing and this persists until the baby reaches 2 years of age. The condition will worsen for up to 2 years of age and then it subsides automatically. It is only about in 15% of all Laryngomalacia cases that there is a requirement of surgical intervention.

As the child has noisy breathing, the healthcare provider will take into consideration the medical history of the child and refer the child to an otolaryngologist. This is an ENT specialist, who will run some tests. These are –

• Laryngoscopy: The healthcare provider will pass a thin and flexible scope through the mouth or nose and the throat to confirm the condition.
• X-ray to Check Chest and Neck Airways: To make sure that there are no additional airway problems in the chest or neck, the doctor will run an X-ray of the chest and neck.

Most of the time, as the child reaches 18 months of age and above, Laryngomalacia troubles gradually subside on their own. This is because by this time, the epiglottis develops properly and grows strong. Hence, it doesn’t hang loose and block the airway. Therefore, there is no way that noise will be generated while breathing.

In other cases, where the problem doesn’t subside on its own, Supraglottoplasty surgery may be recommended. In this surgical treatment method, the surgeon will trim off the epiglottis in such a way that it doesn’t come in the way of the breathing path. This will not eliminate the noise production completely, but it will improve the condition to a great extent. There are situations and circumstances in which the children have to undergo further surgeries for complete treatment of Laryngomalacia.

There is nothing that could be done with the problem of noisy breathing in case of Laryngomalacia. However, the other associated symptoms can be managed well. One such associated problem of Laryngomalacia is GERD or Gastro-oesophageal Reflux. To reduce GERD of your child, as a parent or as a caregiver, you need to –

• Make sure that the baby sits straight upright while you are feeding him or her and the position must be maintained at least for 30 minutes after eating. This will prevent the food from coming up.
• No acidic juices or foods should be given to the baby. This includes orange juice or any other citrus fruit.
• The baby must not be laid flat on his or her back with a bottle propped into the mouth.
• While feeding, the child must be burped gently.

In case the condition is serious, you need to discuss with the healthcare provider of the baby about which food would serve best for the child. The doctor or healthcare provider might ask you to avoid giving milk or at least give less milk to the child as it might sometimes cause more acidity.