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When Should I Be Concerned if My Child Has Laryngomalacia?

When Should I Be Concerned if My Child Has Laryngomalacia?

Guest Post By Genevieve Kane, MSN, RN

Does your baby squeak when they breathe? Noisy breathing feels concerning when you’re a new parent. If you hear high-pitched squeaking sounds from your infant, especially at rest, it could be a sign of a type of breathing called stridor.

Laryngomalacia is one of the most common causes of stridor, according to the American Academy of Pediatrics (AAP). Fortunately, stridor is rarely serious.

However, it’s important to note that if you have any concerns about your child’s breathing, contact a healthcare professional for advice. If your little one seems like they are struggling to breathe, seek immediate medical attention.

While stridor and laryngomalacia aren’t usually serious, there are instances where medical intervention is necessary.


What is Laryngomalacia?

Children’s Hospital of Philadelphia explains that laryngomalacia is a condition where laryngeal tissue is softer than it should be and falls over the airway, partially blocking it. A blocked or narrowed airway is what causes the stridor sound.

Most infants with laryngomalacia develop symptoms within the first three months of life. Mild cases of laryngomalacia tend to get better with conservative treatment between one and two years old. Examples of conservative treatment include feeding upright, antireflux therapy, and observing respiratory symptoms to ensure they don’t worsen.

The main symptom of laryngomalacia is noisy breathing, which is known as stridor. The stridor may peak between 4-8 months of age. However, other symptoms may be present, too.

Signs Laryngomalacia is More Serious

Several symptoms indicate laryngomalacia might be more severe and require medical intervention. These symptoms include, and are not necessarily limited to:

  • Trouble feeding
  • Poor weight gain or weight loss
  • Choking while feeding
  • Apnea, or stopping breathing
  • Aspirating food
  • Cyanosis or turning blue
  • Extra work of breathing, which may look like the neck and chest being pulled in
  • Gastroesophageal reflux disease (GERD)

If your child has any of these symptoms, your healthcare provider may prescribe them medications or consider surgical interventions. For example, if your child experiences GERD, medication to treat GERD may be prescribed. This is because GERD can worsen laryngomalacia by causing additional swelling and breathing work.

It is essential that if at any point you are concerned about your child’s breathing, or it appears they are struggling to breathe, that you seek medical attention.

Surgical Intervention for Laryngomalacia

Of the children who have laryngomalacia, 10-20% of them will have severe cases that may require surgical intervention. If surgery is necessary, it is typically a procedure known as supraglottoplasty. This procedure is generally indicated in cases where a child experiences failure to thrive (not gaining weight appropriately) or worsening problems with their airway.

If your child does require surgery, the surgery will be tailored to meet the needs of your child’s specific case. A special type of surgery, supraglottoplasty, may include dividing aryepiglottic folds that are shortened, removing extra tissue, an epiglottopexy, or a combination of these surgical interventions. Regardless of the specific surgical interventions performed, the goal is to help open and stabilize the airway.

If your child requires surgical intervention, a specialized doctor, called an ears, nose, and throat specialist (ENT), will do the procedure. An ENT is the same type of provider as Dr. Steven Goudy, the founder of the NozeBot.

As with any surgical procedure, risks are involved. However, the procedure is generally well tolerated. You can expect your child to need some care in the hospital afterward, but how long is up to the surgical team and your child’s recovery. Post-operatively the goal is to decrease any inflammation, often through the use of steroids and pain management.

When Should I Be Concerned if My Child Has Laryngomalacia?

While it is scary to have a child needing surgery, the procedure has a high success rate. It is estimated that there is a 95% success rate for children who need a supraglottoplasty procedure. Occasionally, additional revision surgeries are necessary. Further surgical intervention is typically required in instances of:

  • Infants who are two months or younger at the time of surgery
  • The presence of neurological conditions such as hypotonia, seizure disorders, or cerebral palsy
  • The presence of cardiac conditions such as septal defects, aortic or pulmonary stenosis, or pulmonary hypertension

If your child has a neurological condition that affects their respiratory function, in addition to the laryngomalacia, they are at a higher risk of needing a tracheostomy to keep the airway functioning appropriately.

Having a medically high-needs child is stressful. If your child does fall into one of these categories where additional surgical interventions are necessary, it is essential to be aware of hospital support. For example, most children’s hospitals have a child life team. Child life professionals can help make hospital procedures less scary and reduce stress.

Some facilities also offer therapy dog programs that can help alleviate stress for caregivers and patients. Social work is often available, as are chaplains. And if you need to travel out of town for a procedure, there may be the option for housing at a Ronald McDonald house.

Looking for more tips on respiratory care or surgery in kids? You’ll find these helpful:

Key Takeaways

Typically, laryngomalacia is a minor condition that peaks at 4-8 months of age and then resolves on its own by two years. However, certain symptoms or coexisting conditions occasionally make the condition more serious.

If your child’s laryngomalacia is severe, surgical interventions are often successful and a well-tolerated procedure. However, regardless of the success rate, any time your child undergoes surgery, it is scary!

When Should I Be Concerned if My Child Has Laryngomalacia?

It is vital to work closely with your child’s medical team to ensure you understand the diagnosis, what signs and symptoms to watch for at home, and that you feel comfortable with the interventions offered to you and your family. You are your child’s best advocate. If you have questions or concerns about your child’s symptoms, contact your child’s healthcare team for advice.

Genevieve Kane, MSN, RN, is a mother of four and a registered nurse with a background in pediatrics. When she's not working, you can find her cooking up tasty family dinners or keeping up with her kids on a hiking trail in her home state of Colorado.

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