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What to Know About Laryngomalacia in Babies

Reviewed by Poonam Sachdev on November 24, 2021

Babies born with laryngomalacia—a type of birth defect— make a noisy sound when they breathe. In fact, this condition is the most common cause for your infant's noisy breathing.

The noise tends to get worse when your baby is laying on their back, just after feeding, when they’re agitated, or when they’re crying. In most babies, this will be the only symptom. Although the sounds might be distressing, in 90% of cases, the condition clears up on its own. 

Nevertheless, you should inform your doctor if you hear a noisy breathing sound coming from your infant. Even if the condition is mild, your doctor will want to monitor your baby’s progress as they grow up. 

What Is Laryngomalacia?

Laryngomalacia causes the soft tissues in your child’s larynx—or voice box—to fall into their airway when they inhale.

These tissues—made of cartilage—partially block your child’s airways and cause a high-pitched whining sound. This symptom is called stridor, so the condition is sometimes called congenital laryngeal stridor. 

What Are the Causes of Laryngomalacia?

The exact cause of laryngomalacia is unknown, but theories include: 

  • A lack of necessary muscle tone in your infant’s upper airway leads to flapping tissue. 
  • Gastroesophageal reflux sends acid above the voice box and aggravates the tissue.
  • Abnormal movement of air moves the tissue.

The cause may also be a combination of all three of these problems.

There are a handful of cases of people inheriting laryngomalacia and of multiple siblings developing laryngomalacia, but in general, the condition does not appear to have a genetic cause.  

However, the condition is also commonly seen alongside other birth defects. In anywhere from 30% to 80% of cases, children with laryngomalacia are also born with either a cleft palate or a cleft lip

What Are the Symptoms of Laryngomalacia?

Laryngomalacia symptoms usually appear shortly after your child is born or within their first month of life. 

The main symptom—and the one that parents are most likely to notice first—is the high-pitched, noisy breathing that the flapping tissue creates. Other symptoms include: 

  • Feeding difficulties either with or without weight gain problems
  • Apnea when breathing occasionally pauses
  • Pulling in their chest and neck while the baby sleeps
  • Cyanosis—turning blue
  • Gastroesophageal reflux—spitting up stomach acid into the throat
  • Aspiration (i.e., food is inhaled into the lungs) 

In mild cases, your child will only have noisy breathing and none of the other complications. Out of all reported cases of laryngomalacia, 90% of them are mild. 

In moderate cases, your child can have issues with feeding, reflux, and involuntary neck and chest movements, but they shouldn’t have any issues with weight gain, and you shouldn’t be concerned about their development because of this level of defect. 

Severe cases are rare and affect only around 1% of infants with laryngomalacia. If your infant’s symptoms are severe, they’ll need to be treated immediately. Symptoms are severe when there is/are: 

  • Problems with weight gain—also known as a failure to thrive
  • Life-threatening apnea 
  • Prolonged episodes of turning blue
  • Heart or lung problems from oxygen deprivation 

In severe cases, you need to seek treatment immediately. Contact your doctor or seek emergency services if your child has stopped breathing for over ten seconds, if the neck and chest pulling won’t stop, or if the baby's lips turn blue while they make loud sucking noises. 

What Is the Treatment for Laryngomalacia?

Your child won’t need any special form of treatment if they only have mild laryngomalacia. They’ll simply grow out of the noisy breathing. 

If your child has moderate laryngomalacia, your doctor will most likely prescribe some form of antacid or other acid-suppressing medication. This should cut down on the acid reflux and relieve your child’s symptoms.

In all mild and most moderate cases, your child’s noisy breathing will have completely cleared up by ages 18-20 months. The breathing may get worse for the first four to eight months of symptoms; then, it’ll slowly start to improve. 

However, your child will need surgery if their symptoms are severe. This is called supraglottoplasty. Some of the problematic tissue is removed during this surgery. 

Surgery may not completely eliminate the noisy breathing, but it should clear up all of the dangerous symptoms. Your baby may need other surgeries, though, to handle the symptoms from any additional birth defects, such as a cleft palate.  

Show Sources

SOURCES: 

Boston Children’s Hospital: “Laryngomalacia.” 

Children’s Hospital of Philadelphia: “Laryngomalacia,” “Supraglottoplasty.” 

Children’s Hospital at Vanderbilt: “Laryngomalacia.”  

Genetic and Rare Diseases Information Center: “Laryngomalacia.” 

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