Information on Laryngomalacia

Laryngomalacia is a congenital abnormality of the laryngeal cartilage. It is thought to represent a delay of maturation of the supporting structures of the larynx.  This disorder may become obvious as early as the first two weeks of life, with noisy, raspy breathing while taking a breath in. Furthermore, it is the most common congenital laryngeal anomaly. It is often associated with general noisy respiration.  The stridor is most prominent when the child is in the supine position or when the child is agitated. 

More force able inspiration tends to effect in a louder stridor quality due to greater prolapse and thus greater obstruction. Laryngomalacia may be more often in children with Down syndrome. Children with laryngomalacia will do better at a 30 degree angle, or by positioning their heads to alleviate or decrease the obstruction. The child should also be held in an upright position for 30 minutes after feeding and never fed lying down. Crying exacerbates the obstruction and work of breathing; a pacifier may be useful to calm an agitated infant. Sixty percent of infants born with congenital laryngeal stridor will have symptoms in the first week of life.

Most other infants will show symptoms by 5 weeks old. Males are affected twice as often as females. Laryngomalacia arises from a continued immaturity of the larynx. Laryngomalacia becomes symptomatic after the first few weeks of life, and may get louder over the first year, as the child moves air more vigorously. It generally resolves spontaneously by the second year of life. In most cases, laryngomalacia is a harmless condition that resolves on its own, without medical intervention. The condition usually improves by the time the infant is 18 months old, and results in no long-term impairment.

In several cases, the stridor is heard up until the age of five. Each child's case is exclusive. A small percentage develops severe respiratory problems that need medical or surgical intervention. In rare cases, surgery is necessary. Most generally, this involves cutting the aryepiglottic folds to let the supraglottic airway spring open. In severe cases, a temporary tracheotomy may be essential. The most useful method to determine if your child's laryngomalacia is causing significant problems is appears to be interfering with feeding. Your baby requires frequent breaks while feeding. Your baby is having difficulty gaining weight.