By: John E. McClay, MD, FAAP
If your baby's breathing is noisy sometimes, you might be wondering why. It could be stridor, a term for abnormal, loud breathing sounds. Stridor can have many different causes, including upper airway infections. When newborns and infants have stridor, however, one of the most common causes is a condition called laryngomalacia. Thankfully, stridor and laryngomalacia are usually not serious.
What is stridor?
Stridor is a type of noisy breathing. It's most common in babies because their airways are narrower. It's usually described as a repetitive or high-pitched squeaking sound. It may happen occasionally or when your baby is resting. When a baby has stridor, this is a sign that something is partially blocking the upper airway.
There are many causes of stridor in children, including:
Narrowing of the airway (subglottic stenosis)
Inhaled foreign object
Infections such as croup or epiglottitis
Masses or lesions on the vocal cords
Vocal cord weakness or paralysis
In infants, the most common cause of stridor is a condition called laryngomalacia.
What is laryngomalacia?
Laryngomalacia is a common condition in newborns. It occurs when the tissues in the larynx (voice box) fall into the airway as your baby inhales, causing noisy breathing (stridor). The larynx is made of cartilage. In newborns, the cartilage is often soft and immature, which can make it floppy.
The good news is that for most infants this condition is not serious and goes away with time. In some cases, babies do end up needing surgery to treat the symptoms.
How do I know if my baby has laryngomalacia?
Most babies who have laryngomalacia start having symptoms within a few days to weeks after birth. These symptoms may include:
Difficulty feeding or gasping/choking noises while feeding
Spitting up a lot and being fussy after feeds.
Retractions—when the skin in your baby's neck or between their ribs is sucked in with every breath
Pauses in breathing while sleeping
If your baby has any of these symptoms, they should be checked for laryngomalacia.
How is laryngomalacia diagnosed?
A pediatric ear, nose, and throat (ENT) specialist usually makes the diagnosis of laryngomalacia.
First, the ENT will get a thorough history of the types of symptoms your baby has. Next, the doctor will examine your baby with a procedure called flexible laryngoscopy. This procedure uses a small scope that's inserted into your baby's nose in the office. The laryngoscopy lets the doctor look at your baby's vocal cords and larynx.
How is laryngomalacia treated?
Most babies with laryngomalacia don't need treatment. As your baby grows and the cartilage in their voice box becomes stronger, the symptoms usually go away by the time they're a year old. However, it can take until your child is about 18 months to 2 years of age to resolve completely. In the meantime, it's important to make sure that your child is growing and developing normally.
Babies who have laryngomalacia also commonly have gastroesophageal reflux (GER). GER is a condition in which stomach acid and food flow back up into the esophagus, the tube that connects the stomach to the mouth. GER is hardly ever serious in babies, but it can make laryngomalacia symptoms worse. Your baby may need medication for GER, which can improve their reflux symptoms and may also help with breathing.
When laryngomalacia surgery may be needed
If your baby is having serious breathing problems, feeding problems, or isn't gaining weight like they should, surgery may be needed.
The surgical procedure to treat laryngomalacia is called a supraglottoplasty. It's done microscopically through your baby's mouth. Small instruments are used to remove the tissue that's causing the breathing problems from the larynx.
The procedure generally takes less than an hour. Your baby will likely be kept overnight in the hospital after surgery, but you should be able to go home the day after surgery. In most cases, your baby's symptoms will improve very quickly after the procedure.
Don't hesitate to talk with your child's pediatrician if you have any concerns about your child's health.
About Dr. McClay
John E. McClay, MD, FAAP, is a fellowship trained pediatric otolaryngologist–ear nose and throat surgeon–who has taken care of children for more than two decades. Dr. McClay has authored over 30 professional articles in peer reviewed medical journals describing his research studies. He was an academic professor in the Department of Otolaryngology/Head and Neck Surgery at the University of Texas at Southwestern Medical School in Dallas for 17 years, where he had an academic Professorship in his honor. He has now been in private practice for more than 6 years. He has been named one of D Magazine's Best Pediatric Specialists every year since its inception in 2003, and one of the best pediatric specialists in the state of Texas by Texas Monthly for the last 13 consecutive years. Within the American Academy of Pediatrics, he is the Education Committee Chair for the Executive Committee of Otolaryngology.