When a baby breathes louder than average, it may be the first sign of laryngomalacia (pronounced la-ring-oh-ma-lay-shia), a birth defect that results in a partial blockage of the voice box. Laryngomalacia is the most common cause of noisy breathing in infants.

What is laryngomalacia?

Laryngomalacia is a congenital condition (present at birth) in which the tissue directly above the vocal cords is softer than usual. When the baby takes a breath, the softness of the tissue flaps in the airway. This can cause a partial blockage of the airway, which results in noisy breathing, particularly when babies are on their back.

Laryngomalacia Symptoms

Symptoms of laryngomalacia can be mild, moderate or severe. If the baby has mild, moderate, or severe symptoms, contact their pediatrician.

Mild and Moderate Laryngomalacia Symptoms

Stridor, a noisy, wheeze-like sound during breathing, is the most common symptom. Stridor can worsen during the baby’s first few months of life, but it should resolve before their second birthday. In most cases, the baby will not have any trouble eating or breathing.

If the infant has a mild or moderate form of laryngomalacia, their breathing gets louder when doing activities such as:

• Eating
• Lying down
• Sleeping
• Crying

Severe Laryngomalacia Symptoms

If the baby has a severe form of laryngomalacia, their symptoms can include the following in addition to stridor:

• Difficulty swallowing
• Long pauses in breathing (apnea)
• A bluish skin hue (cyanosis)
• Pulling of food into the lungs when breathing (aspiration)
• Feeding problems
• Chronic acid reflux (gastroesophageal reflux disease, also known as GERD)
• Poor weight gain

If the baby is experiencing these severe symptoms, contact their pediatrician.

Respiratory distress is another severe symptom, but should be handled by taking the baby to the emergency room

Life Threatening Laryngomalacia Symptoms

Parents should take their baby to the emergency room immediately if the baby experiences:

• Prolonged pauses when breathing or apneic episodes
• Blue discoloration around the lips

Is laryngomalacia life threatening?

Laryngomalacia is usually not life threatening. In most cases, the baby can breathe when experiencing laryngomalacia, though parents should consider scheduling an appointment with the baby’s pediatrician for an examination and treatment recommendations. If the baby develops symptoms suddenly or has GERD, parents should contact the child’s pediatrician.

Diagnosing Laryngomalacia

Usually, a pediatric otolaryngologist — an ear, nose and throat (ENT) specialist — makes the diagnosis of laryngomalacia, and will thoroughly review medical history and perform a physical examination. Your baby’s airway is typically evaluated with an in-office laryngoscopy, which includes the use of a small camera scope in the baby’s nose to look at the larynx and vocal cords.

Laryngomalacia Treatment

Most cases of laryngomalacia resolve without treatment intervention before the infant reaches 18 months of age. If the baby experiences GERD, the pediatrician may provide an anti-reflux medication.

In cases in which the baby has trouble breathing or is not gaining weight appropriately as a result of laryngomalacia, the doctor may decide that surgery is required. Severe cases may require supraglottoplasty, a surgery during which the area above the vocal cords is opened by cutting the folds of the tissue. This surgery should improve both feeding and breathing for the baby.