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Laryngomalacia / Congenital Laryngeal Stridor

What is laryngomalacia?
Laryngomalacia (also called congenital laryngeal stridor) results from a congenital (present at birth) anomaly of the larynx (voice box). A weakness in the structures in the larynx, can cause stridor. Stridor is a high-pitched sound that is heard best when the child breaths in (inspiration).


What causes laryngomalacia?
Laryngomalacia is a defect that is present at birth. During fetal development, the structures in the larynx may not fully develop. As a result, there is a weakness in these structures at birth, causing them to collapse during breathing. In children, laryngomalacia is the most common cause of chronic stridor. 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.


What are the symptoms of laryngomalacia?
The major symptom of this disorder is the stridor that is heard as the infant breathes. The stridor is usually heard when the infant breathes in (inspiration), but can also be heard when the infant breaths out (expiration). Other characteristics of the stridor may include:
  • The stridor changes with activity - is louder when agitated or upset.
  • The stridor is usually less noisy when the child is laying on his/her stomach.
  • The stridor gets worse if the infant has an upper respiratory infection.
The symptoms of laryngomalacia may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.


How is laryngomalacia diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for laryngomalacia may include endoscopy of the airways - a procedure which involves a tube being passed into the airways to allow your child's physician to observe the airways during breathing.


Treatment for laryngomalacia:
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 has no long-term complications. In some cases, the stridor is apparent until about the age of 5. Each child's case is unique. About 10 percent develop severe respiratory problems which require medical and surgical interventions.

The most helpful way to determine if your child's laryngomalacia is causing significant problems is:
  1. if it appears to be interfering with feeding
  2. your baby requires frequent breaks while feeding
  3. your baby is having difficulty gaining weight
Your child should be seen by an otolaryngologist (ENT) if these are present.
  1. your child has signficant retractions (chest sucking in)
  2. breathing problems
  3. cyanosis

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