Laryngomalacia and reflux
Laryngomalacia is the most frequent cause of noisy breathing or stridor in infants and children. It is the most common birth defect of the voice box or larynx. It is best described as floppy tissue above the vocal cords. This floppy tissue falls into the airway when the infant breathes in. The cause of laryngomalacia and the reason why the tissue is floppy is currently unknown, but the part of the nervous system that gives tone to the airway may have underdeveloped.
Symptoms of Laryngomalacia
Infants with laryngomalacia have intermittent noisy breathing when breathing in which may be better or worse in different positions. The inspiratory stridor very often becomes worse with agitation, crying, excitement, feeding or positioning/sleeping on the back. These symptoms are often present at birth, and are usually present within the first 10 days of life. However, the noisy breathing of laryngomalacia may begin any time during the first year of life. Symptoms will often increase or get worse over the first few months after diagnosis, usually between 4 to 8 months of age. Most infants with laryngomalacia outgrow the noisy breathing by 12 to 18 months of age.
Other symptoms that can be associated with laryngomalacia include:
- Feeding difficulties
- Poor weight gain (failure to thrive)
- Regurgitation of food (vomiting or spitting up)
- Choking on food
- Gastroesophageal reflux (spitting up acid from the stomach)
- Chest and/or neck retractions (chest and/or neck sinking in with breathing)
- Cyanosis (turning blue)
- Apnea (pauses in breathing)
Laryngomalacia can be mild, moderate or severe. About 99% of infants with laryngomalacia have mild or moderate laryngomalacia.
Mild Laryngomalacia: Noisy breathing or inspiratory stridor. There is no significant airway obstruction, feeding difficulties or other symptoms associated with laryngomalacia. The noisy breathing is annoying to caregivers, but does not cause other health care problems. Infants with mild laryngomalacia usually outgrow the stridor by 12 to 18 months of age.
Moderate Laryngomalacia: Noisy breathing or inspiratory stridor. They may also have:
- Feeding difficulties without poor weight gain
- Regurgitation of food (vomiting or sicking up)
- Choking on food
- Gastroesophageal reflux (sicking up acid from the stomach)
- Mild to moderate chest and/or neck retractions (chest and/or neck sinking in with breathing), but no severe distress
Infants with moderate laryngomalacia usually outgrow the stridor by 12 to 18 months of age, but may require treatment for gastroesophageal reflux. Stomach acid, if it reaches the upper part of the oesophagus and voice box, can cause swelling of the floppy tissue above the vocal cords. Very often, infants with moderate or severe laryngomalacia need oral medications to treat gastroesophageal reflux.
Severe Laryngomalacia: Noisy breathing or inspiratory stridor. They may also have:
- Feeding difficulties with poor weight gain
- Significant chest and/or neck retractions (chest and/or neck sinking in with breathing)
- Significant cyanosis (turning blue)
- Life threatening apnea (pauses in breathing)
- Heart or lung problems from chronic oxygen deprivation (low oxygen)
- Airway symptoms severe enough to cause multiple visits to an emergency department or hospital
Only 1% of infants with laryngomalacia have severe laryngomalacia. Infants with severe laryngomalacia usually need surgery.