Laryngomalacia in Children

What is laryngomalacia?


Laryngomalacia (also known as laryngealmalacia) is a condition that results from a birth defect in your child’s voice box (larynx). The soft tissues of the larynx fall over the airway opening and partially block it. This can result in stridor — a high-pitched sound that is heard when your child inhales. Laryngomalacia is sometimes referred to as congenital laryngeal stridor and is the most common cause of noisy breathing in infants.

What are the symptoms of laryngomalacia?

If your child is born with laryngomalacia, symptoms may be present at birth. The primary symptom is noisy breathing, known as stridor. This is a wheezing sound your baby makes when inhaling. It is often worse when your baby is on his or her back, because the floppy tissues can fall over the airway opening more easily in this position. Stridor may also get worse before it improves.

Other symptoms may include:

  • difficulty feeding
  • poor weight gain
  • choking while feeding
  • apnea (pauses in breathing)
  • pulling in neck and chest with each breath
  • cyanosis (blue spells)
  • gastroesophageal reflux (spitting, vomiting and regurgitation)
  • Inhalation of food into the lungs (aspiration)

What causes laryngomalacia?

The exact cause of laryngomalacia is not known. A lack of proper muscle tone in the upper airway may contribute to the condition.

How we care for laryngomalacia

Many infants with laryngomalacia are able to eat and grow normally, and the condition will resolve without surgery by the time they are around 20 months old. However, a small percentage of babies do struggle with breathing, eating and weight again, and their symptoms require immediate treatment. The Center for Airway Disorders at Boston Children’s Hospital is designed to care for children with rare conditions of the airway, including laryngomalacia. Our team provides the most advanced testing and surgical treatments available for this condition.


Laryngomalacia |Diagnosis & Treatments

How is layrngomalacia diagnosed?

Based on the severity of symptoms, your child’s doctor may suggest any of the following tests to evaluate the condition:

  • chest X-ray
  • airway fluoroscopy
  • bronchoscopy
  • cat scan (CT) with 3‐D reconstruction
  • echocardiogram
  • functional endoscopic evaluation of swallowing (FEES)
  • laryngoscopy
  • rigid bronchoscopy

How is laryngomalacia treated?

While most cases of laryngomalacia resolve over time without surgery, more severe cases require a treatment called supraglottoplasty. This surgery involves cutting the folds of tissue to open the supraglottic airway (the area above the vocal chords).

During this procedure, your child will be under general anesthesia. After surgery, your child will be admitted to the hospital for a 24-hour observation period.