Information
Laryngomalacia means “Soft Larynx”. It is caused by floppiness of the laryngeal tissues above the vocal cords. During inspiration these tissues collapse inwards causing a partial obstruction. This creates inspiratory stridor.
Stridor is a high pitched, musical noise that can occur in either phase of breathing (inspiration or expiration) or both (biphasic). It is different from stertor, which is a noise originating in the nasopharynx and sounds like snoring.
Laryngomalacia is the most common cause of noisy breathing in infants. More than 50% will present during the first week of life and most have developed symptoms by 2-4 weeks of age.
Signs and Symptoms
- Inspiratory stridor, louder with exertion, feeding and crying.
- May be accompanied with a by mild tracheal tug
- Symptoms are often worse when lying flat or after a feed and improve when sleeping or quiet.
- Stridor will become louder over the first few months as the infant grows and becomes more active. Things will then improve over the first year of life.
- The majority of children will have completely outgrown this by 2 years without need for intervention or any sequalae.
- Commonly associated with Gastro-oesophageal Reflux Disease.
Red Flags
- Difficulty feeding such as increased effort in breathing when feeding or struggling to take full volumes due to work of breathing.
- Poor weight gain
- Apnoeas
- Cyanotic episodes
- Hoarse voice / cry
- Biphasic stridor.
C.M. & G.T. 20-01-25
Who can refer:
Any experienced care provider medically assessing an infant who has any above red flags.
Who to refer:
All infants with red flags.
Who not to refer:
Infant with signs of laryngomalacia without red flags.
How to refer:
Outpatient referral to RHCYP
Reassurance should be given to families that in the absence of any concerning features, infants with laryngomalacia will thrive and gradually outgrow this problem. If any red flags occur, they should seek medical attention.
If signs of Gastro-oesophageal Reflux manage with feed thickeners, anti-reflux formula milks or Omeprazole. This can improve underlying irritation and in turn improve stridor and symptoms.
