Laryngomalacia
Laryngomalacia is the most common cause of noisy or squeaky breathing (stridor) in infants. It occurs when the tissues above the vocal cords are unusually floppy and collapse inward during inhalation. This causes a high-pitched and squeaky sound as air passes through the voice box. This is especially significant when the baby is feeding, crying or lying on their back. Laryngomalacia typically becomes noticeable within the first few weeks of life and often peaks around 3-4 months of age.
In most cases, laryngomalacia is a mild and self-limiting condition. Symptoms can include noisy breathing, mild feeding difficulties and occasional choking or gagging. However, more severe cases can lead to poor weight gain, frequent vomiting or reflux, apnea (pauses in breathing) and significant difficulty with feeding or breathing. Babies with severe laryngomalacia may also struggle to gain weight or may appear to be in distress during feeding or sleep.
When a baby is suspected of having laryngomalacia, referral to our specialists at ENT for Kids is important. Our physicians will usually perform flexible laryngoscopy, a quick, in-office procedure using a small camera passed through the nose to examine the airway. In more complex or unclear cases, further evaluation such as a sleep study or airway endoscopy under anesthesia may be recommended to assess the entire airway and rule out other contributing conditions.
Management of laryngomalacia depends on the severity of the symptoms. Mild cases are typically managed with careful monitoring, positioning strategies (like keeping the baby upright after feeds) and treatment for associated acid reflux, which can worsen airway irritation. In moderate to severe cases, or when there are complications such as feeding failure, poor weight gain or oxygen desaturation surgical intervention may be necessary. During surgery, our physicians repair laryngomalacia with a supraglottoplasty, in which the floppy tissue above the vocal cords is trimmed to open the airway and reduce the collapse.
Supraglottoplasty is usually performed under general anesthesia and is highly effective in improving breathing and feeding in children with severe laryngomalacia. Most babies recover quickly and show significant improvement within days.
If your baby has persistent noisy breathing, feeding difficulties, or seems to struggle to breathe comfortably, talk to your pediatrician about referral or reach out to the team at ENT for Kids to arrange a consultation.