Are Those Normal Baby Noises? A Guide to Laryngomalacia

If you notice that your baby makes squeaky or high-pitched sounds when they are breathing, it can be alarming! The most common cause of this type of noisy breathing in infants is called “laryngomalacia.” Here is what parents and caregivers need to know.

What is Laryngomalacia?

Laryngomalacia sounds complicated but means “soft voicebox” – “larynx” is the voice box and “malacia” means soft. A baby’s larynx sits at the top of their trachea (windpipe) and helps to control breathing, swallowing, and talking. In babies with laryngomalacia, the tissue of the larynx is extra soft and floppy. When the baby takes a breath in, the tissues can collapse inward and cause a high-pitched sound that we call “stridor.”

What would I notice if my child has laryngomalacia?

Laryngomalacia can look different from one baby to another, but we commonly see:

• Noisy breathing on the breath in (inspiratory stridor) – characteristically high-pitched and worse with breathing in than breathing out. Parents may notice that the sound is louder when baby is feeding, crying, or lying on their back.
• Difficulty feeding. To breastfeed or take milk or formula from a bottle, babies need to coordinate a pattern of sucking, swallowing and breathing. This can be hard work in some babies with laryngomalacia.
• Trouble gaining weight. The energy from food is sometimes used for breathing, rather than going toward your baby’s growth.
• Increased effort with breathing (retractions) – the tissue above a baby’s breastbone, under the ribs, or over the windpipe may pull in with breathing.

Rarely, severe laryngomalacia can cause pauses in breathing, or blue spells. If you notice these symptoms, we recommend seeking urgent medical attention.

How is laryngomalacia diagnosed?

If you or your baby’s pediatrician suspect that your baby may have laryngomalacia, the next best step is to schedule a visit with a pediatric ENT (ears, nose and throat doctor). In the office, we will:

• Watch and listen to your baby’s breathing – sometimes this can give us important clues.
• Perform a flexible laryngoscopy. Our camera is the size of a spaghetti noodle and lets us look directly at your baby’s voice box. This is captured on a video screen so we can show you exactly what we see.
• Possibly recommend a visit with our feeding specialists. If there is significant feeding concern, further evaluation of your baby’s swallowing may be recommended.

How is laryngomalacia treated?

The good news is that most babies improve with growth and time. By 12 to 18 months, laryngomalacia has resolved in more than 80% of babies.

For babies who have a lot of reflux or spit up, we may recommend a medication to help. Acid reflux can make the airways more swollen, which makes them even more floppy.

For babies with more severe symptoms – difficulty gaining weight, effortful breathing or pauses in breathing, or blue spells – we may recommend a surgery called a “supraglottoplasty.” This surgery involves trimming some of the floppy tissue in the voice box so that the airway is more open.