Feature Article

Laryngomalacia in infants: when to treat

Marlene Soma, Joanna Walton



Laryngomalacia is the most common cause of stridor in infants. It is caused by collapse of the tissues above the vocal cords on inspiration. Surgical intervention may be required to manage failure to thrive, respiratory distress or sleep apnoea.

Key Points

  • Laryngomalacia is the most common cause of infantile airway noise, usually becoming prominent in the first few weeks of life.
  • The hallmark symptom of high-pitched inspiratory stridor helps to differentiate laryngomalacia from other airway conditions.
  • There is a spectrum of severity, but many cases of laryngomalacia are mild and resolve spontaneously by 2 years of age.
  • Severity is determined by the presence of feeding difficulties, poor weight gain, respiratory compromise, hypoxia or hypercapnia, aspiration, cyanotic episodes, apnoea and cor pulmonale.
  • Weighing the child regularly to monitor growth, supportive management to improve feeding, and acid suppression therapy for concurrent symptoms of gastro-oesophageal reflux disease may be of benefit as initial steps.
  • The patient should be referred to an ENT surgeon if there are obstructive airway symptoms, failure to thrive or any other parental concerns. A fibre-optic examination performed in the office can confirm the diagnosis of laryngomalacia and the need for further investigation or intervention with supraglottoplasty.

    Picture credit: © Blend/Ariel Skelley/Medical Images
    Models used for illustrative purposes only