Why is breathing noisy?
In a newborn, the tissues of the entrance to the larynx are soft and pliable. During inhalation, negative pressure is created in the airways, and pliable structures are pulled inward, narrowing the lumen. The air passes through the constriction with vibration - this is how a characteristic sound arises. That is why the noise is heard mainly during inspiration, increases when the child cries, worries or lies on his back, and decreases when lying on his stomach and during sleep in a calm state. As the cartilage strengthens, the lumen stops collapsing and the stridor disappears.
- Softness of the cartilages of the entrance to the larynx
- Retraction of structures during inhalation
- Increased with crying and feeding
- Decrease on abdomen and at rest
- Appearance in the first weeks of life
- Gradual disappearance by 12–18 months
Other causes of stridor
Although laryngomalacia is the most common condition, noisy breathing can have other causes, so an examination is always necessary. These include congenital narrowing of the subglottic space, paresis of the vocal fold, cysts and hemangiomas of the larynx, vascular rings compressing the trachea, as well as tracheomalacia. Separately, there are acute conditions: croup with barking cough and hoarseness, swelling of the larynx due to allergies and the entry of a foreign body, in which noisy breathing suddenly occurs in a previously healthy child. These situations require immediate attention.
- Laryngomalacia is the most common cause
- Tracheomalacia
- Congenital subglottic stenosis
- Vocal fold paresis
- Cysts and hemangiomas of the larynx
- Vascular ring
- Acute croup and foreign body as urgent causes
What to watch for parents
The main guideline is not the volume of the sound, but the child’s well-being. A calm infant who is suckling vigorously, making normal weight gains, and sleeping well usually only needs observation, even if breathing is noisy. Difficulties during feeding should alert you: the baby takes a few sips and breaks away to catch his breath, sweats while eating, spits up, feeding takes a very long time. Signs of increased work of breathing - retraction of the fossa above the sternum and intercostal spaces, swelling of the wings of the nose - require consultation with a doctor.
- Weight gain by age
- Ability to suck without interruptions for shortness of breath
- No retractions when breathing
- Normal skin and lip color
- Restful sleep without frequent awakenings with pauses in breathing
- Noise dynamics: decreasing or increasing
Survey
The primary assessment is carried out by a pediatrician: listens to breathing, determines whether noise is heard during inhalation or exhalation, evaluates the work of the respiratory muscles, blood oxygen saturation and weight gain. The main method of confirming laryngomalacia is flexible laryngoscopy, in which a thin endoscope is passed through the nose and the movement of the laryngeal structures is observed during breathing. The examination takes minutes and is performed without anesthesia. If a lesion below the larynx is suspected or symptoms are severe, additional endoscopic examination of the airway and other imaging techniques are performed.
- Examination by a pediatrician and assessment of weight gain
- Pulse oximetry
- Flexible laryngoscopy through the nose
- Feeding assessment
- Additional endoscopic examination for severe forms
- Consultation with a gastroenterologist for severe reflux
What to do and when surgery is needed
For most children, observation is enough: a doctor monitors weight gain and breathing, and parents receive clear criteria for when to contact immediately. Selecting a feeding technique helps: a more vertical position, pauses, feeding in smaller portions more often. Since many children have laryngomalacia combined with gastroesophageal reflux, which increases swelling in the larynx, the doctor may prescribe treatment for reflux. A severe form with growth retardation, episodes of apnea and a drop in oxygen requires surgical correction - supraglottoplasty, which usually gives a good result.
- Monitoring and weight control in mild cases
- Feeding in a more upright position, fractionally
- Treatment of gastroesophageal reflux as prescribed by a doctor
- Pulse oximetry if necessary
- Supraglottoplasty in severe cases
- Immediate treatment for cyanosis and pauses in breathing