Tracheomalacia

Tracheomalacia is a combination of two words: Trach refers to the trachea or the windpipe and malacia means soft and flexible. If the trachea is softer and more flexible than expected, a baby might be diagnosed with tracheomalacia.

The cartilage in the trachea of an infant is naturally softer and more flexible than that of an older child or adult. The problem comes when the trachea is so floppy that it partially collapses when air is leaving the lungs (exhaling). When this happens, the breathing is noisy and sometimes more labored than it should be.

What causes tracheomalacia?

The most common type of tracheomalacia is called congenital tracheomalacia. This means that the baby was born with the condition and it will usually show up early in infancy.

Other types of tracheomalacia can occur later when something outside the trachea presses on the previously normal tracheal cartilage. For example, an abnormal blood vessel may surround the trachea putting pressure on the walls of the airway. Tracheomalacia can even develop after a child has been on a ventilator for quite a while. These two types of tracheomalacia are much less common than the congenital type.

What are the symptoms of tracheomalacia?

Symptoms of tracheomalacia include:

• High-pitched breathing (called stridor) and noisy, rattly breathing
• Noisy breathing worsens with big breaths, like crying or coughing
• Upper respiratory infections (colds) make the noisy breathing noisier
• Breathing tends to be quieter and easier during sleep

How is tracheomalacia diagnosed?

A physician's exam usually confirms the diagnosis. An X-Ray of the airway may show narrowing of the airway when exhaling. Even if the X-Ray does not show anything abnormal, it is helpful in ruling out other problems. An airway fluoroscopy is another type of test for tracheomalacia that is actually an X-Ray video of the moving airway. Sometimes a barium swallow or upper GI series might be necessary as well. If a definite diagnosis is needed or it is necessary to determine the severity of the tracheomalacia, a laryngoscopy could be performed. This test involves putting thin, lighted scope into the airway to watch the airway move during breathing.

How is tracheomalacia treated?

There is no treatment or cure for tracheomalacia. However, when an infant with tracheomalacia gets a cold or respiratory infection he must be watched more closely. The increase in airway secretions and mucous that comes along with a cold can make it harder to breathe for a baby with tracheomalacia.

In rare cases, if the tracheomalacia is unusually severe, airway support like CPAP or even surgery might be necessary.

Are there other complications of tracheomalacia?

Respiratory infections like colds make the breathing noisier and more rattly and may result in more difficulty breathing. If your baby is having a harder time breathing than usual, you need to contact your baby's doctor. Often, babies with congenital tracheomalacia also have gastroesophageal reflux disease (GERD). Your doctor may test your baby for reflux or choose to treat reflux symptoms (like recurrent spitting up or fussiness after feeding) with anti-reflux medications. Reflux precautions such as keeping the baby upright after feeding and elevating the head of the crib can be helpful as well.

What should I expect if my baby has been diagnosed with tracheomalacia?

The noisy breathing that comes with tracheomalacia may not be present at birth but will usually be noticed by four to eight weeks of age. As the baby gets bigger and takes bigger breaths, the noisiness and heavy breathing becomes more noticeable and is often at it's worst around 6-12 months of age.