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Tracheomalacia - congenital

Congenital tracheomalacia is a weakness and floppiness of the walls of the windpipe (trachea), which is present at birth.

Alternative Names

Type 1 tracheomalacia

Causes, incidence, and risk factors

Tracheomalacia in a newborn occurs when the cartilage in the windpipe (trachea) has not developed properly. Instead of being rigid, the walls of the trachea are floppy. Because the windpipe is the main airway, breathing difficulties begin soon after birth.

Congenital tracheomalacia is very uncommon.

Symptoms

Symptoms can range from mild to severe and may include:

  • Breathing noises that may change with position and improve during sleep
  • Breathing problems that get worse with coughing, crying, feeding, or upper respiratory infections
  • High-pitched breathing
  • Rattling or noisy breaths

Signs and tests

A physical examination confirms the symptoms. An x-ray will be done to rule out other problems. The chest x-ray may show narrowing of the trachea when breathing in.

A procedure called a larngoscopy provides a definitive diagnosis. This procedure lets the otolaryngologist (ear, nose, and throat doctor, or ENT) see the airway structure and determine the severity of the problem.

Other tests that may be done include:

  • Airway fluoroscopy
  • Barium swallow
  • Bronchoscopy -- camera down the throat to see the airways and lungs
  • CT scan
  • Lung function tests
  • Magnetic resonance imaging (MRI)

Treatment

Most infants respond well to humidified air, careful feedings, and antibiotics for infections. Babies with tracheomalacia must be closely monitored when they have respiratory infections.

Often, the symptoms of tracheomalacia improve as the infant grows.

Rarely, surgery is needed.

Expectations (prognosis)

Congenital tracheomalacia generally goes away on its own by the age of 18-24 months. As the tracheal cartilage gets stronger and the trachea grows, the noisy respirations and breathing difficulties gradually stop. Persons with tracheomalacia must be monitored closely when they have respiratory infections.

Complications

Babies born with tracheomalacia may have other congenital abnormalities such as heart defects, developmental delay, or gastroesophageal reflux.

Aspiration pneumonia can occur from inhaling food.

Calling your health care provider

Call your health care provider if your child has breathing difficulties or breathing noises. It can become an urgent or emergency condition.

References

Finder JD. Bronchomalacia and Tracheomalacia. In: Kliegman, RM, Behrman RE, St. Geme III JW, Schor NF, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 381.

Licameli GR., Richardson MA. Diagnosis and Management of Tracheal Anomalies and Tracheal Stenosis. In: Flint PW, Haughey BH, Lund VJ, Niparko JK, Richardson MA, Robbons KT, Thomas JR, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 207.

Updated: 5/10/2013

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.


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