A Noisy Breather and Recurrent Barking Cough

1/4/2008

A six month old baby was seen in my office with a history of loud breathing since birth. The baby has been thriving and developing well. He has had two episodes of a barking cough which mom describes as croup which was treated by the baby’s pediatrician. On examination the baby is comfortable and happy but makes a continuous loud sound on inspiration.

This baby very likely has a benign condition of early childhood called laryngomalacia. This term is used to describe a self-limited condition whereby the baby’s larynx (the upper part of the airway) is easily collapsible especially when taking an inspiratory breath (breathing in). Years back it was believed that these babies had poor formation of the cartilage that the larynx is made of. We now believe that this easy collapsibility is more of a functional issue rather than a distinct structural deficiency. The airway is “immature”, therefore it collapses on itself with each inspiration. The only time this issue becomes a problem is when the baby gets a mild upper respiratory infection and the larynx becomes slightly swollen. This sometimes results in a worsening of the breathing or a croup like episode. Croup is a barking cough and difficulty breathing that happens when the upper airway is affected by a virus. These children need good humidification and hydration. If the cough is bad, a quick five-ten minutes in the steam shower might help. Severe croup requires treatment with oral cortisone (usually dexamethasone) for two-three days.

Children with laryngomalacia will usually outgrow this condition with age and increased weight gain. They might have episodes of recurrent croup until this developmental condition of early childhood is outgrown. A visit to a pediatric ENT (ear, nose and throat specialist) would be indicated only for the most difficult kids or those in whom the diagnosis in unclear.

      

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