Tracheomalacia occurs when the cartilage in the windpipe, or trachea, has not developed the way it should. Instead of being rigid or firm, the walls of the trachea are floppy. This can make it hard to breathe because the cartilage cannot keep the windpipe fully open while breathing. It may collapse when exhaling.

Tracheomalacia can be mild enough to not need any treatment. It can also be moderate or severe (life-threatening). Most children with this condition will either outgrow it by the time they turn 2 or have symptoms that are not severe enough to need surgery.

Cause of Tracheomalacia

Most often, tracheomalacia is congenital. This means the child was born with the condition.

Other types can occur later when something presses on the tracheal cartilage, such as a blood vessel that crosses too closely to the trachea, putting pressure on the walls of the airway. Tracheomalacia can also develop after a child has been on a ventilator for quite a long time. These two causes are much less common than the congenital type.

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

Symptoms of Tracheomalacia

• Noisy breathing that may change with position and improve during sleep
• Cough or noisy breathing that gets worse with activity
• Breathing problems that get worse with coughing, crying, feeding or upper respiratory infections
• High-pitched breathing or rattling during breathing
• Frequent lung infections such as bronchitis or pneumonia

Diagnosis of Tracheomalacia

A physical exam can confirm the symptoms. A chest X-ray may show narrowing of the trachea, but often the X-ray is normal. A bronchoscopy, which lets a doctor see down into the airway, can confirm the diagnosis. Other tests may include:

• Airway fluoroscopy
• Video barium swallow study
• CT scan
• Lung function tests
• Magnetic resonance imaging (MRI)

Treatment for Tracheomalacia

Most often, symptoms improve as a child grows. Only severe cases need surgery. Most infants respond well to humidified air, careful feedings, and antibiotics for infections. Babies with this condition must be closely watched when they have respiratory infections.

Congenital tracheomalacia most often goes away on its own by the age of 18-24 months. As the tracheal cartilage gets stronger and grows, over time, the noisy breathing problems stop.

When to Call Your Child’s Doctor

Call the doctor if your child:

• Has trouble keeping food down and spits it up all the time
• Is losing weight or is not gaining weight
• Begins to feed less and tires easily in the middle of feeding
• Begins to choke on food
• Struggles between eating and breathing

Take your child to the hospital if your child:

• Stops breathing for longer than 10 seconds
• Has dusky or blue color around lips along with noisy breathing
• Has chest or neck retractions (sinking in with each breath) that do not stop with changing your child's position or waking your child up