From the Guidelines
The best approach to manage laryngomalacia in a 9-month-old infant is typically conservative watchful waiting, as most cases resolve spontaneously by 12-24 months of age. This approach is supported by the fact that laryngomalacia is often caused by the immaturity of laryngeal cartilage, which naturally stiffens with age, leading to improvement of symptoms without intervention 1.
Key Considerations
- Parents should be educated about positioning techniques during feeding, such as keeping the infant in an upright position and using smaller, more frequent feedings to minimize reflux and aspiration risk.
- For infants with moderate symptoms, acid suppression therapy may not be necessary, as the benefits of reducing medication adverse effects, avoiding unnecessary treatment, and reducing cost outweigh the risk of delaying treatment of gastrointestinal disease 1.
- Close monitoring of weight gain and breathing patterns is essential to identify any potential complications early on.
- For severe cases with failure to thrive, significant respiratory distress, or cyanotic episodes, surgical intervention with supraglottoplasty may be necessary, as it has been shown to improve PSG parameters and reduce symptoms of obstructive sleep apnea 1.
Management Strategies
- Avoid overfeeding and frequent burping during feeding to reduce the frequency of regurgitation.
- Upright positioning in the caregiver’s arms after feeding and avoidance of secondhand smoke can help manage GER symptoms.
- Thickening feedings with commercially thickened formula may decrease the frequency of regurgitation, but its effect on esophageal acid exposure is unclear 1.
- Exclusive breastfeeding should be encouraged whenever possible, as it has been shown to decrease the frequency of GER in infants.
Follow-up and Monitoring
Regular follow-up with a pediatric otolaryngologist is recommended to assess symptom progression and development, and to identify any potential complications early on. This will help determine the best course of treatment and ensure the infant receives the necessary care to manage their laryngomalacia symptoms effectively.
From the Research
Management of Laryngomalacia in a 9-Month-Old Infant
The management of laryngomalacia in infants typically involves a combination of medical and surgical interventions.
- Most cases of laryngomalacia are mild and self-resolve, but severe symptoms require investigation and intervention 2.
- There is a strong association with gastroesophageal reflux disease in patients with laryngomalacia, and thus medical treatment with antireflux medications may be indicated 2.
- Supraglottoplasty is the preferred surgical treatment of laryngomalacia, reserved only for severe cases 2, 3, 4.
Surgical Intervention
Surgical intervention is typically considered for infants with severe laryngomalacia who have significant respiratory distress, failure to thrive, or other complications.
- Supraglottoplasty is an effective method to treat severe laryngomalacia, with successful extubation achieved in most patients 3.
- Patients who will benefit most from supraglottoplasty are those with severe laryngomalacia that is uncomplicated by neurological conditions or multiple medical problems 3.
- The results of supraglottoplasty are excellent, and severe complications, such as supraglottic stenosis and aspiration, are uncommon 5.
Non-Surgical Management
Non-surgical management of laryngomalacia may include medical treatment with antireflux medications and noninvasive ventilation (NIV) in some cases.