Tracheomalacia - congenital
Type 1 tracheomalacia
Congenital tracheomalacia is weakness and floppiness of the walls of the windpipe (trachea). Congenital means it is present at birth. Acquired tracheomalacia is a related topic.
The major passages and structures of the lower respiratory tract include the windpipe (trachea) and within the lungs, the bronchi, bronchioles, and alveoli. Deep in the lungs, each bronchus divides into secondary and tertiary bronchi, which continue to branch to smaller airways called the bronchioles. The bronchioles end in air sacs called the alveoli. Alveoli are bunched together into clusters to form alveolar sacs. Gas exchange occurs on the surface of each alveolus by a network of capillaries carrying blood that has come through veins from other parts of the body.
Causes
Tracheomalacia in a newborn occurs when the cartilage in the windpipe has not developed properly. Instead of being rigid, the walls of the trachea are floppy. Because the windpipe is the main airway, breathing problems begin soon after birth.
Congenital tracheomalacia is very uncommon.
Symptoms
Symptoms can range from mild to severe. Symptoms 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 (such as cold)
- High-pitched breathing
- Rattling or noisy breaths
Exams and Tests
A physical exam confirms the symptoms. A chest x-ray will be done to rule out other problems. The x-ray may show narrowing of the trachea when breathing in.
A procedure called laryngoscopy provides the most reliable diagnosis. In this procedure, an otolaryngologist (ear, nose, and throat doctor, or ENT doctor) will look at the structure of the airway and determine how severe the problem is.
Other tests may include:
- Airway fluoroscopy -- a kind of x-ray that shows the images on a screen
- 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.
Outlook (Prognosis)
Congenital tracheomalacia most often goes away on its own by the age of 18 to 24 months. As the cartilage gets stronger and the trachea grows, the noisy and difficult breathing slowly improves. People with tracheomalacia must be monitored closely when they have respiratory infections.
Possible 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 into the lungs or windpipe.
When to Contact a Medical Professional
Contact your health care provider if your child has breathing difficulties or noisy breathing. Tracheomalacia can become an urgent or emergency condition.
References
Finder JD. Bronchomalacia and tracheomalacia. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 416.
Green GE, Ohye RG. Diagnosis and management of tracheal anomalies and tracheal stenosis. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 210.
Sun X. Normal and abnormal structural development of the lung. In: Polin RA, Abman SH, Rowitch DH, Benitz WE, Fox WW, eds. Fetal and Neonatal Physiology. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 55.
Version Info
Last reviewed on: 4/28/2023
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
