Laryngomalacia (Floppy Airway)
Content reviewed against published AAP, NIH guidelines
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If your baby has been diagnosed with or you suspect laryngomalacia (floppy airway), here is what the evidence says.
The short answer
Laryngomalacia is the most common cause of noisy breathing (stridor) in infants. It occurs when the tissue above the vocal cords is unusually soft and floppy, causing it to collapse inward during breathing and create a high-pitched squeaky sound. It typically appears within the first 2 weeks of life, peaks in severity at 4-8 months, and resolves on its own by 12-18 months. Most cases are mild and require no treatment beyond monitoring.
Key takeaways
- Laryngomalacia is the most common cause of noisy breathing (stridor) in infants. It occurs when the tissue above the vocal cords is unusually soft and floppy, causing it to collapse inward during breathing and create a high-pitched squeaky sound. It typically appears within the first 2 weeks of life, peaks in severity at 4-8 months, and resolves on its own by 12-18 months. Most cases are mild and require no treatment beyond monitoring.
- Usually normal when: Baby has high-pitched breathing noise when inhaling that started in the first few weeks of life
- Call your doctor if: Baby turns blue or very pale during a breathing or feeding episode
- Varies by age — see the age-by-age breakdown below
“Fever itself is not an illness — rather, it is a sign or symptom that the body is fighting an infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria.”
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By Age
What to expect by age
0-3 months
Laryngomalacia usually becomes noticeable within the first 2 weeks of life. You will hear a high-pitched squeaky or fluttery sound when your baby breathes in. The noise is typically worse when your baby is on their back, feeding, crying, or congested. It often improves when your baby is on their stomach or in an upright position. Your pediatrician can usually diagnose it based on the characteristic sound and circumstances.
3-6 months
Symptoms often peak between 4-8 months as your baby becomes more active and breathes harder. The stridor may get louder, which can be alarming but is part of the natural course. If your baby is feeding well, gaining weight appropriately, and not having color changes or apnea, this worsening is expected. However, if feeding difficulties, choking episodes, or poor weight gain develop, your pediatrician may refer you to a pediatric ENT specialist.
6-12 months
Improvement typically begins after the peak at 4-8 months. The stridor should gradually become less frequent and quieter. Your baby should be feeding well and gaining weight. Approximately 10-15% of babies with laryngomalacia have severe disease requiring surgical intervention (supraglottoplasty). Signs of severe disease include significant feeding difficulties, failure to thrive, obstructive apnea, or cyanosis.
12 months+
Most cases of laryngomalacia resolve by 12-18 months, though some mild stridor may persist until age 2. If your child still has significant noisy breathing after 18 months, or if stridor returns after previously resolving, further evaluation by an ENT specialist is warranted to rule out other airway conditions. Children who had laryngomalacia may be more prone to noisy breathing during upper respiratory infections.
What Should You Do?
When to take action
- Baby has high-pitched breathing noise when inhaling that started in the first few weeks of life
- Noisy breathing improves when baby is placed on their stomach or held upright
- Baby is feeding well and gaining weight despite the noisy breathing
- Stridor is getting gradually quieter and less frequent after 6-8 months of age
- Baby is having difficulty feeding, choking during feeds, or not gaining weight well
- Stridor is getting significantly louder or more persistent after 8 months of age
- Baby seems to struggle to breathe or has episodes of pausing breathing during sleep
- Baby turns blue or very pale during a breathing or feeding episode
- Baby has severe retractions, appears to be struggling significantly to breathe, or stops breathing -- call 911
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss Laryngomalacia (Floppy Airway).
Things to mention
- Baby is having difficulty feeding, choking during feeds, or not gaining weight well
- Stridor is getting significantly louder or more persistent after 8 months of age
- Baby seems to struggle to breathe or has episodes of pausing breathing during sleep
Observations to share
- Baby is having difficulty feeding, choking during feeds, or not gaining weight well
- Stridor is getting significantly louder or more persistent after 8 months of age
- Baby seems to struggle to breathe or has episodes of pausing breathing during sleep
Urgent signs to report immediately
- Baby turns blue or very pale during a breathing or feeding episode
- Baby has severe retractions, appears to be struggling significantly to breathe, or stops breathing -- call 911
My notes
From ismybabyalright.com — free, evidence-based baby health guides
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Month-by-Month Development
Detailed monthly development guides from birth through 24 months.
When to Call the Doctor
General guide on when to call the pediatrician, visit urgent care, or go to the ER.
Frequently asked questions
Is laryngomalacia (floppy airway) normal?
When should I call the doctor about laryngomalacia (floppy airway)?
When is laryngomalacia (floppy airway) normal?
What causes laryngomalacia (floppy airway)?
What should I mention to my pediatrician about laryngomalacia (floppy airway)?
Is laryngomalacia (floppy airway) normal at 0-3 months?
Is laryngomalacia (floppy airway) normal at 3-6 months?
Should I go to the ER for laryngomalacia (floppy airway)?
Does laryngomalacia (floppy airway) go away on its own?
References
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Resources
Bottom line
Most cases of laryngomalacia (floppy airway) are normal. Talk to your pediatrician if baby turns blue or very pale during a breathing or feeding episode.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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