Medical Conditions

Tracheomalacia in Babies

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If your baby has been diagnosed with or you suspect tracheomalacia in babies, here is what the evidence says.

The short answer

Tracheomalacia is a condition where the cartilage supporting the trachea (windpipe) is soft and floppy, causing the airway to partially collapse during breathing. This creates noisy breathing, a characteristic "barky" or "honking" cough, and sometimes wheezing. It can be congenital (present from birth) or acquired (often from prolonged intubation in premature babies). Most cases of congenital tracheomalacia improve as the cartilage strengthens with growth, typically by age 2-3.

Key takeaways

  • Tracheomalacia is a condition where the cartilage supporting the trachea (windpipe) is soft and floppy, causing the airway to partially collapse during breathing. This creates noisy breathing, a characteristic "barky" or "honking" cough, and sometimes wheezing. It can be congenital (present from birth) or acquired (often from prolonged intubation in premature babies). Most cases of congenital tracheomalacia improve as the cartilage strengthens with growth, typically by age 2-3.
  • Usually normal when: Baby has a characteristic barky cough and noisy breathing that has been evaluated and diagnosed as tracheomalacia
  • Call your doctor if: Baby has a "dying spell" with significant color change, extreme breathing difficulty, or goes limp -- call 911
  • 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.”
— Fever and Your Child, American Academy of Pediatrics (AAP)

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By Age

What to expect by age

0-3 months

Tracheomalacia may be present from birth or develop in premature babies who required mechanical ventilation. Symptoms include noisy breathing (often a low-pitched rumbling or rattling sound, different from the high-pitched stridor of laryngomalacia), a barky or seal-like cough, and sometimes feeding difficulties. Symptoms typically worsen with crying, coughing, or respiratory infections. Your pediatrician may refer you to a pediatric pulmonologist or ENT for diagnosis.

3-6 months

Symptoms may seem to worsen as your baby becomes more active and breathes harder. Respiratory infections can significantly worsen tracheomalacia symptoms because inflammation further narrows the already compromised airway. These babies may develop more severe wheezing, respiratory distress, or a "dying spell" (brief episode of difficulty breathing) during viral illnesses. Your medical team should have a plan for managing respiratory illnesses.

6-12 months

As your baby grows, the tracheal cartilage gradually becomes firmer. You may begin to notice improvement in the noisy breathing and cough. However, respiratory infections remain a concern and may trigger more significant symptoms than in babies without tracheomalacia. If your baby has been diagnosed with tracheomalacia and develops a cold, monitor breathing closely and follow your doctor's guidance for when to seek care.

12 months+

Most children with congenital tracheomalacia see significant improvement by age 2-3 as the airway grows and the cartilage strengthens. Some children may still have a noisy cough or be prone to more symptoms during respiratory infections. Severe tracheomalacia that does not improve or causes significant breathing difficulty may require surgical intervention (aortopexy or tracheal stenting) in rare cases. Regular follow-up with your pulmonologist is important.

What Should You Do?

When to take action

Probably normal when...
  • Baby has a characteristic barky cough and noisy breathing that has been evaluated and diagnosed as tracheomalacia
  • Symptoms are stable and your baby is feeding, growing, and developing normally
  • Noisy breathing worsens with crying or activity but resolves when calm
  • Symptoms are gradually improving as the baby gets older
Mention at your next visit when...
  • Your baby has persistent noisy breathing or an unusual cough that has not been evaluated
  • Symptoms are worsening rather than improving with age
  • Your baby has recurrent respiratory infections with significant breathing difficulty
Act now when...
  • Baby has a "dying spell" with significant color change, extreme breathing difficulty, or goes limp -- call 911
  • Baby with known tracheomalacia develops severe respiratory distress during an illness that is not improving with usual measures

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Tracheomalacia in Babies.

Things to mention

  • Your baby has persistent noisy breathing or an unusual cough that has not been evaluated
  • Symptoms are worsening rather than improving with age
  • Your baby has recurrent respiratory infections with significant breathing difficulty

Observations to share

  • Your baby has persistent noisy breathing or an unusual cough that has not been evaluated
  • Symptoms are worsening rather than improving with age
  • Your baby has recurrent respiratory infections with significant breathing difficulty

Urgent signs to report immediately

  • Baby has a "dying spell" with significant color change, extreme breathing difficulty, or goes limp -- call 911
  • Baby with known tracheomalacia develops severe respiratory distress during an illness that is not improving with usual measures

My notes

From ismybabyalright.com — free, evidence-based baby health guides

Triage

Breathing Difficulty Triage

Assess breathing concerns and know when to seek emergency care.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

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 tracheomalacia in babies normal?
Tracheomalacia is a condition where the cartilage supporting the trachea (windpipe) is soft and floppy, causing the airway to partially collapse during breathing. This creates noisy breathing, a characteristic "barky" or "honking" cough, and sometimes wheezing. It can be congenital (present from birth) or acquired (often from prolonged intubation in premature babies). Most cases of congenital tracheomalacia improve as the cartilage strengthens with growth, typically by age 2-3.
When should I call the doctor about tracheomalacia in babies?
Baby has a "dying spell" with significant color change, extreme breathing difficulty, or goes limp -- call 911 Baby with known tracheomalacia develops severe respiratory distress during an illness that is not improving with usual measures
When is tracheomalacia in babies normal?
Baby has a characteristic barky cough and noisy breathing that has been evaluated and diagnosed as tracheomalacia Symptoms are stable and your baby is feeding, growing, and developing normally Noisy breathing worsens with crying or activity but resolves when calm
What causes tracheomalacia in babies?
Tracheomalacia is a condition where the cartilage supporting the trachea (windpipe) is soft and floppy, causing the airway to partially collapse during breathing. This creates noisy breathing, a characteristic "barky" or "honking" cough, and sometimes wheezing. It can be congenital (present from birth) or acquired (often from prolonged intubation in premature babies). Most cases of congenital tracheomalacia improve as the cartilage strengthens with growth, typically by age 2-3. Common explanations include: Baby has a characteristic barky cough and noisy breathing that has been evaluated and diagnosed as tracheomalacia. Symptoms are stable and your baby is feeding, growing, and developing normally.
What should I mention to my pediatrician about tracheomalacia in babies?
You should mention tracheomalacia in babies at your next visit if: Your baby has persistent noisy breathing or an unusual cough that has not been evaluated. Symptoms are worsening rather than improving with age. Your baby has recurrent respiratory infections with significant breathing difficulty.
Is tracheomalacia in babies normal at 0-3 months?
Tracheomalacia may be present from birth or develop in premature babies who required mechanical ventilation. Symptoms include noisy breathing (often a low-pitched rumbling or rattling sound, different from the high-pitched stridor of laryngomalacia), a barky or seal-like cough, and sometimes feeding difficulties. Symptoms typically worsen with crying, coughing, or respiratory infections. Your pediatrician may refer you to a pediatric pulmonologist or ENT for diagnosis.
Is tracheomalacia in babies normal at 3-6 months?
Symptoms may seem to worsen as your baby becomes more active and breathes harder. Respiratory infections can significantly worsen tracheomalacia symptoms because inflammation further narrows the already compromised airway. These babies may develop more severe wheezing, respiratory distress, or a "dying spell" (brief episode of difficulty breathing) during viral illnesses. Your medical team should have a plan for managing respiratory illnesses.
Should I go to the ER for tracheomalacia in babies?
Seek emergency care if baby has a "dying spell" with significant color change, extreme breathing difficulty, or goes limp -- call 911, or if baby with known tracheomalacia develops severe respiratory distress during an illness that is not improving with usual measures. When in doubt, call your pediatrician's after-hours line for guidance.
Does tracheomalacia in babies go away on its own?
In many cases, tracheomalacia in babies resolves on its own, especially when baby has a characteristic barky cough and noisy breathing that has been evaluated and diagnosed as tracheomalacia. By 12 months+, most children with congenital tracheomalacia see significant improvement by age 2-3 as the airway grows and the cartilage strengthens. Some children may still have a noisy cough or be prone to more symptoms during respiratory infections. Severe tracheomalacia that does not improve or causes significant breathing difficulty may require surgical intervention (aortopexy or tracheal stenting) in rare cases. Regular follow-up with your pulmonologist is important.
NIHMAYO CLINIC

References

  1. [1]National Library of Medicine. Tracheomalacia. MedlinePlus, NIH. NIH
  2. [2]Mayo Clinic. Tracheomalacia. Diagnosis and Treatment. Mayo Clinic

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources

Related Resources

Breathing TriageWell-Baby Visit PrepBaby Tracker

Bottom line

Most cases of tracheomalacia in babies are normal. Talk to your pediatrician if baby has a "dying spell" with significant color change, extreme breathing difficulty, or goes limp -- call 911.

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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