Selected Podcast
Yet to Bloom: Noisy Breathing and Laryngomalacia
Dr. Kara Meister discusses laryngomalacia and possible treatment options.
Featuring:
Kara Meister, MD
Dr. Kara Meister is a pediatric ear, nose, and throat surgeon at SCH in the Aerodigestive and Airway Reconstruction Center. She specializes in the treatment of children with airway problems and tumors of the head & neck. Outside of LPCH, she is a wife, mom, and loves to hike, bike, and drink wine (though not at the same time!). Transcription:
Scott Webb (Host): Laryngomalacia is a condition where floppy tissue above the vocal cords falls into the airway when a child breathes in, causing stridor. Stridor is a medical term for noisy breathing and joining me today to discuss laryngomalacia and tracheomalacia and when our baby's breathing sounds are reason for concern is Dr. Kara Meister. She's a Pediatric Head and Neck Surgeon at Stanford Children's Health and the Children's Thyroid Center. This is Health Talks from Stanford Children's Health. I'm Scott Webb. So, Dr. Meister, thanks so much for your time today. What are the most common causes for noisy breathing in babies?
Kara Meister, MD (Guest): You know, babies make all types of noises and some noisy breathing is normal and expected in infants and toddlers. As far as the most common reasons that I, as a pediatric ear, nose and throat doctor see children for noisy breathing, really the top of the list is laryngomalacia and tracheamalcia. What do those mean?
So, when laryngomalacia exactly what it sounds so larynx or voicebox, malacia means floppy. So floppy voicebox, similarly, tracheamalacia. Floppy trachea. So, trachea malacia and that's just it, basically it's slow growth or that the baby's voicebox or trachea just isn't quite strong enough yet. And those are the top two. There are a lot of different reasons, but I think we're going to focus on those two today.
Host: Yeah, we are. And I watched a video just to make sure that I understood laryngomalacia or tracheamalacia better and interesting in the video that when the pediatrician had the baby lying flat, there was the noisy breathing, but when they lifted the baby up, the noisy breathing stopped. So, maybe you can explain how and why that happens.
Dr. Meister: So, one way that it was explained to me when I was first learning about this is think of laryngomalacia as a tulip that hasn't quite bloomed. So, if you have this little tulip there, it is small and it's kind of floppy. And so if you lay that back, gravity is working against us, and those tissues flop and fold into the airway.
When they fold into the airway as the child is breathing, that's the noise that we hear. That is what we call stridor or noisy breathing. If you sit the baby up, gravity is helping the baby and you don't hear the noise that much. Similarly, if the baby's really crying, sometimes it goes away because their muscles are strong, cause they're so angry and we won't hear the noise as much. If they're really relaxed and they're feeding and they're sleepy and happy, sometimes the noise is worse. So, think of it as a little tulip that hasn't quite bloomed yet.
Host: That's a great analogy. I love that. And as a dad, myself, you know, you and I were speaking before we got rolling here, and I was saying that anything that didn't sound normal from my kid's crib when they were little, caused mom or dad, or sometimes both, to sprint to their bedrooms. So, I guess I'm wondering when is noisy breathing more than just normal baby sounds and when should we worry?
Dr. Meister: Yeah, you're totally right Scott. We've had a lot of pacing in my house recently with a five month old, but when do we worry? So, we think of the voice box as having three functions. So, breathing number one, swallowing number two, and voice number three. So, any time that any of those three functions are severely impaired, it's time to worry. Or even if you think that they might be, it's worth talking to your pediatrician, seeing if he or she thinks that it's worth having a referral to a pediatric ear, nose and throat doctor. Some of the ways that we can see trouble breathing, swallowing, and voicing are retractions. So, if the muscles of the chest or the muscles of the neck are indenting as the baby is breathing, or if the head is kind of bobbing back and forth. If the baby is using so many calories to breathe, that he or she just can't take in enough to maintain the weight, that's also a problem. Or I tell parents if you are watching this baby all night long, because you're worried about the breathing and you're frequently repositioning and no one in the house is sleeping, that's a problem. Those are kind of the things that I'm looking for to really categorize how severe is this. How worried should we be?
Host: Yeah, and those are some good things to be on the lookout for. And so, as you say, parents might go to the pediatrician, might get a referral to go to an ENT like yourself and what can they expect when they go to see you or any other ENT?
Dr. Meister: So, we'll take a look at the baby and certainly we want to know about the baby's breathing, feeding, swallowing and cry. Cause that's how babies voice of course. The doctor's going to ask about any history of reflux, or spitting up with feeds. They're going to ask about how is sleep and it's always a good parent tip to take the baby in an outfit where the doctor can see the whole chest. So, this is not the day to wear, you know, the three-piece tux, even though it looks really cute, we want to get the baby pretty naked. And then if there is a concern, often what we'll do is we'll take a video of the voice box.
We do that with a tiny camera that goes in the nose, the babies hate it, but it only lasts a minute or two and it gives some really good information. I think of it as like a little drone flying over the voice box. It's in the back of the nose. It peaks down and we can watch what the tissues look like as the baby is breathing. We call that a flexible laryngoscopy and it's pretty benign, it's really valuable.
Host: Yeah, as you say, and those of us who've ever had babies, anything up their noses, definitely not going to like that, but as you say, also it's just a minute or two and a great analogy, a little drone flying over the voice box. So cool. Are there any treatments besides surgery for the laryngomalacia?
Dr. Meister: There are, and actually 90% of kids never need surgery. So, even though I, as a pediatric otolaryngologist, have a bias towards surgical intervention because we see the more severe cases; most children grow out of this by 12 months of age. Okay. So, it's really trying to keep the baby safe and out of the operating room if we can do that safely with a few tips and tricks. So, the number one thing is keep the baby upright after feeding. We know that reflux, while all babies reflux working for here, it strengthens the muscles of the neck and the upper chest, which is great for building tone and making that little tulip bloom. So, tummy time, keeping the baby up after feeds. If we're on the border, we'll consider antireflux medicine. Either one or two different classes of medicine, to try to decrease the reflux, decrease the swelling and improve the breathing.
Host: All great suggestions. And it reminded me of my daughter. She was the little queen of reflux for the first six to nine months or so. And so I just knew that anything that I was wearing when I was feeding her was going you know, have reflux, have spit up all down my shoulder. And as you say, you know, 90% of the kids, they just sort of grow out of these things, but there's things we can do like more tummy time, which is great. Doctor as we get close to wrapping up here I saw an ad online for this special pillow to help with laryngomalacia. Just wondering if they actually work.
Yeah.
Dr. Meister: So interesting question. There are ads for pillows. There are a lot of parent support groups, I think all of those things are reasonable to try with the caveat that the baby needs to be supervised and they are not sleeping devices. So, really what it's working for is, you know, trying to decrease reflux, to keep the gravity working on the baby's side, to help support those tissues and promote easy breathing. So, if the baby is relaxed and calm, upright, I think those pillows are totally fine. If a baby needs surgery, those pillows aren't going to work, right. That's a different kind of level of laryngomalacia that can't be helped. But in our mild to moderate children, it can help the baby more comfortable. Of course only when supervised, not a sleeping device, please don't prop the baby up for sleep. Children need to be back to sleep for decreasing the risk of sudden infant death. So, that's my caveat, but it's reasonable to try those things.
Host: Yeah, reasonable to try it. And as you say, within reason, and obviously to be supervised, not a sleeping device and so on. So, it's great to speak to an expert. I wish my kids were younger, so I could put some of these things into practice. But doctor, as we close here today, what are your takeaways on noisy breathing? When parents should be concerned? What are your takeaways?
Dr. Meister: So a few things. Number one is it's normal for babies to have some noisy breathing, but as a parent, you know your child the best, and if mom or dad are concerned, I take that into account when I meet with a family. And if you're concerned, then we're concerned and it's benign and reasonable to look with the scope.
Even though laryngomalacia is the most common cause of noisy breathing, there can be other more rare things. And the first step is to raise a concern with the doctor, get a scope done if that's what's felt to be needed and everyone will sleep better at night. Okay. The other thing that I like to tell parents is that, you know, laryngomalacia, we're really thinking about peaking around the two to three months of age.
If there's noisy breathing from birth or an abnormal cry from birth, or if it starts closer to a year of age, those raise our suspicions for things other than laryngomalacia. That wouldn't be the typical time course. So, definitely if it's before a week of age or after a year, we'd want to see those children.
Host: Yeah, definitely. Well, so great speaking with you today. I love your expertise, your analogies, your compassion. And you've given us a nice roadmap here for how to deal with noisy baby sounds, when we should be concerned, to speaking with a pediatrician, moving on to an ENT and having the scope done, the drone flying over. So great. And I thank you so much for your time. You stay well.
Dr. Meister: Thanks so much, Scott, you too. Have a great day.
Host: The Pediatric Aerodigestive and Airway Reconstruction Team in Stanford Children's Health is one of the busiest pediatric airway centers in the US. Check out their website at laryngomalacia.Stanfordchildren's.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Children's Health I'm Scott Webb. Stay well, and we'll talk again next time.
Scott Webb (Host): Laryngomalacia is a condition where floppy tissue above the vocal cords falls into the airway when a child breathes in, causing stridor. Stridor is a medical term for noisy breathing and joining me today to discuss laryngomalacia and tracheomalacia and when our baby's breathing sounds are reason for concern is Dr. Kara Meister. She's a Pediatric Head and Neck Surgeon at Stanford Children's Health and the Children's Thyroid Center. This is Health Talks from Stanford Children's Health. I'm Scott Webb. So, Dr. Meister, thanks so much for your time today. What are the most common causes for noisy breathing in babies?
Kara Meister, MD (Guest): You know, babies make all types of noises and some noisy breathing is normal and expected in infants and toddlers. As far as the most common reasons that I, as a pediatric ear, nose and throat doctor see children for noisy breathing, really the top of the list is laryngomalacia and tracheamalcia. What do those mean?
So, when laryngomalacia exactly what it sounds so larynx or voicebox, malacia means floppy. So floppy voicebox, similarly, tracheamalacia. Floppy trachea. So, trachea malacia and that's just it, basically it's slow growth or that the baby's voicebox or trachea just isn't quite strong enough yet. And those are the top two. There are a lot of different reasons, but I think we're going to focus on those two today.
Host: Yeah, we are. And I watched a video just to make sure that I understood laryngomalacia or tracheamalacia better and interesting in the video that when the pediatrician had the baby lying flat, there was the noisy breathing, but when they lifted the baby up, the noisy breathing stopped. So, maybe you can explain how and why that happens.
Dr. Meister: So, one way that it was explained to me when I was first learning about this is think of laryngomalacia as a tulip that hasn't quite bloomed. So, if you have this little tulip there, it is small and it's kind of floppy. And so if you lay that back, gravity is working against us, and those tissues flop and fold into the airway.
When they fold into the airway as the child is breathing, that's the noise that we hear. That is what we call stridor or noisy breathing. If you sit the baby up, gravity is helping the baby and you don't hear the noise that much. Similarly, if the baby's really crying, sometimes it goes away because their muscles are strong, cause they're so angry and we won't hear the noise as much. If they're really relaxed and they're feeding and they're sleepy and happy, sometimes the noise is worse. So, think of it as a little tulip that hasn't quite bloomed yet.
Host: That's a great analogy. I love that. And as a dad, myself, you know, you and I were speaking before we got rolling here, and I was saying that anything that didn't sound normal from my kid's crib when they were little, caused mom or dad, or sometimes both, to sprint to their bedrooms. So, I guess I'm wondering when is noisy breathing more than just normal baby sounds and when should we worry?
Dr. Meister: Yeah, you're totally right Scott. We've had a lot of pacing in my house recently with a five month old, but when do we worry? So, we think of the voice box as having three functions. So, breathing number one, swallowing number two, and voice number three. So, any time that any of those three functions are severely impaired, it's time to worry. Or even if you think that they might be, it's worth talking to your pediatrician, seeing if he or she thinks that it's worth having a referral to a pediatric ear, nose and throat doctor. Some of the ways that we can see trouble breathing, swallowing, and voicing are retractions. So, if the muscles of the chest or the muscles of the neck are indenting as the baby is breathing, or if the head is kind of bobbing back and forth. If the baby is using so many calories to breathe, that he or she just can't take in enough to maintain the weight, that's also a problem. Or I tell parents if you are watching this baby all night long, because you're worried about the breathing and you're frequently repositioning and no one in the house is sleeping, that's a problem. Those are kind of the things that I'm looking for to really categorize how severe is this. How worried should we be?
Host: Yeah, and those are some good things to be on the lookout for. And so, as you say, parents might go to the pediatrician, might get a referral to go to an ENT like yourself and what can they expect when they go to see you or any other ENT?
Dr. Meister: So, we'll take a look at the baby and certainly we want to know about the baby's breathing, feeding, swallowing and cry. Cause that's how babies voice of course. The doctor's going to ask about any history of reflux, or spitting up with feeds. They're going to ask about how is sleep and it's always a good parent tip to take the baby in an outfit where the doctor can see the whole chest. So, this is not the day to wear, you know, the three-piece tux, even though it looks really cute, we want to get the baby pretty naked. And then if there is a concern, often what we'll do is we'll take a video of the voice box.
We do that with a tiny camera that goes in the nose, the babies hate it, but it only lasts a minute or two and it gives some really good information. I think of it as like a little drone flying over the voice box. It's in the back of the nose. It peaks down and we can watch what the tissues look like as the baby is breathing. We call that a flexible laryngoscopy and it's pretty benign, it's really valuable.
Host: Yeah, as you say, and those of us who've ever had babies, anything up their noses, definitely not going to like that, but as you say, also it's just a minute or two and a great analogy, a little drone flying over the voice box. So cool. Are there any treatments besides surgery for the laryngomalacia?
Dr. Meister: There are, and actually 90% of kids never need surgery. So, even though I, as a pediatric otolaryngologist, have a bias towards surgical intervention because we see the more severe cases; most children grow out of this by 12 months of age. Okay. So, it's really trying to keep the baby safe and out of the operating room if we can do that safely with a few tips and tricks. So, the number one thing is keep the baby upright after feeding. We know that reflux, while all babies reflux working for here, it strengthens the muscles of the neck and the upper chest, which is great for building tone and making that little tulip bloom. So, tummy time, keeping the baby up after feeds. If we're on the border, we'll consider antireflux medicine. Either one or two different classes of medicine, to try to decrease the reflux, decrease the swelling and improve the breathing.
Host: All great suggestions. And it reminded me of my daughter. She was the little queen of reflux for the first six to nine months or so. And so I just knew that anything that I was wearing when I was feeding her was going you know, have reflux, have spit up all down my shoulder. And as you say, you know, 90% of the kids, they just sort of grow out of these things, but there's things we can do like more tummy time, which is great. Doctor as we get close to wrapping up here I saw an ad online for this special pillow to help with laryngomalacia. Just wondering if they actually work.
Yeah.
Dr. Meister: So interesting question. There are ads for pillows. There are a lot of parent support groups, I think all of those things are reasonable to try with the caveat that the baby needs to be supervised and they are not sleeping devices. So, really what it's working for is, you know, trying to decrease reflux, to keep the gravity working on the baby's side, to help support those tissues and promote easy breathing. So, if the baby is relaxed and calm, upright, I think those pillows are totally fine. If a baby needs surgery, those pillows aren't going to work, right. That's a different kind of level of laryngomalacia that can't be helped. But in our mild to moderate children, it can help the baby more comfortable. Of course only when supervised, not a sleeping device, please don't prop the baby up for sleep. Children need to be back to sleep for decreasing the risk of sudden infant death. So, that's my caveat, but it's reasonable to try those things.
Host: Yeah, reasonable to try it. And as you say, within reason, and obviously to be supervised, not a sleeping device and so on. So, it's great to speak to an expert. I wish my kids were younger, so I could put some of these things into practice. But doctor, as we close here today, what are your takeaways on noisy breathing? When parents should be concerned? What are your takeaways?
Dr. Meister: So a few things. Number one is it's normal for babies to have some noisy breathing, but as a parent, you know your child the best, and if mom or dad are concerned, I take that into account when I meet with a family. And if you're concerned, then we're concerned and it's benign and reasonable to look with the scope.
Even though laryngomalacia is the most common cause of noisy breathing, there can be other more rare things. And the first step is to raise a concern with the doctor, get a scope done if that's what's felt to be needed and everyone will sleep better at night. Okay. The other thing that I like to tell parents is that, you know, laryngomalacia, we're really thinking about peaking around the two to three months of age.
If there's noisy breathing from birth or an abnormal cry from birth, or if it starts closer to a year of age, those raise our suspicions for things other than laryngomalacia. That wouldn't be the typical time course. So, definitely if it's before a week of age or after a year, we'd want to see those children.
Host: Yeah, definitely. Well, so great speaking with you today. I love your expertise, your analogies, your compassion. And you've given us a nice roadmap here for how to deal with noisy baby sounds, when we should be concerned, to speaking with a pediatrician, moving on to an ENT and having the scope done, the drone flying over. So great. And I thank you so much for your time. You stay well.
Dr. Meister: Thanks so much, Scott, you too. Have a great day.
Host: The Pediatric Aerodigestive and Airway Reconstruction Team in Stanford Children's Health is one of the busiest pediatric airway centers in the US. Check out their website at laryngomalacia.Stanfordchildren's.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Children's Health I'm Scott Webb. Stay well, and we'll talk again next time.