Tracheomalacia in Babies – Symptoms, Diagnosis and Treatment by Dr. Srikanta J T

Now, when only a small part is affected, the collapsed part can move down the windpipe. The windpipe splits into two and goes to the lungs. When the collapsed part of the windpipe goes past this branching-off area, it is called Bronchomalacia.

Signs and Symptoms of Tracheomalacia

How do you know if your tiny baby has Tracheomalacia? Here are some signs and symptoms that can tip you off. These are usually noticed between the ages of 4 and 8 weeks.

• Breathing is noisy, especially if you change the baby’s sleeping position
• Noisy breathing while asleep
• Breathing issues that seem to get worse when the baby coughs, feeds, cries, or has a cold
• Stridor – a high pitched noise while breathing
• High-pitched coughing
• Wheezing or a rattling sound when breathing
• Repetitive or frequent infections in the lungs
• Apnea or Cyanosis
• Breathing difficulties

[Read : Chest Infection In Toddlers]

Causes of Tracheomalacia in Children

Tracheomalacia is a condition that happens due to the windpipe collapsing on its own.

Tracheomalacia can be classified into

1. Congenital Tracheomalacia

Tracheomalacia can be present right from birth but is not a common health condition you are bound to see in newborns. Babies born with this condition may experience a few other complications like acid reflux, developmental delay, or even a heart defect. This is not a very common issue and most likely will sort itself out as the baby grows older.

2. Acquired Tracheomalacia

When Tracheomalacia is the result of an injury or repeated infections to the throat, it is defined as type 2 Tracheomalacia. It can even be due to the prolonged use of a tracheostomy tube.

Diagnosis of Tracheomalacia in Babies

If you notice your baby is making noise when they breathe, you need to consult your doctor immediately. The doctor will listen to the baby’s breathing and ask for further tests to confirm a diagnosis. Some of the tests they can ask for are

1. Bronchoscopy

The doctor will insert a narrow tube with a camera down your baby’s airway, through the mouth. This will help them see the insides of the windpipe and trachea as the baby breathes, coughs and swallows.

2. Laryngoscopy

This procedure is very similar to Bronchoscopy but here the doctor will assess the voice box and the upper airway. It is usually done along with a Bronchoscopy.

3. Fluoroscopy of the Airway

An X-ray with a contrast material will show the movement of the cartilage inside the Trachea. This will help the doctor diagnose the source of noisy breathing

4. Esophagram

This is a type of X-ray test. The technician will take X-ray pictures of the oesophagus which will help the doctor with the correct diagnosis.

5. Endoscopy

In this procedure, a thin tube with both camera and a light will be inserted through the windpipe to get a closer look at the oesophagus, the beginning of the small intestine, and the stomach. This helps to check for acid reflux and the damage created by it.

6. CT Scan of The Chest

CT scan or Computer tomography of the chest is a special test using advanced X-ray equipment to further examine abnormalities seen in basic tests such as X-rays.

7. Pulmonary Function Test

As the name suggests, a pulmonary function test is a test that measures the functioning of the lungs by measuring parameters such as lung volume, lung capacity, rate of gas exchange, etc. These parameters will help the doctor diagnose the problem in the baby.

[Read : Lung Function Test For Children]

8. MRI

Magnetic Resonance Imaging of the lungs allows the doctor to diagnose the source of the problem by giving detailed pictures of the area of testing.

How is Tracheomalacia Treated?

Tracheomalacia is not always serious. In some babies, the condition can be very mild and drastically improve by the time the baby turns 2 years old. However, some babies and toddlers will require treatment. The treatment depends on how severe the condition and the symptoms are.

For Mild Symptoms

If the symptoms are mild, the baby can be given humidified air to breathe and a few antibiotics to treat infections. These along with careful feeding can help the baby get better and the symptoms can diminish by the time the baby becomes 2 years old.

For Respiratory Infections

If the newborn has respiratory infections, it can cause the Tracheomalacia to worsen when they cough. So, medications will be given to control the respiratory infection and to reduce the baby’s coughs and sneezes.

For GERD

If the baby has GERD or acid reflux, it can worsen the Tracheomalacia. So, the doctor will give medications to help with the reflux and control the GERD symptoms.

Some of the other common treatments to help improve Tracheomalacia symptoms are

• Medications to clear the airway
• Nebulisation with saline solutions to thin down the secretions
• Percussion and vibration (physiotherapy to the chest) to reduce mucus in the airway and reduce infections
• Exercises for pulmonary hygiene to reduce mucus in the airway
• BiPAP or CPAP to push air gently into the lungs

Surgery is generally not necessary for very small children as the condition will improve as they grow older. However, in severe cases where the child is unable to eat or breathe normally, surgery might be the only option. Some of these surgeries aim at opening the airway and holding the tissues that are falling and creating the block. Over time, the muscles within will get stronger and the symptoms will reduce.

[Read : GERD and Reflux in Babies]

Surgical Options For Treating Tracheomalacia in Babies

Some of the surgical options available for Tracheomalacia are

• Pexy Procedures, which help open up the airway by attaching the weak part of the trachea to other surrounding organs. Some examples of Pexy procedures include Aortopexy, Tracheopexy, Bronchopexy, Posterior Aortopexy, Posterior Tracheopexy, and Descending Aortopexy
• Tracheostomy where a small opening will be created in the front part of the neck. A small tube will be inserted through this opening to help with breathing.
• Tracheal Resection to remove all secretions to make the airway as normal as possible.
• Rotational Esophagolplasty
• Placing a Stent, a rarely suggested temporary option.

Outlook For Babies With Tracheomalacia

If your baby is having difficulty breathing, you will need to attend to it immediately. If you are not satisfied with the diagnosis, get a second opinion. But in most cases, doctors try to avoid surgeries as children get better with age. Getting help and following medical advice can help and make a big difference to both your child and your quality of life.

Babies born with Tracheomalacia might develop other issues as mentioned earlier. If needed, a specialist will have to be considered to treat those issues and help your child. Overall, it is a condition that can be treated and controlled with treatments and medications.

FAQ’s

1. Is Tracheomalacia Life Threatening?

In some cases yes. If the damage to the airway is severe and prevents the child from breathing or eating properly, it can cause severe problems. However, in most cases, symptoms will get better as the child reaches the age of 2.

2. Is Tracheal Tug an Emergency?

Yes, it is. It is a block to the upper airway and can cause respiratory distress, meaning prevent the child from breathing. The doctor will observe and decide on the next course of action based on the evaluation.

Read Also: Laryngomalacia in Infants – Symptoms, Diagnosis and Treatment by Dr. Srikanta J T