Baby squeaking when feeding


Laryngomalacia - The Squeaky Baby

by Dr. Christopher Chang, last modified on 4/13/21.
Read and comment below!

Babies make all sorts of unusual cute sounds, but one sound that is not cute is a squeaky or some other type of noisy sound that occurs with breathing, specifically with inhalation. This sound called stridor is due to a "floppy" airway known as laryngomalacia. This alarming sound typically occurs only with inhalation and more prominently when crying, feeding, or some other type of exertion. Depending on severity, it may also occur at rest or even while sleeping. Typically, most parents describe an intermittent "noisy" breathing (lower pitched and guttural) when at rest that turns into more of a high-pitched squeak with exertion.

Other related symptoms which may or may not be present include:

• Turning blue
• Reflux leading to a "wet" sound in the throat region (phlegmy, mucus throat)
• Skin retractions immediately above and/or below the sternum that occurs in time with stridor (suprasternal or subxiphoid)
• Difficulty feeding and poor weight gain
• Choking while feeding

These symptoms may be present at birth, but typically becomes more obvious around 3 weeks of age, mainly because newborns within the first 1-2 weeks of life are not able to breath forcefully enough to create the typical stridor / noisy breathing sounds until they are older.

Thankfully, 90% of infants outgrow this problem by 18-20 months of age.

However, if the laryngomalacia is severe enough, surgical and/or medical intervention will be required.

Diagnosis of Laryngomalacia

Beyond history and exam, a trans-nasal endoscopic exam is required to definitively diagnose this condition. This exam is performed without any sedation in the office. It is performed by threading a thin spaghetti-like noodle through the nose down to where the voicebox is located.

Often, this exam is performed with audio and video recording so that it can be played back in slow motion.


Watch Video of an Infant with Laryngomalacia


What Causes the Noisy Breathing?

Normally, breathing is quiet as there's nothing obstructing air from passing through the nose into the lungs. However, with laryngomalacia, the entry of air through the voicebox is partially obstructed. With the smaller than normal opening, it causes a squeak when air passes through just like a whistle.

The reason why breathing is quiet on exhalation is because air blows open apart the area of partial obstruction. The reason the sound only occurs on inhalation is due to the one-way nature of the obstruction like a door which can only open and close in one direction (inward OR outward into a room, but not both directions).

Take a look at the images below comparing normal, mild, and moderate laryngomalacia. Severe is basically where no airway opening (red dot) can be seen. Each of these images were obtained when the infant was inhaling.

Normal

Mild Laryngomalacia


Moderate Laryngomalacia

Severe Laryngomalacia

In the normal picture, air goes between the vocal cords (green dots) into the windpipe (red dot) before ending up in the lungs. The purple dots are the arytenoids (joints that move the vocal cords) and the blue dot is the epiglottis. As you can see, as the severity of the laryngomalacia increases, the airway becomes more obstructed leading to correspondingly increase in noisy breathing and symptoms. In the moderate severity, the mucosa of the arytenoids (purple) are even touching together obstructing the airway to the point one can barely seen the windpipe (red) and vocal cords (green). In the severe case, the epiglottis has folded together like a taco to the point complete obstruction has occurred so one cannot even see the airway, arytenoids, nor the vocal cords.

You can watch a video of an infant with moderately severe laryngomalacia here.

Medical Intervention

With laryngomalacia, the infant has to work harder to pull air into the lungs creating greater than normal negative pressure in the throat region. This negative pressure may get transmitted into the stomach and exacerbate or even cause reflux by pulling stomach contents up into the throat region like someone sucking on a straw (except the straw in this situation is the esophagus).

As such, these affected infants often need to be placed on reflux medications like zantac to avoid throat injury and in severe cases, lung inflammation from soiling due to silent aspiration of reflux juices.

Try to keep infant upright and when sleeping, avoid laying on the back which exacerbates symptoms of laryngomalacia.

90% of the time, infants with laryngomalacia can be managed WITHOUT any need for surgical intervention.

Surgical Intervention

Surgical intervention to treat laryngomalacia is called supraglottoplasty. This procedure is performed only if the symptoms are such that it is adversely affecting the health of the infant to a significant degree. Typically, that entails symptoms of:

• Failure to thrive
• Poor weight gain
• Turning blue with exertion
• Life-threatening apneas
• Significant retractions
• Heart or lung problems stemming from increased exertion from the laryngomalacia
• Need for supplemental oxygen to breath

In particular, turning blue indicates insufficient oxygenation which mandates surgical intervention.

The surgery is performed by trimming away the excess mucosa from the arytenoids and/or epiglottis to enlarge the opening where the obstruction is occurring. Additional cuts between the arytenoids and epiglottis can also be performed to further enlarge the opening.

To prevent airway stenosis due to scarring, the excisions are performed such that they are not adjacent to each other. Take a look at the images below using the moderate and severe laryngomalacia examples from above. Excisions are denoted by the red lines. Green lines denote mucosal division in order to separate the arytenoids away from the epiglottis.




With surgery, symptoms should improve significantly, though typically does not completely resolve (may still have some residual noisy breathing).

Please keep in mind that in our practice, we are not able to offer surgical intervention for laryngomalacia as postop pediatric ICU observation is required (Fauquier Hospital does not have a PICU). We will refer such infants who require surgical intervention to a facility where it can be performed safely.


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Phlegmy Throat


Chronic Throat Clearing


Chronic Cough


Lump in Throat


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When Should a Parent Be Concerned With a Baby’s Noisy Breathing?

| Wendy Healy

Newborn, Pediatrics.

Parents like watching their babies sleep. They find joy in seeing their adorable little ones rest so peacefully. But sometimes babies breathe noisily, making sounds that can cause parents to wonder if something is wrong.

One of the main causes of noisy breathing, or stridor, is called laryngomalacia—a long name for a condition that usually is harmless and resolves on its own. Laryngomalacia is caused by floppy tissue falling over the larynx (voice box) and partially blocking the airway when a child breathes in.

The sound from laryngomalacia is often a high-pitched squeak that often worsens when the baby is agitated, feeding, crying, or sleeping on his or her back. Symptoms usually start within a few weeks or months of birth.

While laryngomalacia is the most common cause of noisy breathing in babies and toddlers, it requires intervention in only a small number of children, according to Jocelyn Kohn, MD, an ear, nose, and throat (ENT) specialist with Stanford Medicine Children’s Health Specialty Services in Walnut Creek. Dr. Kohn also sees patients in the East Bay as part of our partnership with John Muir Health. 

“This condition is referred to by some as a birth defect, but I prefer to think of it as an immaturity of the voice box that 90% of children grow out of,” said Dr. Kohn.

In most cases, children will outgrow laryngomalacia by the time they’re 2 and the larynx develops, she added. “As children get bigger and stronger, their larynx gets stronger too,” she said. But a small number of cases will require surgery, which is safe and effective.

Parents may notice these symptoms in their child:

  • Noisy breathing (stridor) 
  • Difficulty feeding
  • Not gaining weight
  • Gastro reflux (spitting, vomiting, and regurgitation)
  • Choking while feeding
  • Apnea (stopping breathing during sleep)
  • An indentation in the neck and chest with each breath

Severity can vary. “Some babies I see have mild cases, just making a squeaking noise, while others can be more severe. Pediatricians always advise parents to ask their doctor about anything that concerns them,” she said. “This is good advice. But in the case of laryngomalacia, it’s usually nothing that requires treatment.”

In the worst cases, when babies are not sleeping restfully, have difficulty eating, and aren’t gaining weight, it’s best to talk with the doctor. “These may be signs that an intervention by an otolaryngologist is needed,” Dr. Kohn said.

When children with laryngomalacia fail to gain weight, it’s usually because they’re using so much energy just to breathe that they’re exhausted, she said. Breathing difficulties are often seen as an indentation in a child’s chest and neck, indicating that he or she is having trouble getting enough air.

In these cases, specialists take a closer look by inserting a camera down the throat to see what’s happening in the larynx. “Seeing something ourselves can help reassure parents or guide further treatment,” said Dr. Kohn.

If laryngomalacia is worsened by reflux, Dr. Kohn will treat it with medications. Babies can also be positioned to lessen the breathing problem. Most noisy breathing happens when babies are lying flat on their back, which is the correct position for sleeping. Babies who are awake and being watched can be placed on their stomach to help alleviate the problem.

“We tell parents to put gravity on their side. Keeping a baby upright when feeding, frequent tummy time, and positioning them on their stomach while awake all help,” advised Dr. Kohn. 

Very severe cases, and those that last past two years, may require surgery, which is effective in most children, according to Dr. Kohn. She performs a supraglottoplasty, which adjusts the supraglottis, the tissue above the vocal cords. Although the surgery requires general anesthesia, it’s minimally invasive, using endoscopes and microscopes inserted down the throat. Excess tissue is removed, and tight areas are released.

“Babies usually spend one night in the hospital and recover well, with most experiencing mild discomfort that resolves quickly. Most babies can start feeding again right after surgery,” Dr. Kohn said.

There are many reasons for noisy breathing, including cysts, hemangiomas, and inhaled objects, in addition to laryngomalacia. In case of anything with a sudden onset, or if a child put something in his or her mouth and can’t breathe, seek emergency care immediately.

Learn more about laryngomalacia in a HealthTalks podcast from Stanford Medicine Children’s Health.

Authors

Tags: newborn, otolaryngology, pediatrics

why the baby cries while feeding

While the baby is quite a baby, crying is the only way of his communication with his mother and the outside world. If the baby is restless during feeding, he will let you know that he is uncomfortable. We will analyze what can cause baby crying in such a situation.

Dry milk drink "Baby milk" Valio Baby 3 NutriValio for feeding children over 12 months Read more

As a rule, the causes of a baby’s tears at the breast or bottle with a mixture are physiological, and there may be several of them.

Abdominal pain

Most likely, the child is worried about colic (they can start from 2-4 weeks of age and usually end by 3 months). Unpleasant sensations are associated with the fact that the infant has an insufficiently developed intestinal microflora and it is difficult for the digestive system to cope with the task assigned to it. Children's crying during colic is accompanied by arching the back and pulling the legs to the stomach - the pain from the formation of gases in the intestines is always acute. To alleviate the condition of the crumbs, it is useful for a nursing mother to drink teas with fennel, cumin or anise. If your baby is formula-fed, choose formula carefully. Valio Baby baby food is as close as possible to the composition of breast milk and contains the GOS prebiotic, which is necessary for the health of the child's digestive system. The cause of colic is also the wrong feeding technique and, as a result, the capture of excess air by the baby.

#PROMO_BLOCK#

Earache

Children under one year old often suffer from otitis media, this is due to the anatomical features of the structure of the nasopharynx in babies in the first months of life. A baby may cry during feeding because swallowing causes a sharp pain in his ears. Very carefully touch the tragus of the baby's auricles - if he cries, then you need to see a doctor.

Headache

It is no secret that many neurological disorders are accompanied by headaches. It becomes especially strong when swallowing. If the baby is constantly crying during feeding, be sure to make an appointment with a pediatric neurologist.

Inflammation of the oral mucosa

Crying during feeding may signal that the baby is experiencing discomfort in the mouth or throat. Its cause is most often thrush or pharyngitis. These diseases require treatment under the supervision of a pediatrician.

Lack or excess of breast milk

The lactation of a nursing woman is affected by a considerable number of factors - the psychological state, fatigue, stress, malnutrition and its lack, improper organization of breastfeeding. The baby may cry because he does not have enough milk. Whether the food shortage is really critical is easy to check using the wet diaper method. By the way, the crying of a baby may also indicate that there is too much milk - the stream is too strong and the baby simply chokes.

Unusual taste of breast milk

If a mother ate, for example, something spicy on the eve of feeding, this will certainly affect the taste of milk. The baby, of course, will cry. This cause of children's "grief" is the most easily eliminated - be attentive to your menu and do not upset your beloved baby.

In addition to the reasons described, the reason for children's tears during feeding can be erupting teeth and inflammation of the gums, as well as nasal congestion with allergies and SARS. Be attentive to your baby. If all is well, the baby should not cry while feeding.

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