Laryngomalacia, tracheomalacia and vocal-cord dysfunction: Case

This infant has severe laryngomalacia. Her position-dependent inspiratory stridor from three weeks of age, worse with feeding and supine posture, localises the lesion to the supraglottis; but unlike the benign majority she has crossed into severe disease, with feeding failure, cyanotic episodes and apnoea during feeds, and faltering growth from the 25th to below the 3rd centile. The clinical task is to confirm the diagnosis, exclude a second airway lesion, and plan surgical relief of the obstruction. ^[2]

Clinical findings

The key findings are the inspiratory stridor at rest with recession, its worsening with feeding and supine posture, the prolonged tiring feeds with coughing and back-arching, the witnessed cyanotic pauses, and the crossing of weight centiles downward. Together these define severe laryngomalacia rather than the mild disease that needs only reassurance. The normal cry is reassuring against a vocal-cord palsy, but the presence of apnoea and cyanosis is a red flag that mandates urgent airway assessment. ^[1]

The candidate should articulate a clear problem representation: a four-month-old with severe laryngomalacia causing feeding failure, apnoea and faltering growth, requiring airway endoscopy and surgical intervention. This single statement names the diagnosis, the severity and the plan, and signals that this child is in the small minority who need more than observation. ^[3]