Tracheomalacia is when the cartilage in a child’s windpipe (trachea) is not strong enough to keep it open during breathing. This can cause the windpipe to collapse when breathing out, making it hard to breathe.
This condition can range from mild to severe, and in some cases can be life-threatening. Babies born with tracheomalacia are often born with other medical conditions or syndromes, such as heart defects, abnormalities of the esophagus, gastroesophageal reflux or connective tissue disorders.
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What are the signs and symptoms of tracheomalacia?
The signs and symptoms of tracheomalacia can range from mild to severe. They may include:
- Noisy breathing (stridor)
- Noisy cough
- High-pitched breathing
- Trouble breathing
- Shortness of breath
- A bluish tint to the skin (cyanosis)
- Having many respiratory infections
- Choking during feeding
What causes tracheomalacia?
Tracheomalacia is caused by either weak or soft cartilage that isn’t strong enough to keep the trachea open, or by pressure on the cartilages from nearby structures that weakens them. Pressure can occur if there are abnormalities of the heart or large blood vessels in the chest because they can squeeze the trachea from the front or sides. Esophageal Atresia and Tracheoesophageal Fistula are often associated with tracheomalacia for both of the above reasons, because the esophagus can become dilated and press on the trachea from behind, and also the tracheal cartilages in this disease process are often softer and weaker.
How is tracheomalacia treated?
Treatment options can be surgical or non-surgical depending on the severity of the disease.
- Most cases of tracheomalacia do not need any treatment. Instead, your child’s doctor will monitor the condition. In many cases, the child will outgrow the problem as the trachea gets stronger.
In rare cases, tracheomalacia causes difficulty breathing that is severe enough to require a breathing machine, called a ventilator. In these cases, surgery may be required.
- A tracheostomy is a surgery that allows a breathing tube to be placed through the neck, and this tube can be strong enough to keep the airway open and often allow removal of the breathing machine. There are cases of severe tracheomalacia that require a ventilator for more than the newborn period, and a tracheostomy allows these babies to be much more comfortable on a ventilator for long term periods. A tracheostomy allows these babies to smile, to eat by mouth, sometimes to go home from the hospital, and go through normal infant developmental stages, even while we assist their breathing with the ventilator.
- For heart or blood vessel abnormalities, the abnormal blood vessels may be surgically re-routed to remove the pressure.
- Aortopexy is a surgery that opens the trachea by moving up the aorta (the body’s main blood vessel) and attaching it to the back of the breastbone (sternum).
- Posterior tracheopexy is a surgery where the soft part of the trachea is secured posteriorly to the lining tissue of the spine muscles. This helps keep the trachea open. This surgery can be done, if needed, during esophageal atresia repair.There are several surgeries that are designed to repair tracheomalacia and avoid or eliminate a tracheostomy.
Our specialists at Connecticut Children’s are experienced at treating all types of tracheomalacia and we work together to care for children with this disease. The team will discuss specific options with your family based on your child’s individual needs.