A 6-week-old baby girl is brought in to see you because of concerns about her breathing. She is well at rest but, when feeding, makes a high-pitched, crowing noise on inspiration. It also occurs when the child is sleeping on her back. She has no cough, and her cry is normal. On examination, she is afebrile and appears well. Examination of her respiratory system is unremarkable.

1. What is the most likely diagnosis?

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This infant is most likely to have a diagnosis of laryngomalacia.

Laryngomalacia is the commonest congenital laryngeal abnormality and a relatively common cause of stridor in infancy. An abnormality of the laryngeal cartilages causes the larynx to be soft and floppy and collapse during inhalation causing partial airway obstruction.

Presentation tends to occur within a few weeks of birth with inspiratory stridor that is worse when feeding, agitated or lying in the supine position. The stridor is often described as being ‘high-pitched’ or ‘crowing’. The stridor can be worsened by co-existing coryza and tends to initially worsen before spontaneously resolving within the first 18-24 months of life.

2. Which investigation can confirm this diagnosis?

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The diagnosis can be confirmed by flexible laryngoscopy.

3. What advice would you give the parents in this case?

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The parents should have the diagnosis explained and be reassured that it is a benign disorder that usually settles without treatment. A referral to ENT should be made so that the diagnosis can be confirmed.



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