What is tracheomalacia?

Tracheomalacia is the collapse of the airway when breathing. This means that when your child exhales, the trachea narrows or collapses so much that it may feel hard to breathe. This may lead to a vibrating noise or cough. Tracheomalacia can result in recurring respiratory illnesses or make it difficult to recover from a respiratory illness. In the long term, it can lead to progressive lung injury. Tracheomalacia has many different forms. Some children will only experience mild forms. For others, this condition can be life threatening and require immediate intervention to allow your child to breathe regularly again.

What causes tracheomalacia?

A healthy trachea is supported by a series of C-shaped rings made of cartilage that help your child’s airway to stay open during exhalation. The most common form of tracheomalacia occurs when the rings are wide and shaped more like a letter “U,” causing the membrane at the back of the airway to interfere with breathing and restrict airflow.

It is often incorrectly assumed that the condition results when the cartilage that goes around the trachea isn’t strong enough to fully support it. While this theory has long been taught, newer research and our extensive experience at Boston Children’s prove this to be an uncommon cause. Other types of tracheomalacia occur in the lower trachea or bronchi (the branching airways) — known as bronchomalacia — or are caused by a cyst (mass) in the chest or in the airway itself. Almost all babies with esophageal atresia have some degree of tracheomalacia. Sometimes, however, tracheomalacia can occur on its own, without another condition.

Tracheomalacia may be congenital (present at birth), or acquired later. Acquired tracheomalacia, also known as secondary tracheomalacia, can be caused by:

  • a previous treatment for esophageal atresia or another medical condition
  • heart anomalies, such as vascular rings
  • other internal structures or masses that push on the trachea, causing it to narrow
  • recurrent infection
  • tracheostomy tubes

What are the symptoms of tracheomalacia?

There are many types of tracheomalacia, but common symptoms include:

  • high-pitched breathing
  • rattling or noisy breathing (stridor)
  • frequent infections in the airway, such as bronchitis or pneumonia (because your child can’t cough effectively or otherwise clear their lungs)
  • frequent noisy cough
  • exercise intolerance
  • prolonged respiratory infections

More severe signs may include:

  • choking during feeding
  • a halt in breathing, particularly when crying or during strenuous activity
  • blue spells (child appears blue because they aren’t getting enough oxygen)

How we care for tracheomalacia

Tracheomalacia is often undetected or misdiagnosed, often as asthma, recurrent croup or simply noisy breathing. You may have been told that this is the “new normal” for your child or that your child will eventually grow out of it. Many families — and even some doctors — do not know that there are surgical treatments for tracheomalacia.

Although this condition can improve on its own, some children don’t outgrow more severe forms of tracheomalacia. Instead, they adapt to it and learn to live with the discomfort and complications. Our doctors don’t want your child to have to adapt to discomfort or dysfunction. That’s why the Boston Children’s Hospital Esophageal and Airway Treatment Center offers advanced surgical options that can provide your child with complete relief.

Here is our guide to understanding and treating tracheomalacia.