Tracheomalacia (tray-key-oh-muh-LAY-shuh) is the collapse or falling in of the trachea. The trachea, also called the windpipe, is the tube that brings air from the mouth and nose to the lungs. Firm rings made of cartilage hold the windpipe open during breathing. Tracheomalacia occurs most often in babies, when the cartilage in the windpipe has not developed as it should. This soft cartilage makes the windpipe floppy, so it's not stiff enough to keep the airway open.

Another cause of tracheomalacia is when a blood vessel presses on the windpipe so that it can't open enough with breathing. Less often, tracheomalacia affects older children and adults.

Tracheomalacia can be life-threatening and make it difficult to breathe. Trouble breathing can make it hard to be active. Also, the collapse can cause repeated airway and lung infections.

Your child may not need treatment if tracheomalacia symptoms are mild. Symptoms sometimes improve on their own as a child grows and the windpipe gets stronger. If symptoms are more serious and limit a child's quality of life, medicine, therapy and surgery can help.

Symptoms can range from mild to severe. Symptoms may be seen at birth, but they may be mild and not noticed until an infant is about 4 to 8 weeks old. Symptoms may get worse when a child is eating. Symptoms include:

• Coughing often. The cough may sound like a barking seal.
• Noisy breathing, such as high-pitched wheezing or rattling sounds.
• Trouble getting enough air that gets worse with crying, coughing, eating or activity.
• Trouble clearing mucus from the airway.
• Frequent infections in the airway, such as pneumonia or bronchitis.
• Trouble swallowing or eating.
• Shortness of breath when active, for example, playing with other children or playing sports.

Tracheomalacia may affect the whole windpipe or only a small section. When tracheomalacia includes the airways in the lungs, also known as the bronchi, it's called tracheobronchomalacia (tray-key-oh-brong-koh-muh-LAY-shuh).

When to see a doctor

If you have concerns about your child's growth and development, talk with your healthcare professional.

Make an appointment with a healthcare professional if your child has:

• Trouble with breathing, such as making high-pitched wheezing or grunting noises when breathing.
• Trouble with choking when eating.
• Lost weight or is not gaining enough weight.

Go to the emergency room at a hospital if your child:

• Has trouble breathing and can't speak or cry.
• Can't breathe easily and the ribs seem to suck inward when breathing in.
• Has short stops in breathing.
• Has blue or gray skin, lips and fingernails due to low oxygen levels. Depending on skin color, these changes may be harder or easier to see.
• Seems slow moving, weak or very tired.

Causes of tracheomalacia include:

• A trachea that is not fully developed. In newborns, the cartilage may not be developed enough. The soft cartilage causes the windpipe to be floppy. The windpipe doesn't stay open when breathing.
• Changes in how the trachea develops. In some infants the trachea doesn't develop in the typical way. For example, it might not have enough cartilage. Some infants are born with an opening between the esophagus — the tube that goes from the mouth to the stomach — and the trachea. This can cause tracheomalacia. Changes can make the windpipe more likely to collapse when breathing.
• Pressure on the trachea from a blood vessel. A blood vessel, such as the aorta or the main branches of the aorta, may press on the windpipe so it doesn't open enough with breathing.
• Damage to the trachea from injury or illness. For example, the windpipe can be damaged from surgery or medical procedures or from having a breathing tube for a long time. Examples of illnesses that can damage the windpipe include chronic obstructive pulmonary disease (COPD), gastroesophageal reflux disease (GERD) and frequent lung infections.

Risk factors for tracheomalacia include:

• Being born too early. The windpipe may not be fully developed in infants born too early. The cartilage is not strong enough to hold the airway open.
• Differences in main blood vessels. These blood vessels bring blood from the heart to the rest of the body. Pressure on the windpipe from these blood vessels increases the risk of tracheomalacia.
• Being born with a passage between the trachea and the esophagus. The opening, called a tracheoesophageal fistula, can increase the risk of tracheomalacia.
• Injury to the windpipe. Surgery, medical procedures or having a breathing tube for a long time can injure the windpipe so that it collapses with breathing.
• Illnesses that affect the windpipe. Having frequent airway and lung infections, such as bronchitis and pneumonia, can irritate and weaken the windpipe. GERD also can irritate and weaken the windpipe.

Tracheomalacia can be life-threatening if severe. It can result in:

• Low oxygen in the body.
• Blue or gray skin color due to low oxygen levels. Depending on skin color, these changes may be harder or easier to see.
• Short stops in breathing.
• Choking during eating.
• Losing weight or not gaining enough weight.
• Breathing trouble with activity.
• Severe and frequent lung infections.

Infants born with tracheomalacia may have other conditions at birth. These can include changes in the development of the heart, lungs or esophagus.

To diagnose tracheomalacia, a healthcare professional talks with you about symptoms and other health conditions. The healthcare professional also does a physical exam. This includes listening to the chest with a stethoscope.

Tests

One or more of these tests may be needed:

• Chest X-ray. A chest X-ray gives pictures of the airway and lungs. Sometimes the chest X-ray does not show any changes.
• CT scan of the chest. A computerized tomography (CT) scan combines a series of X-ray images to create 3D pictures of the airway and lungs. The images can show what happens to the windpipe during breathing.
• Laryngoscopy. A tool with a light is used to look at the back of the throat and voice box. The voice box also is called the larynx.
• Bronchoscopy. A thin tube with a camera is passed through the nose or mouth, down the throat, through the windpipe and into the lungs. The camera can look at the windpipe and lungs during breathing. A healthcare professional gives your child medicine called a sedative to relax and to not feel or remember the procedure.
• Upper endoscopy. A thin tube with a camera is passed into the esophagus. A healthcare professional gives your child medicine called a sedative to relax and to not feel or remember the procedure.
• Lung function tests. Also called pulmonary function tests, these can be done to find out how well the lungs are working.

Tracheomalacia sometimes occurs along with other conditions. Other tests or a referral to other specialists may be needed. For example, your child may need a specialist for changes in the heart, digestive system, or growth and development.

Treatment of tracheomalacia can vary depending on how severe symptoms are. Multiple specialists may work together with you to decide on the best treatment options. In some infants, symptoms improve as the child grows. By about age 2 years, the windpipe gets stronger, so symptoms may get better.

When needed, treatment may include medicine, therapy and surgery.

Medicine

Your healthcare professional may recommend medicine to:

• Lessen mucus. Mucus can clog the windpipe and make breathing harder. Medicines that cause the body to make less mucus can help make breathing easier.
• Control GERD. These medicines help control stomach acid and keep it from irritating the windpipe.
• Treat infections. Even minor airway infections, such as a cold, can make breathing more difficult. Treating airway infections as soon as possible can help.

Therapy

Therapy includes chest physical therapy. Also called chest physiotherapy or pulmonary hygiene, this therapy can help clear mucus from the lungs.

Surgery

Sometimes children need surgery to treat tracheomalacia. The type of surgery depends on the cause and how severe the symptoms are. A plan for surgery is designed specifically for your child and may involve a combination of procedures. The healthcare team may create a 3D model of your child's chest organs to help plan for surgery.

Surgery options include:

• Posterior tracheopexy (TRAY-key-oh-pek-see). The surgery attaches the floppy back wall of the windpipe to the front of the spine for support. This prevents the windpipe from collapsing. Often this surgery can be done using minimally invasive techniques through tiny cuts in the skin. Minimally invasive techniques result in less pain and shorter recovery time than those of open surgery.
• Aortopexy (ay-OR-toe-pek-see). If the large blood vessel in the chest called the aorta is pushing on the front of the windpipe, this surgery moves the aorta forward. This gives the windpipe more room to open. This often can be done using minimally invasive techniques through tiny cuts in the skin, with less pain and a shorter recovery time. If the aorta is pushing on the back of the windpipe, the surgery to move the aorta out of the way is called posterior descending aortopexy.
• Custom splints. A splint that is made to fit properly can be placed on the outside of the windpipe to prevent collapse. The splint provides support that keeps the windpipe open. The splint does not need to be removed. It dissolves over time after the airway is stronger.

As part of the treatment plan for tracheomalacia:

• Use a humidifier. If the air in your child's room is dry, a cool-mist humidifier or vaporizer can moisten the air. This may help loosen mucus and lessen coughing. Be sure to keep the humidifier clean so that bacteria and mold don't grow in the machine.
• Take care with feeding so choking doesn't happen. Talk with a doctor or other healthcare professional, such as a dietitian, for advice if your child chokes when eating, is losing weight or is not gaining enough weight.
• Keep vaccinations up to date. Any airway or lung illness can be more severe for someone with tracheomalacia. Get the usual childhood vaccines for your child. Also get the flu vaccine every year for children over 6 months of age. Get any other vaccines your healthcare professional recommends. Stay away from people with colds or flu.
• Stay away from smoke. Don't smoke, and stay away from secondhand smoke. Talk with your healthcare professional if you smoke and need help quitting.
• Get regular healthcare visits. Lifelong care with regular healthcare visits is important to find issues early and adjust treatment as needed.

If your child is diagnosed with tracheomalacia, your family may face some challenges. These tips may help.

• Learn about tracheomalacia. This can help you know what to expect and what treatment options can help.
• Find support. Talking openly about how you feel can help. It also may help to talk with others who are dealing with the same issues.
• Talk with a healthcare or mental health professional. You can talk about your feelings and find coping strategies.

Symptoms of tracheomalacia may be found at birth. Or you may first bring up your concerns with a healthcare professional. After an exam, your child may be referred to one or more specialists for testing and treatment.

You may want to ask a trusted family member or friend to join you for the appointment to offer emotional support and help you remember all the information you get.

Here's some information to help you get ready for your first appointment.

What you can do

Before your appointment, make a list of:

• Any symptoms your child has and how long your child has had them.
• Key medical information, including other health or developmental concerns.
• All medicines, vitamins, herbs and other supplements your child takes. Include the doses.
• Information about your family history.
• Questions to ask the healthcare professional.

Questions to ask may include:

• What likely is causing the symptoms?
• Are there any other possible causes for these symptoms?
• What tests does my child need?
• Should my child see a specialist?
• What treatment do you recommend?
• What are options other than the treatment you're recommending?
• Are there print materials or websites that you'd suggest to help me learn more about tracheomalacia?

Feel free to ask other questions during your appointment.

What to expect from your doctor

A healthcare professional is likely to ask you questions, such as:

• What are the symptoms?
• When did you first notice these symptoms?
• How severe are the symptoms?
• What, if anything, makes these symptoms worse?
• What, if anything, makes these symptoms better?

Be ready to answer questions so that you have time to talk about what's most important to you.