An infant has inspiratory stridor but is now failing to thrive, has pectus recession and repeated cyanotic episodes during feeds. What is the most appropriate management?
Severe laryngomalacia is defined by physiological consequences rather than loudness alone. Growth failure, apnoea, cyanosis and marked work of breathing justify endoscopic assessment and possible surgery.
A. Reassure solely because laryngomalacia is usually self-limiting: Severe features make observation unsafe.
B. Urgent specialist airway assessment with consideration of supraglottoplasty: Severe laryngomalacia is defined by physiological consequences rather than loudness alone. Growth failure, apnoea, cyanosis and marked work of breathing justify endoscopic assessment and possible surgery.
C. Perform tracheostomy as the automatic first operation: Most severe isolated cases are treated with supraglottoplasty.
D. Prescribe antibiotics: The problem is dynamic supraglottic collapse.
E. Delay review until school age: Airway and nutritional harm are current.
If the infant fed and grew normally with mild stridor and no hypoxia, reassurance and monitoring would be appropriate.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
Back to the Section 1 bank