Noisy breathing is one of the most common complaints that ENT doctors hear from new parents, and in most cases it doesn't pose a serious threat and is easily managed.

However, noisy breathing can indicate a condition that may need a thorough medical evaluation. If your baby has noisy breathing, here are a few steps to think about that will help both parents and the treating physician understand the situation.

1.  Listen for a Difference Between Upper and Lower Airway Noises, i.e.: Stridor vs. Wheezing

These are confusing terms, and if your baby is not breathing smoothly it’s always going to be stressful. When a baby breathes in (inhales), and a bark-like cough is heard or other rattling noise, that noise breath is stridor and implies something may not be right  with the upper airway like the throat or voice box or even trachea.

However, if a baby breathes out (exhales), and makes a noise, and often appearing to be coming from the chest, that is wheezing and suggests that the lungs themselves are the site of the challenge.

While there are exceptions, typically an ENT specialist will need to assess upper airway stridor noises while wheezing is often best assessed by the pediatrician and pulmonary doctors.

2.  Make Sure Your Baby's Airway is Clear

When the baby’s breathing is not smooth, it can a frightening moment. If possible try to quickly inspect your baby’s nasal and oral airways in general terms. Perhaps, try to clear the nasal congestion with topical saline (saltwater) drops and then gentle use of a nasal aspirator. Look in your baby’s mouth and see if there is a foreign object that is easily seen and removed.

3.  An Upper Airway Noise (Stridor) Could Be Croup

Stridor is an extremely common condition typically caused by croup. You can usually identify croup by a harsh, bark-like cough that results from inflammation in the larynx (voice box area and below). It is usually brought on by an upper respiratory viral infection (URI). In many cases, this is easily treatable with cool humidified air and steroids. But sometimes it will need an urgent care center to give a aerosolized does of racemic epinephrine.

4.  A Common PERSISTENT Condition of Noisy Breathing Is Known As Laryngomalacia

Laryngomalacia is one of the most common sources of noisy breathing, especially in children under one month old. Laryngomalacia is caused by floppy tissue above the voice box. Specifically, the aryepiglottic (A-E) folds fall into the airway somewhat  when the child inhales. It is most noticeable when he or she is awake or upset. Once identified by an ENT physician, the good news is that typically it goes away on its own over 6+ months and no treatment is typically needed. Exceptions to this is include when the airway noise starts to impede normal eating, sleeping, and/or developmental progress.

5.  Could Recurrent Croup Be a Problem?

If your baby or toddler has a diagnosis of croup more than twice or more in a year, it’s probably time to schedule an appointment with an ENT. Repetitive episodes of croup MAY imply something wrong with the anatomy of the subglottis, the area under the vocal cords. If deemed necessary, a laryngoscopy is typically performed to determine whether there is narrowing in the larynx. Sometimes, conditions like pediatric acid reflux can be identified as causative factors and treated to lessen the recurrence.

6. Assess Noisy Breathing In Relationship to the Baby’s Sleeping, Eating, and Crying Moments

While a baby is sleeping, apneic episodes can happen. Apnea is a when there is a lack of, or inability to make a respiratory effort. When sleeping, there may be a noisy breathing occurring, and then silence, and then noise again. Sometimes, if that silence occurs and the chest is not rising and falling, there may be apnea going on. Apnea in infants is not typically tonsil and adenoid hypertrophy and may need a thorough multi-team approach to the evaluation.

If noisy breathing occurs soon-after or during eating, the noises may be do to GERD(reflux) where stomach acid regurgitates back up, lands on the airway, and makes the tissue irritated and swollen. Other eating associated airway noises, albeit rare, include things such as laryngeal clefts and fistulas. 

If crying is associated with an increase in airway noises, this can be linked to issues ranging from laryngomalacia to vascular abnormalities such as rings and growths like hemangiomas. Vascular challenges to the airway usually require an extensive work up and complicated treatment plans, but the outcomes are very positive.

7. Record Your Child's Breathing

Since your child's noisy breathing can come and go, you should try to make an audio or video recording of it before seeing a doctor. This will improve the diagnostic process to make sure your child receives proper treatment.

If your baby shows signs of noisy breathing that require attention from an ENT, take the safe route and schedule an appointment with Virginia Ear Nose & Throat.