National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Congenital tracheomalacia

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Is this a condition to be very worried about in a one month old infant? Should tests be performed to confirm diagnosis, or just presume that is what it is and that the infant will out grow it? What are the dangers associated with this defect in terms of sleeping and breathing and feeding? And finally, how common is it that other congenital defects may be present?

The following information may help to address your question:


What is congenital tracheomalacia?

Congenital tracheomalacia is when an infant is born with weak cartilage around the windpipe (trachea) that makes it difficult to keep the airway open.[1] The trachea can collapse when breathing out. Symptoms vary from mild to severe and may include noisy breathing (stridor), shortness of breath, difficulty breathing, and bluish skin (cyanotic spells). Symptoms typically worsen during periods of activity. Tracheomalacia can occur on its own or along with other airway problems. It can also occur with congenital abnormalities that affect other parts of the body.[2] Tracheomalacia often resolves on its own by the second year of life.[1] Treatment of symptoms may include humidified air, chest physical therapy, or continuous positive airway pressure (CPAP) for respiratory distress.[2] Severe tracheomalacia may need to be treated with surgery.[1]
Last updated: 2/2/2017

How is congenital tracheomalacia diagnosed?

Diagnosis typically includes reviewing the infant's medical history and performing a bronchoscopy to view the airway. Additional tests that may be considered include CT scan, dynamic MRI, or fluoroscopy.[1][3]
Last updated: 2/2/2017

How does tracheomalacia affect feeding, sleeping, and breathing?

Signs and symptoms of tracheomalacia vary depending on where the narrowing occurs and if it is mild or severe. If a large area is involved the symptoms tend to begin earlier. The child may have noisy, rattling breathing that changes with body position and improves during sleep. Breathing problems can get worse with coughing, crying, and feeding. Also, children with tracheomalacia tend to have more frequent upper respiratory infections that can also make breathing problems worse.[4][5]
Last updated: 2/2/2017

Are infants with tracheomalacia more likely to have other congenital defects?

Congential tracheomalacia can occur alone, but often occurs along with other birth defects of the airway, such as laryngomalacia, bronchomalacia, largelaryngeal clefts, tracheo-esophageal fistulae (TEF), or esophageal atresia (EA). These airway problems can occur alone or in association with a variety of conditions/syndromes such as craniofacial disorders, chromosome anomalies, mucopolysaccharidase deficiency, and heritable connective tissue disorders.[6]
Last updated: 2/2/2017

What is the long-term outlook for congenital tracheomalacia?

The long-term outlook of congenital tracheomalacia is good in children with no associated problems. These children tend to improve by age 2.[6] Children who have tracheomalacia in combination with other malformations tend to have symptoms that last into later childhood.[7] Studies suggest that some people with tracheomalacia have exercise intolerance as adults.[7] 

Possible serious complications of tracheomalacia include complete airway blockage, repeat infection, respiratory failure, and failure to thrive. Treatments to prevent these complications include positive pressure ventilatory support (cPAP) or surgery (e.g., aortopexy, tracheopexy, tracheal stent). Surgery is reserved for treatment of very serious cases.[7][6][5]
Last updated: 2/2/2017

We hope this information is helpful. We strongly recommend you discuss this information with your doctor. If you still have questions, please contact us.

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GARD Information Specialist

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  1. Snijders D, Barbato A. An Update on Diagnosis of Tracheomalacia in Children. Eur J Pediatr Surg. August, 2015; 25(4):333-335. https://www.ncbi.nlm.nih.gov/pubmed/26276910.
  2. Daniel S Schwartz. Tracheomalacia. Medscape Reference. July 20, 2016; http://emedicine.medscape.com/article/426003-overview.
  3. Testing & Diagnosis for Tracheomalacia in Children. http://www.childrenshospital.org/conditions-and-treatments/conditions/t/tracheomalacia/testing-and-diagnosis. Accessed 2/2/2017.
  4. Congenital tracheomalacia. MedlinePlus. http://www.nlm.nih.gov/medlineplus/ency/article/001084.htm. Accessed 8/19/2015.
  5. Tracheomalacia Symptoms & Causes. Boston Children's Hospital. http://www.childrenshospital.org/conditions-and-treatments/conditions/t/tracheomalacia/symptoms-and-causes. Accessed 2/2/2017.
  6. Hysinger EB, Panitch HB. Paediatric Tracheomalacia. Paediatr. Respir. Rev. January 2016; 17:9-15. https://www.ncbi.nlm.nih.gov/pubmed/25962857.
  7. Oermann CM. Congenital anomalies of the intrathoracic airways and tracheoesophageal fistula. UpToDate. Dec 7, 2016;