Hazkani, I., Valika, T., & Thompson, D. M. (2026). Congenital Laryngomalacia: Pathophysiology, Clinical Spectrum, and Holistic Management. Otolaryngologic Clinics of North America.

I hope that this just-published paper on congenital laryngomalacia informs your infant feeding practice and critical thinking like it did mine. It is from the amazing physicians at Lurie Children’s in Chicago. Reading the literature designed for our physician colleagues helps us speak from a perspective of knowledge when we advocate for the infants we care for.

Feeding difficulties are common in this population, and often include color change, inspiratory stridor, wheezing and recurrent respiratory infections. Depending on the setting of their co-morbidities, these infants are often worrisome for silent aspiration as a consequence of co-occurring anatomic and neuromuscular differences and inflammatory mechanisms. There is an interactive relationship between the infant’s dynamic airway obstruction, resulting changes in pressure gradients throughout the aerodigestive system, and altered respiratory regulation that combine to disrupt the swallow-breathe interface swallow-breathe interface. Resulting crying and physiologic stress provoke further risk for airway invasion. Multiple papers have reported a resulting high risk for aspiration, often silent, and chronic airway inflammation. The authors note that:  “Given the high prevalence of silent aspiration, the threshold for ordering swallow studies should be low, and dysphagia assessment should be incorporated into routine evaluation.”

KEY POINTS quoted from the abstract

• “Congenital laryngomalacia is a multifactorial disorder in which structural laxity, neuromuscular immaturity, and inflammation interact to produce dynamic supraglottic collapse and feeding–airway discoordination.
• Clinical severity reflects the combined burden of airway obstruction, dysphagia, and aspiration risk, with comorbidities significantly influencing outcomes.
• Given the high prevalence of silent aspiration, the threshold for ordering swallow studies should be low, and dysphagia assessment should be incorporated into routine evaluation.
• Flexible laryngoscopy remains the diagnostic gold standard, while instrumental swallow studies and laryngoscopy and bronchoscopy provide essential adjunctive evaluation in complex or atypical presentations.
• Conservative therapy, particularly feeding modifications, is effective for most infants; acid suppression lacks evidence of benefit and should be used selectively.
• Supraglottoplasty yields rapid, durable improvement in severe cases, enhances feeding and family quality of life, and remains the cornerstone of surgical management”