If your daughter is thriving and putting on weight, there's probably no need to worry. Both laryngomalacia and gastro-oesophageal reflux are common in small babies and in most cases resolve with time as the child grows, leaving no lasting problems. Simple treatment, especially of the reflux, is usually enough to keep on top of symptoms.

Laryngomalacia

Laryngomalacia is a condition seen in small babies in whom the larynx (or voice box) is particularly soft and limp. There are several types - the mildest may cause no problems, while the most severe can be associated with other abnormalities of the respiratory tract, and with neurological problems, and will need a tracheotomy (a hole made in the air passage) to allow breathing.

Problems with breathing

Until the larynx becomes stronger, problems can arise for several reasons:

• The soft limp tissues of the larynx can collapse as the baby breathes in. This interrupts the flow of air and causes noisy breathing, with a sound called stridor, which is a sign of obstructed air flow. It may be worse if the baby has a respiratory infection.
• In some children, laryngomalacia can interfere with feeding.
• There may be other ear, nose and throat problems.

Link with gastro-oesophageal reflux

Doctors believe there's a link between laryngomalacia and gastro-oesophageal reflux, although there isn't a single common mechanism to link these two problems, so several theories exist.

It does seem that in some patients with laryngomalacia, reflux may be the primary cause of their airway problems. In others, it's an additional factor on top of neurological or anatomical abnormalities.

Reflux is common in babies less than one year old, because the muscular valve at the entrance to the stomach (which holds food in the stomach) may be weak in small infants.

Research suggests 68 to 80 per cent of babies with laryngomalacia also have reflux, while other studies claim that all children with laryngomalacia have reflux of gastric acid up to the pharynx (back of the throat).

Many researchers have also shown that stomach acid, and the enzyme pepsin found in gastric juices, have detrimental effects on the larynx and tracheobronchial tree (air passages into the lungs). This may cause persistent swelling (oedema) of the larynx lining, which is common in children with laryngomalacia.

There's no consensus yet about managing this link, but it makes sense to think simple treatments to control reflux could help resolve the laryngomalacia more quickly, too. More interventional treatments such as surgery, with all their inherent risks, are best avoided if possible.

Simple treatments include:

• Changing the child's sleeping position. Raise the end of the cot by a few inches to let gravity help keep stomach contents down.
• When she's awake, prop up your child in a baby chair rather than letting her lie down on the ground.
• Thicken her feed with rice flour, cornflour or carob flour (but talk to your health visitor about this first).
• If your baby is weaned, introduce more solids to the diet.

Your GP can also prescribe several treatments that may help to restrict the damage of reflux, by increasing the muscular tone of the gullet or reducing acid production in the stomach.

If there are other ear, nose or throat problems, such as laryngitis, otitis or sinusitis, some studies suggest that actively treating the reflux may help to resolve them.

This article was last medically reviewed by Dr Trisha Macnair in April 2008