Health Library

Bronchomalacia in Children

Bronchomalacia may be caused by weakness or softness of the cartilage of the airways or floppiness of the backside of the airway wall. Bronchomalacia can be mild or severe, depending on symptoms. People most often have bronchomalacia symptoms, such as wheezing episodes, noisy breathing, breathing harder or faster, or increased work of breathing, when they breathe out or cough.

What Causes Bronchomalacia?

Bronchomalacia is most often congenital (children are born with it). It may be found in newborns, including premature babies whose lungs have not fully developed. Around one in 2,000 children has bronchomalacia or a related condition like tracheomalacia. Bronchomalacia is sometimes related to other conditions such as:

• Chromosomal disorders like trisomy 21 (Down syndrome) or trisomy 18
• Chronic inflammation or frequent respiratory infections
• Congenital heart disease
• History of prolonged intubation or ventilation, which can weaken the airway over time
• Premature birth with bronchopulmonary dysplasia (chronic lung disease of prematurity)
• Tracheoesophageal fistula (a connection between the trachea and esophagus that causes trouble swallowing)

What are the Signs and Symptoms of Bronchomalacia?

Symptoms of bronchomalacia may be mild or severe depending on how much your child’s airway is collapsing and how their breathing is impacted. You may not notice mild symptoms since they might not happen as often or seem harmful. Severe symptoms may happen more often and cause greater distress. Symptoms may include:

• Wheezing or noisy breathing
• Breathing problems that get worse with respiratory tract infections
• Problems clearing airway secretions
• Spells of difficult breathing
• Shortness of breath with exercise

How is Bronchomalacia Diagnosed?

Bronchomalacia is most often diagnosed in newborns, including premature babies. Doctors may suspect bronchomalacia based on health history, symptoms and physical exam. A bronchoscopy, which lets a doctor see down into the airways, can confirm the diagnosis.

Other tests may help diagnose bronchomalacia, such as:

• Computed tomography (CT) scan
• Lung function tests (for older children)

How is Bronchomalacia Treated?

Bronchomalacia may be mild enough to not need any treatment. In rare and very severe cases, it can be life-threatening. For premature babies on ventilators, your child’s doctor may change their ventilator settings to open their airways. They may also have a special process for weaning off respiratory support.

For most children, treatment includes supportive care to ease their symptoms. Treatments are specific to each child’s needs. That includes treating other conditions like asthma, pneumonia and bronchitis. These conditions make breathing difficult, which can promote more airway collapse. Humidification and breathing treatments like nebulizers and inhalers may help with managing symptoms.

Only severe or complicated circumstances require continuous positive pressure ventilation or, in rare cases, surgery. That includes for children who have had:

• Failure to thrive, or if your child cannot gain enough weight
• Frequent pneumonia or bronchitis that keeps your child out of school or activities
• Many hospital stays
• Quality of life limitations

Bronchomalacia Prognosis

For most children, bronchomalacia symptoms will improve as they grow, usually by 2–3 years old. This is because the walls of the airway become stronger. Few children have persistent symptoms beyond early childhood. Having a tailored approach for each child based on the severity and persistence of their symptoms is important.