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Start acid supression therapy
and consider feeding
therapy/swallow evaluation
Suspected aspiration
Consider CXR if not already
done for problems with
oxygen saturatiion
FEES and/or VFSS
No evidence of respiratory
compromise but apsiration
on FEES/VFSS
Feeding modification
If pulmonary compromise or
no improvement refer or
perform supraglottoplasty
*see Severe Laryngomalacia
If improves continue
treatment for moderate
larygnomalcia as above
Aspiration on FEES/VFSS with
evidence of respiratory
compromise
Perform or refer for
supraglottoplasty
*see Severe Laryngomalacia
No aspiration on FEES/VFSS
No clinical signs of aspiration
Infant progressing on growth
curve
Clinical follow up for
symptom check
Infant falling off growth curve
Consider supraglottoplasty
Prior or concurrent to surgical
management, neurologic work-up
should be considered in infants with:
1. Hypotonia
2. Endoscopy with aspiration,
pooled/frothy secretions,
absent supraglottic sensation
Fig. 3.
Management of the difficult to feed infant with laryngomalacia.
Fig. 4.
Post-surgical treatment algorithm and persistent laryngomalacia.
J. Carter et al./International Journal of Pediatric Otorhinolaryngology 86 (2016) 256–261
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