2017 Sec 1 Green Book

J. Carter et al./International Journal of Pediatric Otorhinolaryngology 86 (2016) 256–261

Start acid supression therapy and consider feeding therapy/swallow evaluation

Suspected aspiration

No clinical signs of aspiration

Consider CXR if not already done for problems with oxygen saturatiion

Infant progressing on growth curve

Infant falling off growth curve

FEES and/or VFSS

Clinical follow up for symptom check

Consider supraglottoplasty

No aspiration on FEES/VFSS

Aspiration on FEES/VFSS with evidence of respiratory compromise

No evidence of respiratory compromise but apsiration on FEES/VFSS

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

Perform or refer for supraglottoplasty *see Severe Laryngomalacia

Feeding modification

If pulmonary compromise or no improvement refer or perform supraglottoplasty *see Severe Laryngomalacia

If improves continue treatment for moderate larygnomalcia as above

Fig. 3. Management of the difficult to feed infant with laryngomalacia.

Fig. 4. Post-surgical treatment algorithm and persistent laryngomalacia.

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