Tracheomalacia is a very rare condition that occurs when the cartilage that forms the walls of the windpipe, which is normally rigid, becomes weak and floppy. The condition is usually congenital, appearing at birth because the cartilage has not developed properly. In some cases, it is acquired when the weakening develops after birth. It causes a variety of respiratory complications and, left untreated, the breathing difficulties can increase to the point of requiring urgent or emergency care. Often, tracheomalacia is associated with esophageal atresia (a blockage of the esophagus) and tracheoesophageal fistula (an opening between the trachea and the esophagus) but may occur without other conditions.

Tracheomalacia (TM) is a disorder of the airway consisting of a weakness of the anterior tracheal cartilaginous rings and laxity of the posterior membranous trachea, resulting in dynamic airway obstruction. The clinical symptoms range from a chronic cough and wheezing.

What Causes Tracheomalacia?

Some babies are born with the cartilage of the trachea being weak, known as congenital tracheomalacia. A breakdown of the windpipe cartilage after birth is referred to as acquired, or secondary, tracheomalacia. It may occur as a result of large blood vessels putting pressure on the airway, complications from surgery for tracheal-esophageal fistula or oesophagal atresia, or from extended use of a breathing tube.

Symptoms and Signs of Tracheomalacia

The symptoms of tracheomalacia vary from mild to severe breathing difficulties. Problems occur because the weakened walls of the trachea are not rigid enough to keep the windpipe properly open.

Signs of tracheomalacia include:

  • Noisy or rattling breaths
  • High-pitched breathing
  • Breathing noises during sleep that can change as position changes and improve while sleeping
  • Breathing problems made worse during feeding and by coughing, crying and upper respiratory infections

The types of symptoms are the same for both congenital tracheomalacia and acquired tracheomalacia. Newborns with tracheomalacia may also exhibit the symptoms of other disorders such as gastroesophageal reflux, heart defects and delayed development.

Survivability of Tracheomalacia

The prognosis for tracheomalacia is generally good, with most cases resolving naturally as cartilage in the windpipe grows stronger over time. Breathing noises and respiratory problems usually improve gradually and stop by the time a child reaches the age of two. However, other more serious congenital abnormalities related to tracheomalacia, such as heart defects, may be present.

Additional risks from tracheomalacia include aspiration pneumonia, a potentially fatal complication caused by inhaling food. Upper respiratory infections require that a person with tracheomalacia be monitored closely and receive follow-up care by an ear, nose, and throat health care provider. Adults with tracheomalacia caused by being on a breathing machine often develop serious lung problems.

Acquired tracheomalacia occurs after birth. It can be the result of abnormal blood vessels which put pressure on the trachea and cause it to break down, as well as infections of the trachea. Prolonged use of a ventilator can also contribute to the development of tracheomalacia, as can certain surgeries, which may cause cartilage breakdowns as a complication. Since this condition is a known risk of certain standards of care and medical procedures, patients at risk may be monitored and screened for any signs of tracheomalacia.

How we treat tracheomalacia 2017

Esophageal and Airway Treatment Center | Boston Children’s Hospital

Talked though by the World Famous Dr. Jennings.

Tracheomalacia and complex congenital airway problems released 11 Jan 2017

Tracheomalacia and complex congenital airway problems and treatment

 Here on the 12th Jan 2017

By Dr Jennings

Published on 11 Jan 2017

Surgical Grand Rounds Jan 11, 2017, on Complex Congenital Airway Treatment by Dr. Jennings and colleagues. In detail discussion of current treatments for tracheomalacia, tracheal compression, tracheal anomalies and vascular rings including the aberrant subclavian artery, circumflex aorta, and double aorta. He also discusses treatment for tracheal strictures with resection and slide tracheoplasty and slide bronchoplasty


Published on Nov 1, 2015

Severe Tracheomalacia Assessment and Treatment


Dr. Russell Jennings explains the current diagnostic methods for children with noisy breathing, with a focus on tracheomalacia. He also goes into some of the current effective treatment techniques, including the posterior tracheopexy.


Published on Jul 1, 2012 (Thank you to the Parents that posted this so we can show that from the struggle and first you as Parents will get through. Read the positive comments below Under Video.

Baby ****** is about 7 weeks old here and had just come home from his first stay in the NICU after he was born 32 weeks preemie with an EA/TEF repair needed and NEC. He has tracheomalacia and laryngomalacia with extreme GERD. He ultimately had many ‘blue spells’ and one “blue death” resulting in Mommy resuscitating him at home and 2 subsequent Nissen Fundoplication surgeries and frequent hospitalizations for a host of bronchial and GI issues.

What are blue spells?

Blue spells, which are also called “cyanotic spells”, are short periods when a reduced amount of blood flows into the lungs. Since blood carries oxygen, less oxygen is delivered to the body. As a result, a child may appear blue or bluish. Most spells last less than a minute.

During a blue spell, your child may

  • Suddenly feel uncomfortable or be cranky or less alert
  • Begin to breathe faster and deeper
  • Turn blue, especially around the mouth and face
  • Faint or feel faint

Blue spells are caused by reduced blood flow to the lungs

The most common cause of blue spells is contraction or narrowing of the path between the heart and the lungs. This narrowing lowers the amount of blood going to the lungs. The children most often affected by blue spells are those with Tetralogy of Fallot (a form of congenital heart disease). However, blue spells may also occur in children with other forms of heart disease in which blood flow to the lungs is reduced.

Some children may appear blue after getting cold or having a bath; this is not a blue spell.

Blue spells are most common

  • when a baby cries strongly
  • soon after waking
  • soon after a feeding
  • soon after a bowel movement
  • if a baby is dehydrated and needs liquids

Helping your child during a blue spell

If your child has a blue spell, do not panic. To help your child, follow these steps:

For babies

  • Place your baby on their back.
  • Bring the baby’s knees up to touch the chest and hold them firmly in place. You can also do this while holding your baby.
  • Comfort and settle your baby by holding and rocking, giving a soother, and gentle cuddling.
  • Remain calm. Your baby can sense when you are upset, which will make it harder to settle the baby.

For older children

Place your child on their side, bringing the knees up to the chest and hold them firmly in place. Some children will automatically squat during a blue spell. This is their way of bringing their knees to the chest on their own. Make sure you can see your child’s face so you can watch for colour changes and check the degree of alertness and length of the spell.

When you should call the doctor

  • If this is your child’s first blue spell, tell your child’s cardiologist (heart specialist).
  • If the frequency of your child’s blue spells increases, tell your child’s cardiologist.
  • If the blue spell lasts longer than one minute, take your child to the nearest emergency department.

If the blue spell lasts longer than one minute and there is also a change in your child’s level of alertness or if your child faints, call 911 0r 999

Key points

  • During a blue spell, your child may suddenly feel uncomfortable; be cranky or less alert; breathe faster and deeper; turn blue, especially around the mouth and face; faint; or feel faint.
  • If your child has a blue spell, stay calm.
  • If your child is a baby, place them on their back and bring their knees up to touch their chest. Comfort and soothe them.
  • If your child is older, place them on their side and bring their knees up to their chest.
  • If the blue spell is long and your child is less alert, or if your child faints, call 911 or 999


Cyanosis is a purplish-blue colour to the skin. Newborns with cyanosis are sometimes called “blue babies.”

Cyanosis means that there is less oxygen being carried by the body’s blood cells. In this situation, there may not be enough oxygen being carried to the tissues in the body.

The colour is caused by high levels of reduced (deoxygenated) haemoglobin in the blood near the surface of the skin. Haemoglobin is the molecule that allows red blood cells to carry oxygen. Oxygenated haemoglobin is bright red, while deoxygenated haemoglobin is bluish.

There are two main categories of cyanosis: central and peripheral. Central cyanosis causes a bluish colour in the lips, tongue, and skin, especially the fingers and toes. Peripheral cyanosis is seen only in the fingers and toes.

Cyanosis caused by congenital heart conditions is often seen soon after birth, but sometimes it does not appear until a baby is older.

What causes cyanosis?

Cyanosis may mean that the lungs are not oxygenating the blood properly, or that not enough oxygenated blood is getting to the body.

Central cyanosis has many possible causes, including:

  • breathing and lung problems
  • heart defects that allow oxygen-poor blood from the right side of the heart to mix with oxygen-rich blood on the left side of the heart, so the blood that is pumped out to the body is low in oxygen; these defects are known as right-to-left shunts
  • problems with blood flow to and/or from the lungs: this may be due to abnormal connections of the blood vessels between the heart and lungs, or obstruction of the blood vessels
  • fluid build-up in the lungs (pulmonary edema) caused by congestive heart failure
  • disorders of hemoglobin, which mean the blood cannot carry oxygen properly

Peripheral cyanosis can also be caused by cold temperature, crying in a newborn, seizures, or shock, among other things.

Congenital heart defects that cause cyanosis include transposition of the great arteries, pulmonary atresia, tetralogy of Fallot, tricuspid atresia, hypoplastic left heart syndrome, truncus arteriosus, and interrupted aortic arch.

What tests will your child need?

Your child may need a variety of tests, including some of the following:

  • blood work to measure arterial blood gases, pH, haemoglobin, and blood sugar
  • oxygen saturation monitoring
  • a chest X-ray
  • an electrocardiogram (ECG)
  • an echocardiogram
  • cardiac catheterization

What is the difference between a sign and a symptom?

Signs and symptoms are not the same things. A sign is a clinical feature of a disease or condition that the doctor looks for. It is something that can be seen or measured. This includes things like redness or the heart murmur, things that the patient may not necessarily feel.

A symptom is something the patient feels or complains about, like fatigue or pain. Symptoms cannot be directly observed. Both signs and symptoms are assessed in order to make a diagnosis.

What influences how common or severe a symptom is?

Symptoms and signs vary according to the type and severity of the heart condition, the child’s activity level, and whether or not the child has been treated for the heart condition.

What are possible symptoms of a heart condition?

  • rapid heartbeat
  • difficulty breathing (shortness of breath)
  • cyanosis (“blue spells”)
  • difficulty with feeding (prolonged or ineffective)
  • failure to thrive (poor growth)
  • decreased exercise tolerance
  • palpitations
  • fainting/dizziness
  • chest pain

What are possible signs of a heart condition?