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What Do Persistent Cough, Rattling While Breathing And Mucus In An Infant Indicate?

Posted on Thu, 11 Jun 2015

Question: My daughter is almost 5 months old now but for the past 3 months I have been trying to get answers about her breathing issues. She has a persistent cough, rattly breathing, stridor and on a number of occasions has not been able to take a breath in. She freaks out, throwing her arms around and visibly trying to take a breath but cant, I have learnt that leaning her forward with her feet above her head helps her breatg again. every time this has happened I have needed to clear her airways and mouth of very thin but sticky mucus. One doc has told me its asthma and put her on ventalun syrup but another doc days her trachea is collapsing... please help me its so scary

Answered by Dr. Diptanshu Das (1 hour later)

Brief Answer:
The main treatment is supportive

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone carefully through the question. It seems that your daughter has a condition called laryngo-tracheo-malacia which means that the cartilage that forms the trachea and larynx is ill formed. Normally these structures do not close with respiration. But in the case of your daughter, these are partly or fully collapsible. If these structures collapse, she gasps for breath. This is the cause of her breathlessness and stridor. Additionally, such a condition predisposes her to a condition called bronchiolitis which is basically a viral infection manifesting with common cold. It is also associated with thick mucus.

About the laryngo-tracheo-malacia, nothing really needs to be done other than being supportive. Surgery is not required. Condition will improve with age. About the bronchiolitis and thick mucus, she needs nebulization. Get a home nebulizer. Add 2 ml of normal saline to the nebulizer mask and give nebulization multiple times a day. That is the best solution that can be provided. Ventorlin may be given if there is associated wheezing. Please note that although ventorlin would relieve bronchospasm, if any, it will not relieve the stridor which is due to the collapse of the trachea.

Feel free to communicate back in case of further queries.

Regards
Dr. Diptanshu Das

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Diptanshu Das (2 days later)

thank you very much :) I have hypermotion syndrome so my cartilage in my body is very soft have been told this may be why my daughter has this condition. At what point would this condition become severe enough to need intervention? She has apnea and occasionally she will not be able to breathe at all until I physically move her. Also Her eardrums are also always dark pink to red also been told this may be due to the unusually soft cartilage in the ear tubes collapsing and not being capable of draining the fluid away from the eardrum... any thoughts on this?

Answered by Dr. Diptanshu Das (8 hours later)

Brief Answer:
You need to play a crucial role in the management

Detailed Answer:
Thanks for writing back.

Hyperextensive joints occur in case of certain genetic conditions which are characterized by a defect in the structure of collagen, the molecule that forms many structures of the body including the cartilagenous rings of the trachea and bronchus. Needless to say that it has been passed on to your daughter. You have to be observant about her. In her case, frequent respiratory tract infections and intermittent respiratory distress would not be unusual. You have to learn to deal with these conditons at home. Nebulization with Ipratropium might be needed from time to time to relieve the wheezing (and stridor). Since her epiglottis is not firm, she might be prone to aspiration and this is likely to be the cause of apneic episodes. It might be essential to give her nasogastric tube feeding (Ryle's tube feeding) and you need to learn the techniques of insertion of the tube and checking its position. As the problems are likely to continue for at least a few years (may be more), if you can get to learn the techniques, taking the baby to the doctor every now and then could be averted. In any case, if the condition does not seem manageable or if the child becomes lethargic or chokes, you should rush the child to a doctor without delay.

I would not worry about the colour of her ears. Indeed the cartilage there is lacking. But it should not be a cause of concern.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Diptanshu Das (19 minutes later)

thank you so much forgetting back to me. can you please explain what nasogastric tube feeding is?? She is going to see an ENT specialist but we have to go on a waiting list so not sure how long til we see them..

Answered by Dr. Diptanshu Das (14 minutes later)

Brief Answer:
It is a simple technique to avoid aspiration and apnea

Detailed Answer:
Thanks for writing back.

Nasogastic tube is a tube that is inserted through one of the nostrils and it reaches the stomach directly. Feeding through this tube averts the possibility of aspiration occurring. It can be inserted by any pediatrician or even a general physician. ENT specialists are not requried for the same. Please talk to your pediatrician regarding it.

Regards

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Diptanshu Das (18 minutes later)

Thank you. I just seem to be getting nowhere fast with tje pediatrician and gps here. Im at a loss and worried. Thank you again for all your help and advice much appreciated :)

Answered by Dr. Diptanshu Das (14 minutes later)

Brief Answer:
Glad to be of service

Detailed Answer:
Feel free to communicate back in case of further queries, if any.
Regards

Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Prasad