Airway Disorders in Children

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Airway disorders can affect how babies and children breathe, eat, swallow, and sleep. These conditions may be diagnosed before birth or develop over time as the result of an infection or traumatic injury. Duke pediatric otolaryngologists (ENTs) work closely with experts in many pediatric specialties to diagnose and treat your child’s airway disorder. We also work with you and your child to help improve eating, sleeping, swallowing, and breathing.

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Understanding Airway Disorders

There are many different conditions that can affect your child’s airway.

Narrowed Throat, Trachea, and Nasal Passages
Children may be born with throat, trachea, or nasal passages that are too narrow to let air and food flow comfortably or allow swallowing to happen naturally. Specific conditions include:

  • Subglottic stenosis
  • Pyriform aperture stenosis
  • Choanal atresia and stenosis 
  • Complete tracheal rings

Airway Obstructions
Obstructions in the airways between the nose, throat, and lungs that are present at birth can also have a significant impact, including causing sleep apnea. Examples include:

  • Cysts
  • Floppy tissue around the vocal cords (laryngomalacia)
  • Laryngeal cleft, a rare condition in which there is a deep groove or opening on the back wall of the voice box that allows food and liquid to pass into the airway (aspiration)
  • Collapsed or weakened windpipe (tracheomalacia or bronchomalacia), which can cause a child to choke while eating and can also cause difficulty with breathing 
  • Dysphagia (swallowing difficulty either from anatomical issues or functional swallowing disorders) can cause your child to inhale food or liquid into their lungs (aspiration), which then can lead to underlying lung and breathing problems

Blocked airways can also occur suddenly. If your child experiences a sudden blockage in their airway from an object, allergic reaction, or any other reason, call 911 immediately.

Related Medical Conditions
Children can also develop airway disorders as a result of other medical conditions, such as:

  • Cystic fibrosis, which causes mucus to build up in the lungs.
  • Vocal cord lesions or paralysis, which may develop following an injury, stroke, tumor, or infections. These can damage the nerve that controls the vocal cords and cause problems with your child's voice. They can also cause problems with swallowing and eating, and allow food and liquids to pass into the windpipe.

Many Specialists Involved in Your Child's Care
Because these conditions require care from different specialists, your child’s team may include head and neck surgeons, pulmonologists, neurologists, allergists, gastroenterologists, speech pathologists, nutritionists, and social workers who are specially trained to work with children. We coordinate your child’s care and help them overcome challenges.

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Duke Health offers locations throughout the Triangle. Find one near you.


Children with airway disorders require highly personalized care. Treatments may range from simple, ongoing monitoring to complex surgery.


Antihistamines and epinephrine (EpiPen) can reduce airway swelling and inflammation of the nasal passages, throat, and tongue caused by an allergic reaction. When an infection is to blame, antibiotics and anti-inflammatory medicines can reduce swelling to unblock airways.

EXIT Procedure (Ex-utero Intrapartum Therapy)

Some airway disorders that are diagnosed before birth may be treated with this procedure during the baby’s delivery. Pediatric otolaryngologists perform the EXIT procedure to open the airway before the umbilical cord is cut. 

Endoscopic Surgery

A lighted tube called an endoscope is inserted through the mouth to access a blocked airway in the nasal passages, windpipe, voice box, or lungs. Surgeons use small tools that are passed through the tube to remove a blockage or inflate balloons to expand narrow passageways.

Open Surgery
In some cases, open surgery (in which an incision is made in the neck to access the airway) is required to clear an airway blockage. Your doctor will discuss the best options for your child, which may include procedures to stabilize the windpipe or a create a new airway (tracheostomy).

Airway Reconstruction Surgery
Certain airway disorders require reconstruction surgery to rebuild or expand parts of the airway, such as the voice box or windpipe. Reconstruction procedures can be performed with endoscopic or open surgical techniques. Conditions that may need reconstruction include laryngeal cleft, laryngomalacia, subglottic or tracheal stenosis, tracheal rings, and tracheomalacia. 

Swallowing and Feeding Therapy
Your child may work with a speech pathologist to improve his or her ability to swallow. The therapist will help your child improve chewing, sucking, and tongue movements and strengthen the muscles in the mouth and throat that are used for swallowing.

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Tests and Procedures

Diagnosing and caring for children with airway disorders requires many types of imaging. Our pediatric otolaryngologists may request the following tests or procedures.

X-Ray, CT Scan, or MRI

Imaging of the head, neck, and chest are taken to check for blockages. These tests are fairly quick and are painless.


A tube called a bronchoscope is inserted through the nose or mouth and into the lower airway to check for foreign objects and other possible causes of airway blockages. This procedure is done while your child is asleep under general anesthesia.


A flexible tube called an endoscope is inserted into the nose or mouth to examine the voice box (larynx), vocal cords, and throat. Usually, this procedure can be done in the clinic while your child is awake. In cases that require a more thorough evaluation or intervention, your child would be asleep under general anesthesia. 

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This page was medically reviewed on 08/08/2022 by