Tracheomalacia

A harsh expiratory noise in an infant who is crying, feeding, or fighting a respiratory infection may reflect a collapsing trachea rather than asthma. The airway narrows when intrathoracic pressure rises, so agitation can turn a mild sound into increased work of breathing, desaturation, or apnea. The bedside priorities are to identify the phase of the noise, keep the patient calm, support airway patency, and recognize when dynamic collapse is becoming an airway emergency. Diagnostic testing must capture the airway during spontaneous dynamic breathing; treatment then ranges from observation and secretion management to positive airway pressure or surgery according to severity.