Any problem with the cartilage framework which normally supports the trachea will mean that the wall making up the airway is softer than it should be. If there is a long section without cartilage, this can cause a ‘floppiness’ of the trachea, and this is called tracheomalacia.

Mucus is a sticky fluid which is found on the surfaces of the normal airway. Its main function is to trap dust particles in the air, before they travel deep into the lungs. The specialised lining cells of the airway have mechanisms both to produce this mucus, and then to transport it - together with the trapped dust particles - up the airway to the throat, where it is either coughed out or swallowed.

The mechanism is normally so efficient that most people hardly notice that they have mucus to clear and just automatically clear their throat from time to time.

Severe tracheomalacia

In extreme cases, the infant may experience acute life-threatening episodes often called ‘near death episodes,’ when the baby seems to be choking and unable to breathe. The trachea actually collapses, so that no air can pass through it.

Because these extreme situations are so rare, many doctors have never witnessed one of these episodes; the child is in any case often perfectly well by the time they get to hospital or are seen by a doctor.

The story of a baby going blue with hard crying may suggest ‘breath holding attacks’ - which are relatively common. However, these tend to occur in older toddlers who are either angry or very upset, and happen at the end of a big breath in or out. The ‘near death episodes’ usually happen in the midst of a normal crying spell, and happen near the start of either breathing in or out (depending on where the tracheomalacia is). Observers who can describe these kinds of detail about episodes can help greatly in making a correct diagnosis.

The attacks can be very distressing. Nonetheless, when the child passes out, their relaxed state helps to open up the airway, bringing recovery; gently pulling the tongue forward may help as a first aid measure. If the baby is unconscious and not breathing, blowing gently into the airway by mouth to nose-and-mouth respiration is the correct course of action.