Most patients come to attention by the first 4-6 weeks of life. The history can be helpful in determining the cause of stridor. Differential diagnosis of stridor can be divided into supralaryngeal, laryngeal, tracheal, and nonanatomic categories. Supralaryngeal causes include choanal atresia, vallecular cysts, thyroglossal cysts, and tongue dermoid or teratoma. Laryngomalacia is the most common cause of congenital stridor.
Patients typically have high-pitched inspiratory stridor that increases with crying and when supine.
It rarely interferes with feeding. Symptoms are usually present at birth or within the first 4 to 6 weeks of life. Laryngomalacia usually resolves of its own accord within 18-24 months. Vocal cord paralysis may cause a patient to have a weak cry. They also may be worse with feeding.