A nurse is caring for an infant with laryngomalacia. Which position would the nurse place the infant in to decrease the incidence of stridor?

1. A

   Prone

2. B

   Supine

3. C

   Supine with the neck flexed

4. D

   Prone with the neck hyperextended

Appeared in: DHS 2018 shift 1st

Explanation

• Laryngomalacia involves the collapse of soft supraglottic tissues into the airway during inspiration, causing stridor.
• The prone position uses gravity to pull these floppy tissues (e.g., the epiglottis) forward, away from the airway opening.
• Adding neck extension helps to further straighten the airway passage, maximizing its diameter.
• This combined position provides the most significant relief from the airway obstruction and the resulting stridor.

Why Other Options Were Wrong

• Option A: While the prone position is helpful, this option is less complete. The combination with neck extension provides a greater degree of airway opening.
• Option B: The supine position is contraindicated for relieving stridor in laryngomalacia. Gravity causes the floppy laryngeal tissues to fall backward, worsening the airway obstruction.
• Option C: This is the most dangerous position. It combines the negative effect of the supine position with neck flexion, which severely narrows the airway and critically worsens the obstruction.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Positional management of laryngomalacia in infants to alleviate stridor to guide bedside assessment, documentation, and the next nursing action.
• Positional changes are a first-line, non-invasive nursing intervention to manage symptoms of mild to moderate laryngomalacia while the infant is awake and supervised.
• A critical nursing responsibility is educating parents on the difference between therapeutic positioning (prone, while observed) and safe sleep positioning (supine, for all unsupervised sleep) to balance stridor relief with SIDS prevention.
• What if? If an infant with laryngomalacia develops feeding difficulties, poor weight gain, or signs of severe respiratory distress (like cyanosis or sternal retractions) despite positioning, the nurse must ensure immediate medical evaluation. This may indicate severe laryngomalacia requiring surgical intervention (supraglottoplasty).

How to Approach the Question

• First, identify the pathophysiology of the condition mentioned: Laryngomalacia means 'soft larynx', where tissues collapse into the airway.
• Next, understand the goal: The question asks how to 'decrease' the stridor, which means you need to find a way to open the airway.
• Analyze the options based on the principles of gravity. Consider how gravity would affect floppy tissues in the throat in each position.
• Eliminate positions that would worsen the condition. Lying on the back (supine) would cause the tissues to fall back and block the airway, so options B and C are incorrect.
• Compare the remaining options. Both involve the prone position, which is correct. The option that describes an additional maneuver to further open the airway (neck extension) is the most complete and therefore the best answer.

Concept Tested & Keywords

• Concept Tested: Positional management of laryngomalacia in infants to alleviate stridor.
• Stem keywords: infant, laryngomalacia, position, stridor
• Lead-in keywords: decrease the incidence
• Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

Question ID

QfGWKNx_FjFCIYLC9mV8BF

Copy ID