1. Authors mentioned that the basis for the diagnosis of tracheomalacia in this study was >50% reduction of airway lumen due to collapsing of anterior tracheal wall against the posterior wall. Although there is no accepted diagnostic criteria for the trachea-bronchomalacia, a luminal collapse of >25% is considered as significant and children with more than >50% of luminal collapse are usually symptomatic [2]. If authors had considered >25 % luminal collapse as the basis of diagnosis, they could have diagnosed more children with tracheomalacia.

2. Gastroesophageal reflux (GER) is commonly associated abnormality with trachea-bronchomalacia which could be responsible for recurrent or persistent respiratory symptoms such as wheezing, stridor, cough and aspiration pneumonia. Furthermore, GER itself can also lead to trachea-bronchomalacia and studies have shown that treatment of GER may lead to improvement in trachea-bronchomalacia [3]. The association of GER in trachea-bronchomalacia varies from 25-70% in different series [3,4]. In this study, authors did not provide any information about association of GER with tracheomalacia, which might have been helpful in making treatment decision.

3. Bronchoalveolar lavage (BAL) is an important part of bronchoscopy in pediatrics, especially when there are recurrent or persistent respiratory symptoms. In this study, many children had pneumonia, lung collapse and wheezing. Although authors have provided information about associated radiographic and echocardiography findings, they did not mention BAL findings in this study.

4. Although, most often tracheomalacia is a self-limiting condition [5], authors could have shared treatment strategy and outcome in this series for the benefit of the general pediatrician.