Another thought to consider regarding a baby who sounds congested: babies
with noisy inspiratory breathing could have a condition called
laryngomalacia. The epiglottis which protects the airway when the baby feeds
also partially obstructs the airway during breathing because the epiglottis
in this condition is not very stiff. These children do better lying on their
stomach, sitting upright or at a 30 degree angle, or by repositioning their
heads to reduce or relieve the obstruction. They outgrow the mild and common
form of this by 18 months or so.

Another cause of stridor is tracheomalacia, a defect in the cartilage rings
that keep the trachea open. Stridor is heard on expiration and the rings
collapse. Babies with this problem usually have trouble coordinating
breathing and feeding and present as a disorganized feeder, choking and
sputtering, sometimes with milk coming out their nose. In severe cases the
baby fails to gain weight and medical intervention might be necessary.
Otherwise, it is simply outgrown as the baby gets older and the cartilage
rings stiffen with maturity.

These babies do better when fed prone at the breast. Some also do better when
using a thin nipple shield which slows the fast flow of milk and helps baby
pace the feeding better.

Marsha Walker, RN, IBCLC
Weston, MA

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