If this baby can safely swallow while breastfeeding (and this was not at
all addressed by the barium swallow test), then he should be breastfed.
  If the baby cannot swallow safely, then a slower method of feeding,
such as a Haberman feeder might be helpful.
If the barium swallow test was done with a regular bottle nipple, it is
meaningless.  Many infants with respiratory problems cannot keep up with
the flow from the bottle.
The true test would be to do a videoflouroscopic swallowing study of the
baby at breast.  It would take some doing to set up the machine (which
is oriented so that the baby is in a plastic infant seat, reclining at
about a 45 degree angle) for breastfeeding.  A simpler approach would be
to listen to the baby's stridor with a stethescope during breastfeeding,
and observe the baby's ability to coordinate sucking, swallowing and
breathing.

Usually, head extension, prone positioning at breast (mom reclining),
and short, frequent feeds are enough for babies with laryngomalacia to
do well.  If this is too stressful, mom could bottlefeed ebm with a
haberman feeder on slowest flow, using external pacing (taking the
bottle away to let baby breathe) if neccessary, and place baby at the
recently pumped breast so he can still breastfeed with a slower flow.

The other issue is aspiration.  If the baby is prone to aspiration, one
does not want anything but breastmilk to enter his mouth.  Breastmilk is
not nice to aspirate, but it will not cause chemical pneumonia like
foreign substances will.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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