Nikki,
You are not really missing anything, except that reflux is a common
feature (80% incidence) of laryngo/tracheo/bronchial malacias, due to
the increased intrathoracic pressure that these infants need to generate
to breathe overcoming the tone of the lower esophageal sphincter.
.
Infants with even simple laryngomalacia can have difficulty coordinating
swallowing and breathing that lead to aspiration, and make the sucking
look dysfunctional.

The "official" definition of dysfunctional sucking is the presence of an
abnormal movement during sucking (rotary jaw movements, lip pursing,
etc) or the exaggeration of a normal movement such that it interrupts
the sucking rhythm (excessive jaw excursions that are so wide that the
baby repeatedly falls off the breast).  The term is often used much more
loosely any time a baby has feeding issues.

As a baby with a floppy airway continues feeding, they start to fatigue
from the added work of respiration during the exercise of feeding.  As
they fatigue, their ability to smoothly coordinate sucking, swallowing
and breathing deteriorates, and aspiration becomes more likely.  This
poor timing in the latter stages of feeding might be what the feeding
specialist (an undefined term, but often applied to OT's or Speech
Therapists with interest in feeding) is identifying as dysfunctional,
but it's not technically so.  You could get the mother's permission to
communicate with the feeding specialist and put your heads together to
help this mom.

Extension of the head and pacing the feedings (short and frequent and
not too fast a flow) is the best thing this mom can do for her baby.
Exclusive breastmilk is particularly important for these babies as
microaspiration and reflux are much more common.  Mom has already
figured these things out, and you can reinforce them.

--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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