Jessica writes:

I would  like some informal feedback on any of you working with babies with 
 Laryngomalacia.  Did they all breastfeed?  Did any look like they  were 
feeding, but somehow not transferring normal amounts of milk?  Did  they need 
supplement?  How was breathing during the feed?  Was it  always bad, or only 
towards the end?
Any information will be helpful.   I am just trying to get a range here.  I 
have had three babies with poor  milk transfer +/- 15 cc, copious milk 
supply and an ENT who felt this may be a  suction strength issue more than a 
breathing issue- but then another doc who  thought that made no sense.  



~~
Hi Jessica, and all,
`It's good you are looking for a range because that is exactly what I've  
noted over the years. Some babies are fine until they start to fatigue and 
then  the narrowed airway sounds kick in. Others its very mild and mom only 
hears it  if baby if flat on their back. Some babies have trouble feeding, 
fatigue very  rapidly, have loud uncontrolled swallows with less than adequate 
transfer,  others are loud, but can make it through the feeding if mom leans 
way back, and  latch is optimized, but may need to feed more frequently ( 
sometimes every hour  or so) to get what they need.  If their WOB ( work of 
breathing) is high,  they are almost burning as they are eating it seems, so 
they need a mom to have  a lot of patience. Skin-to-skin can help because it 
means they are more  homeostatically stable and have to expend less energy 
on other things and can  devote it to feeding and growth and development. 
I've seen babies able to  breastfeed and grow well. Some are totally 
overwhelmed by bottles, even slow  ones. Other can't get enough without the 
off-breast assist. It can also help  moms to know that babies who feed adequately, 
and  keep a nice pink color,  just need time and patience. I personally have 
not worked with a baby who became  cyanotic, or needed corrective surgery 
though they exist of course. It also  helps moms to know that that sternal 
retraction they see may be mild or not, and  the sounds often get louder after 
the first few weeks as breath power increases,  but it doesn't mean the baby 
is getting worse. I've heard moms say their baby  sounds like a seal or a 
dolphin, they are often relieved to know what that sound  is and what it 
means. I work with a lot of doctors who tell the parents "oh all  babies are 
noisy, it's nothing, don't worry about it" but of course they do  because they 
are not stupid. They see their babies struggling and are usually  glad to get 
to understand why and have some strategies for helping them. Also  these 
"malacia" issues are often in constellation with frenulum restrictions,  high 
palate, reflux, and other midline issues, I notice.
 
Hope that's helpful.
Peace,
Judy
 
 
Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA

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