I have used the Calma.  It is totally dependent on the baby's ability to exert vacuum on the valve as to the rate of flow.  The stronger the vacuum, the greater the flow.  Not so much about position since it does NOT flow when baby is not sucking.  Since it is not a closed teat, if the baby has not swallowed milk that has been pulled into the teat, baby may drool some of that milk out or it may spill out of the teat.  I recommend total side-lying position, use the Calma teat attached to a volufeeder style of container, etc.  I have used the Calma with baby's with laryngomalacia who needed a bottle and have seen them improve. It works very much like a straw as the valve closes completely when baby is not sucking.  Since it is not a double valve system like the Special Needs Feeder, it is not compatible with babies who have clefts and are unable to create a seal - but if you have a baby with poor central grooving who needs firm stimulation of the tongue to form a seal, it is better than the Special Feeder (because of the texture) and better than a regular bottle (because it does not flow when baby is not sucking).  It is another tool I plan to put in my toolbox when it becomes widely available.  Saves me from going and buying some refrigerator water tubing and squeeze bottles!

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Sarah Reece-Stremtan
Sent: Tuesday, August 30, 2011 4:13 PM
Subject: Re: Choking while using Calma teat

Are you thinking of laryngomalacia?  This ia a softening of the supraglottic structures, usually primarily the epiglottis, that can cause inspiratory stridor as the airway flops in on itself and the laryngeal inlet is narrowed.  Tracheomalacia is a more distal lesion that typically causes fixed or expiratory stridor.  Both are normally watch-and-wait disorders with spontaneous resolution by 12 - 24 months.  My infant was just evaluated for laryngomalacia last week and it is NOT fun -- a flexible fiberoptic laryngoscope is passed through the nose down to the level of the vocal cords to directly view the larynx while the kiddo screams and screams (he has some redundancy of his aryepiglottic folds but not true laryngomalacia per se).  Stridor can also be heard during feeding if breathing isn't well-coordinated with swallowing and air is being inhaled against an incompletely relaxed glottis.

Has your mom tried other bottle nipples?  Tried feeding the baby in a complete side lying position?  We haven't yet found a safe alternative feeding method for my kid (fortunately he's gaining like crazy solely breastfeeding) but the side lying position for practicing bottles for when I return to work seems to cause him the least distress.

Good luck to this mom.

Sarah Reece-Stremtan MD (peds anesthesiologist)

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