Hi Laura,

The sternocleidomastoid is an accessory respiratory muscle too, it helps 
raise the ribcage during breathing, especially during feeding. A baby 
with torticollis is disadvantaged in using this muscle because one side 
is tight and the other is generally weak. The upper airway might even be 
narrower on the affected side. Some babies with torticollis have rapid 
respiratory rates due to these mechanisms, and I've seen others with 
torticollis and malacias.

Your baby's normal length sucking bursts is a good sign. The more a baby 
is struggling to breathe, the shorter their sucking bursts are and the 
longer their respiratory pauses.

Prone positioning during feeding, mild head extension, and offering baby 
the breast frequently are all helpful.

Catherine Watson Genna BS, IBCLC  NYC  www.cwgenna.com

On 7/7/2016 9:17 PM, Laura Spitzfaden wrote:
> PTP,
>
> I asked this question at the facebook group before I was able to get in contact with the PA, so my questions are a little different in this post.
>
> I saw a mom yesterday who has a 3w old. She has very sore cracked nipples and knew this was not normal since she has breastfed 2 children.
>
> Baby shows signs of torticollis (head turning, asymmeteical jaw, a knot in neck/ shoulder area, asymmetrical tongue rise) and appears to have restrictive lingual and maxillary labial frenums. He has a very shallow latch; his lower lip tends to curl inward. He has a receding lower jaw. He has uncoordinated suck, swallow and breathing, with some breath holding and catch up breathing. He has normal length sucking bursts with usually quiet swallowing. Sometimes he coughs when flow is faster. Milk transfer amount and rate was WNL. He transferred 50ml in 16 minutes on one breast and 64ml in 10 minutes, when offered the other breast (30min later). He is gaining at the high end of normal, just under 2oz/day.
>
> All of these issues will be addressed (CST and frenectomy and possibly PT) but I also noticed marked expiratory stridor while he was feeding. The baby sounds like he is humming with every out breath while breastfeeding, more-so when feeding at left breast in cradle hold. I have heard inspiratory stridor but I have never heard expiratory stridor. I wanted his physician to check this out because I know it can indicate tracheomalacia.
>
> Baby had an appointment today and only saw the PA instead of his PCP. I was able to speak with the PA later in the day and she said that respiration and heart sounded normal. She didn't note as much expiratory stridor as I did but she did hear it. She spoke with the physician and they are comfortable with waiting and seeing if there are any other breathing issues and treating the torticollis. Before speaking to the physician, I was concerned about what I should suggest the mom do to address the breathing. Now I am wondering what reasons a baby would have expiratory stridor other than tracheomalacia and how this would progress if it were tracheomalacia?
>
> Someone asked me if I saw retractions. I did not see any at the clavicle but I did not look for retractions at the sternum because Baby was dressed. I saw him unclothed later and he did not note any retractions but he was not feeding then.
>
> Laura Spitzfaden, LLLL, IBCLC
>
>               ***********************************************
>
> Archives: http://community.lsoft.com/archives/LACTNET.html
> To reach list owners: [log in to unmask]
> Mail all list management commands to: [log in to unmask]
> COMMANDS:
> 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
> 2. To start it again: set lactnet mail
> 3. To unsubscribe: unsubscribe lactnet
> 4. To get a comprehensive list of rules and directions: get lactnet welcome

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome