Tiffany,
Tracheomalacia is a structural abnormality of the trachea which makes it
vulnerable to collapse.  Usually the baby exhibits stridor, a difficult, noisy
inspiration (in-breath).  When the baby feeds, the work of breathing increases
greatly.  This tires the baby, who falls asleep or loses his latch.  Baby may
also detach from the breast to take a breath.
        Some ideas for assisting these babies:  Try the football hold, with
baby as well aligned as possible, no twisting of the body or head.  Bring baby
up to mom using pillows, gently curving baby's back around mom's side.  This
flexion assists breathing and suckling.  Experiment with head position: some
babies with respiratory difficulties nurse better with their head slightly
extended on the neck (tipped back).  NEVER flex the neck in a baby having
breathing difficulty, this can push the larynx up into the airway and further
obstruct breathing.  It is possible that this is what is making feeding so
difficult for these babies, in the traditional cradle hold, many moms flex
baby's neck to offer the breast.  (Try it yourself with your own body to see
the difference between moving your head alone (your chin will raise and lower
only slightly) and moving your neck and head (your chin touches your chest)).
        Since feeding and breathing simultaneously are tiring, suggest that
mom feed frequently for short periods of time, perhaps using external pacing.
 In external pacing, mom removes baby from the breast each time baby needs to
breathe.  Not too convenient, but it prevents baby from being distressed, and
decreases the amount of work neccessary to feed.  She only needs to do this
for a short time until baby improves the ability to self pace.  This technique
is useful for any baby with difficulty coordinating suck-swallow-breathe.
        If baby's suck is poor, mom might complement at the breast with pumped
hindmilk, preferably using a 5 french feeding tube and syringe, filling the
syringe with milk and slipping the tube into the corner of the baby's mouth
after latch on.  This allows the mom to deliver milk only as the baby is
sucking, and prevents the gasping respiration that might occur with other
methods of complementation, which might stress baby by dripping.
        Finally, any breathing difficulty increases abdominal pressure, making
GER (gastroesophageal reflux) more likely.  A total diet of human milk will
decrease any morbidity associated with reflux, as well as the severity of the
vomiting.
        Finally, please use letters after your name, it allows us all to
recognise each other's expertise, and appreciate the team we have here.  You
could use LLLL, those letters mean as much to us in this venue as all the
others!
Catherine Watson Genna, IBCLC