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Subject:
From:
"Catherine Watson Genna BS, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 12 Dec 2012 19:38:33 -0500
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This sounds classic for intermittent upper airway obstruction, of which 
laryngomalacia is the most common cause. Stridor is generally most 
severe when the baby is trying to breathe harder or faster than their 
at-rest breathing rate. Feeding is aerobic exercise, and requires the 
baby to get more oxygen while simultaneously requiring them to close off 
their airway for half the usual respiratory cycle to swallow. A baby who 
is just able to meet their oxygen needs at rest will have to take short 
sucking bursts when they are swallowing, and long respiratory pauses. 
The fact that the sucking bursts are normal length on the pacifier is 
typical, because the baby does not have to close the airway as often to 
swallow saliva. The slower swallowing rate might also be why she is more 
relaxed at night, when mother's breasts are typically less full and flow 
is slower, and when many moms feed in sidelying, which can be less 
challenging too.

The air swallowing is because the swallow is often poorly timed when 
babies are trying to get the swallow done fast so they can breathe 
again, and the baby doesn't have as much time to push the air out of her 
nose with her soft palate before swallowing the liquid. An ENT is the 
physician specialist who can evaluate the baby and see if there is a 
different problem (such as a laryngeal web, which usually causes stridor 
to be more frequent) or if the laryngomalacia is severe enough to 
warrant surgery. The fact that the baby is growing well bodes well. I'm 
most likely to encourage specialist referral for a baby who does not 
grow well.

And the lower lip doesn't need to seal well if the tongue does - often 
in young babies you will see the tongue wrapped around the breast, and 
the lower lip just gently supporting the tongue. This is normal.

Having mom lean way back so baby is feeding laying on her tummy with her 
head tipped back is usualyl helpful for laryngomalacia.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com

On 12/12/2012 3:17 PM, Christine Lichte wrote:
> I just read through all of the posts about laryngomalacia.  I have a few questions.  The baby I saw today has a lot of the signs of laryngomalacia.  She is 4 weeks old born healthy at 38 weeks.  From the first swallow at breast she has trouble.  We thought it might be the letdown, but she has trouble during the entire feeding even when milk flow is slow. She has stridor during inhalation. She can only suck a few times then has to stop to breathe and frequently has to come off. Her eyes are wide open and you can tell she is struggling. She sounds like she is swallowing a lot of air.  Her lower lip does not seem to seal well-you can easily see her tongue, but she has a strong rythmic suck. Mom told me she does much better sleeping on her stomach. She never falls asleep at the breast. I watched her suck on a pacifier and she does fine with that, she is relaxed and has longer sucking bursts.  After breastfeeding she burps alot and is fussy and gassy. And yes, the doctor is treating her for reflux.  She is gaining weight well, although mom is willing to nurse her on demand which is every hour.  Mom stated baby seems more relaxed at night and breastfeeds better and sleeps better at night-but a good night is the exception.  During our visit I didn't notice any breathing issues when she was not eating. She was relaxed and alert during diaper change. If a baby does have laryngomalacia do they always having breathing issues/stridor when not feeding or can some babies  have it only during feeding? What type of specialist should I reccommend she see?  I read about different diagnostic tests.  Is it easy to diagnose?  Thanks for your time!
>
> Christine Lichte, IBCLC
>
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