Hello, Lynn.
       You wonder why reflux, if part of this baby's picture, would be worse
during the day and seemingly non-existent during the night.
       I have worked with a number of mothers and babies who exhibit this
pattern, and it sometimes has been a particular food or drink or vitamin
supplement that mom had every day for breakfast but did not consume at other times of
the day, which caused baby to fuss during the day, but had generally worked
out of his system by night.  Examples:  vitamin mom only takes with breakfast;
eggs she usually only eats at breakfast; orange juice, you get the idea.  Once,
it turned out to be a snack the mom ate at 4:00 a.m. when the baby woke for a
feeding.  Mom would get hungry being up then, so would grab a snack (I don't
remember just what anymore) and go back to sleep, which led baby to start
fussing with the first "real" morning feed.  (I consider 4 a.m. to be middle of
the night, since all I want to do then is go back to sleep!)
       You may also want to ask mom if baby squeaks or sounds like a bird
chirping as he eats.  Babies with tracheal malasia often sound like this when
they eat.  I've also seen the same in babies diagnosed with esophageal malasia.
Evidently, when the esophagus kinks, it bends over on the trachea even if the
trachea does not have signs of malasia and the weight/pressure of the
esophagus causes the same problems during feeds as if the condition were tracheal
malasia.  In either of these conditions, the tracheal or esophageal "tube" should
stay open and round when the neck bends, like a flexible laundry dryer exhaust
tube.  In babies with malasia, the supports of the tube are not mature enough
yet, so the "tube" kinks, causing it to be much more difficult for air to get
through.  This leads to the squeaking noise.  It also causes babies to be
more prone to pull off frequently, because they can't get enough air through the
kinked airway.  So they do a few cycles of suck, swallow, breath, but then
when they *really* need air, they throw their head back to open the airway more.
What can help these babies pull off less is to get them latched on, then
instruct mother to tug on baby's diaper to move his bottom away from mom's body.
(If she just tries to move his leg, often the hip moves in its socket and the
baby's body itself does not move.)  By angling his body a little farther from
mom's body, this helps to keep baby's neck straighter so the trachea can
remain more open than it will if he is cuddled (bent) around mom's body as he lays
in her lap.  Although he may still need to pull off for air, it should happen
less frequently.
       If the baby makes louder "goose honk" noises, you may actually be
dealing with partially paralyzed vocal cords.  This condition ranges from not much
to worry about to potentially very serious.  One mother I worked with, when
on my suggestion she insisted her ped actually listen to her baby nurse, at
testing to determine the problem was told that it was a good thing she had gotten
baby in for testing.  His case was so severe that, if he got a cold, mother
needed to be sure to bring him straight to the ER because mucous would coat his
cords and he could die from lack of air.  Had she not known ahead of time,
the baby's first cold could have killed him.  Fortunately, the situation is not
usually so serious, but if baby is making "goose honk" noises, strongly
suggest that mom get this condition ruled out.
       Dee

Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA

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