Have to jump in here because of my own experience with my own problem child.  Would strongly recommend this mom see a pediatric ENT (ear/nose/throat doc or otolaryngologist) for an airway evaluation.  I think that any of the ENTs at my institution would want to scope (flexible nasal scope in the office and likely direct scope under anesthesia in the OR) any baby with this type of presentation to rule out an airway anomaly.

We took my son in to see one when he was about 6 months old after Cathy GW (thanks again, you rock!) found after using cervical auscultation that his SSB sequencing was not very coordinated and that he was having stridor with many swallows.  I persuaded the ENT to do a frenulectomy for his very mild posterior tongue tie and that helped somewhat.  When he transitioned from bottle to cup drinking at around 15 months though, it became obvious that he struggled with thin liquids.  He also developed a chronic cough at that point, coinciding with my stopping pumping and him no longer getting breastmilk in a bottle (wouldn't drink it from a cup, but only from me or a certain bottle/nipple).  My kid also had persistent episodes of significant apnea/bradycardia until 5 months, spit up a TON until he was 18 months old, was treated repeatedly for GERD and was evaluated for EE.

He was finally diagnosed at nearly 3 yo, after a second direct laryngoscopy/bronchoscopy, with a 1a laryngeal cleft.  From what I understand, this is a somewhat rare but under-diagnosed condition, with a typical presentation of feeding intolerance.  And with a variety of approaches for treatment -- thickening fluids considered the most conservative approach, followed by NGT feeding, laryngeal injections to bulk up the area, or surgical repair depending on the surgeon's experience and expertise.

Just one other kind of "zebra" to consider in an otherwise-normal kiddo with feeding difficulties.  Fortunately for us, though, we succeeded in continuing to breastfeed -- against the advice of many docs who questioned whether it was safe -- and he's now talking about wanting to teach his little brother, expected delivery in 2 months, how to nurse since he fancies himself quite the expert in this area.

Good luck to this mom, 
Sarah Reece-Stremtan M.D. (pediatric anesthesiology fellow in Washington DC)

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