I agree with everything Lisa Marasco said about the etiology of stridor,
bubble palate formed by the tongue-tie, etc.  As far as managing, while the
conventional wisdom says not to nurse babies with trachiomalasia or
laryngealmlasia in side-lying, that is the position I have most success
with.  I think it's because it allows the baby to maintain the hyperextended
head position that most protects the airways.  You may have to allow
frequent pauses (what I describe as "run a lap, walk a lap" feeding) because
fatigue aspiration is a big risk with these babies.  Releasing the
tongue-tie would be a good thing.  Remember also, the Japanese literature
identifies tongue-tie as a potential marker for laryngeal anomalies, so
doing some looking at the baby's swallowing would be a very wise thing to
do.  I support the quick use of an NG tube under the circumstances.  If the
baby winds up needing supplementations, paced bottle feeding should
certainly be employed to help prevent aspiration.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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