Some of you may remember I asked for help last October for a baby diagnosed
with laryngomalacia and I had promised to update those who helped.

To recap:  baby was born at 38 weeks weighing 2100g to Indian Mom. Presented
at 7 weeks with low weight gain (2900g) and very severe breathing difficulty
(inspirational stridor, chest and neck indrawing). A breastfeeding
assessment revealed that she would go on and off the breast (suck, suck,
suck, gasp, gasp gasp) eventually pulling right off, turning limp and taking
several minutes to recover. She had been seen by several paediatricians and
an ENT specialist before being diagnosed with laryngomalacia.  ENT wanted
her to weigh 5 kg before he was prepared to anaesthetize her for exploratory
surgery. One paed had recommended formula supplements by bottle, mother had
been attempting to comply, but the only way she could get this down the baby
was by tipping her horizontal and dropper-feeding, forcing her to swallow or
drown, and baby was coughing, spluttering and becoming frantic.  She was
also receiving extra water on the advice of granny.

I received an unbelievable amount of help and info from many of you, for
which I am so grateful. Most of you expressed concern that the baby might
have a cardiac defect, or some other anomaly and suggested urgent evaluation
of this possibility.  In fact the baby did subsequently have Xrays, ECG,
ECHO, and barium swallow and the diagnosis did not change. In essence, I
recommended a return to very frequent, exclusive breastfeeding and keeping
the baby upright as much as possible to assist breathing.

It turns out that mom was able to achieve this, mainly because breastfeeding
was the *only* feeding method the baby would accept without fighting, and
the baby's weight gradually improved from an average daily gain of 10g/day
to 12.5, 15.5, 16.71 and 17.74g/day. At the last check-up at 5 months,
although she only weighed 4500g, she had more than doubled her birthweight.
Mom reports that, although small, the baby is bright and alert and smiles a
lot.  She has recently started taking small quantities of cereal twice a
day, but she still breastfeeds a lot in the day, sleeping longer at night.
The throat indrawing has gone, but there is still indrawing of the chest.
Her breathing is not quite so noisy and she has times when there is no sound
of breathing difficulty at all.  Her paediatrician has advised the parents
*not* to subject the baby to surgery in view of the fact that diagnosis is
still laryngomalacia and that symptoms are improving slightly.  Mom tells me
she intends to continue breastfeeding.

So this is just to update you and to THANK everyone who gave such valuable
opinions, educated me on what might be happening with this little one, and
reinforced my care plan.

Pamela Morrison IBCLC, Zimbabwe