Wolf and Glass sometimes do swallowing studies on babies while
breastfeeding, and they find the results are more texture related than
delivery related.  Babies who have fatigue related aspiration late in a
feeding are more likely to do better at breast since they have more
control of the flow, and babies with respiratory problems usually do
better at breast for the same reason, but infants with neurologically
based swallowing difficulties may do just as poorly at breast.

I have worked with breastfed infants with swallowing issues, and helped
mom with management strategies to help babies with flow, but I have seen
feeding induced apnea (from mom's oversupply and fast flow), aspiration
(which is less dangerous when it is human milk), etc.

If baby has a problem with coordinating swallowing and breathing, we can
always start them at the freshly pumped breast for a minimal flow, and
let them start practicing that way.
Catherine Watson Genna, IBCLC  NYC

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