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Subject:
From:
"Catherine Watson Genna, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 1 Aug 2004 14:53:05 -0400
Content-Type:
text/plain
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Tracheomalacia  is a softening of the cartilage rings of the windpipe.
When the baby breathes out, the Bernoulli effect causes the pressure
inside the trachea to be lower than that outside, and the weakened rings
collapse, narrowing the airway and making the baby work very hard to
breathe.  There will be a high pitched whistling sound when this
happens, which is called stridor. (Newborns with tracheomalacia may have
inspiratory stridor as well as expiratory, due to lower muscle tone.)

Feeding is aerobic exercise in infants.  Therefore anything that makes a
baby work harder to breathe leaves less respiratory reserve for
feeding.  Failure to thrive is common in infants with moderate to severe
airway malacias.

To help the baby feed, positions that minimize milk flow and maximize
head extension to reduce airway resistence are helpful.  Some babies
with malacias feed well in prone on mom's chest while she is reclining
or laying supine.  If effort of breathing is high, baby will probably
need short, frequent feeds to allow him to recharge his oxygen in
between.  If the baby cannot breatfeed, fingerfeeding in prone with a
slow flow device can be helpful until respiratory capacity improves.

Babies usually grow out of this condition by 6-18 months of age, and
sometimes pediatricians fail to take it seriously since it is
developmental.  Most of the time the baby can compensate, but if the
baby has feeding problems, everyone in the health care team should
cooperate to help.

Reflux is also very prevalent (80% risk) among babies with respiratory
malacias, because of the excess pressures they need to exert in order to
move air through their narrowed airways.
Catherine Watson Genna, IBCLC  NYC

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