Some Japanese docs have found an association between ankyloglossia
(tongue-tie) and a malformed airway.  I have not found anything
published in the US literature, but the Japanese article is in English
and has wonderful color photos.
Mukai, S et al; Ankyloglossia with Deviation of the Epiglottis and
Larynx.  Ann Otil Rhinol Laryngol 100:1991. p 3-20.

Tongue tie is considered a midline defect.  So is laryngomalacia.  Often
babies with one midline defect have others, so we should not be
surprised if this infant also has some structural defect of the airway.

Things that can help a micrognathic baby with tongue tie and stridor
breastfeed:
Use an extreme asymmetric latch with as much head extension as possible
(sidelying often gives the greatest head extenstion if baby is flat on
the mattress and moved downward toward mom's feet a bit, so he needs to
reach "up" to the breast.  Allow the baby short, frequent feeds.  Try a
newborn nipple shield rather than the small, as the tiny teat of the
small may be difficult for the tight tongue to grasp.  (If the baby
can't take more than the teat in the mouth, then the small is the
correct choice).  Keep baby's tummy pulled in to mom's hip if using a
transitional hold to maintain strong head extension to reduce stridor by
maximizing the airway.  The same can be done in sidelying by mom
pressing against the baby's thoracic spine (midback) to keep him close
to her and his head extended.

Keep us posted on this little one. I'm glad the doc is paying attention.
  I see too many kids with laryngomalacia or tracheomalacia who are not
diagnosed until they see the LC, even if the parents complain about the
stridor.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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