This baby could possibly have some deficiency of the airway.
Laryngomalacia is often missed because baby seems fine when not
stressed, but when he nurses he has suprasternal retractions and stridor
(that whooping sound when the baby breathes in), particularly after
swallowing.  This condition is a weakness of the cartilages of the
larynx, making the baby work hard to keep the airway open.  The baby may
also turn dusky or bluish when crying.  When the baby is laid on the
back, the head is neutral on the neck.  Babies with laryngomalacia
breathe better with head extension (the head tipped back).  Mom can try
placing baby on his side, and gently extending his head.  She can also
put a folded blanket under his shoulders to tip his head back if he is
supine.
Another possibility is Pierre Robin sequence, or a very short mandible
with a long tongue.  When the baby is placed on the back, the tongue
falls into the airway and the baby has difficulty breathing.  Even a
moderately recessed mandible can make breathing more difficult for the
baby.  A baby with this problem may be safer on his belly.
The ENT should be able to pick up either of these problems.

Reflux is another issue.  If the baby's reflux is especially severe, he
could be aspirating some of the refluxate.  Treating the reflux with a
combination of medications,a nd altering the breastfeeding management to
provide lots of short frequent feeds, and holding baby upright or at a
45 degree angle should be helpful if this is the case.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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