The baby described has multiple issues and more than just laryngomalacia needs to be managed. But speaking just about laryngomalacia (and a bit about reflux)... I know the books all say nurse in upright positions, but you could experiment with side-lying with a very extended head position. I've had good results with this. The excellent postural support provided by a firm mattress helps increase the stability for feeding. Placing the baby in an extended, open body position prevents increased abdominal pressure resulting from being flexed across the tummy or having the diaper waistband jammed into the gut. This helps prevent reflux episodes from occuring during the feeding. The open throat position facilitated by an extended head position helps the baby maintain the structural stability of the throat and facilitates better, SAFER, breathing and swallowing. I think the baby feels more in control and not so worried about being overwhelmed. It may even be that the lack of attention to pacing techniques is CAUSING some of the reflux behavior by causing too much chugging, choking, etc. When well supported, relieved of excessive abdominal pressure, and allowed to pull off and self-pace, babies with laryngomalacia can enjoy some breastfeeding. Whether they get enough to grow just breastfeeding needs verification by test weights and careful growth monitoring. Often refluxing babies self-limit their intake. And because this is a baby with really serious respiratory issues (collapsed lung!) it is wise to take it as a GIVEN that babies with respiratory compromise are not dependable feeders. Their respiratory disability compromises both their energy for feeding and makes them wary and defensive of rapid flow rates. They tend to fall asleep early into the feeds both as the result of low energy and as a strategy to get a "breather". Teaching pacing techniques for all the alternate methods of feeding are very important so that in trying to get food into the baby the parents don't create increasingly more serious feeding aversions. Tip: Mom can also harvest the hind milk (cream) with a good pump. The cream has a higher specific gravity, which makes it better for the reflux and may make it just slightly easier to swallow. Again, it is critical to deliver it with pacing techniques. I have quite a bit of video of paced bottle feeding which I've accumulated over the years and it is technique that is adaptable to cup or finger feeding. A final thought: Defects in the throat are, like clefts etc. considered to be mid-line defects. Mid-line defects can be part of syndromic clusters and there can be multiple things going wrong. This makes management of feeding extra complex. PLEASE NOTE NEW EMAIL ADDRESS: [log in to unmask] Barbara Wilson-Clay, BS, IBCLC Austin Lactation Associates LactNews Press www.lactnews.com *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html