Any time an infant has a cardiac or respiratory issue that interferes with good oxygenation, feeding and particularly swallowing can be stressed. Babies need more oxygen during feeding to support the work of feeding (feeding is aerobic exercise). If the baby has difficulty meeting this oxygen need, there may not be sufficient energy to feed well. Wolff Parkinson White syndrome is caused by the existence of extra tissue that passes signals to cause the ventricles to beat in addition to the atrioventricular node (AV node). The accessory pathway may conduct signals faster than the av node, or it may have a shorter refractory period (it may "recharge" faster). This can cause the ventricles (the large chambers of the heart) to beat much faster than is healthy, and often before they are optimally filled with blood. The result is usually low blood pressure, and low perfusion (ability of blood to get to all the cells to oxygenate them). This can cause exhaustion and dizziness in the baby, which also makes it difficult to feed. Babies often compensate for cardiac inefficiency by breathing harder (increased effort of respiration) or faster (increased respiratory rate). Babies must close their airway for a fraction of a second in order to swallow. You can see how increasing the amount of breathing the baby needs to do reduces the time available for swallowing; and that swallowing will reduce the amount of breathing the baby is able to do. Healthy babies are well able to tolerate the respiratory pauses of breastfeeding, but ill babies given the choice between food and oxygen choose oxygen! Now, when an ill baby is trying to sneak in a very quick swallow so he can go breathe again, the swallow is often stressed and imperfect. Lots of things need to move in order to swallow safely, and this coordination is harder when you are trying to do it in a hurry. So rapid heart and respiratory rates also degrade skillful swallowing. Ways to support babies with these issues include ultra frequent short breast feeds (giving baby unlimited access to the breast by skin to skin carrying (slings work well to support the baby), having mom recline during feeding so baby is prone and "uphill" and can allow milk to fall out of his mouth as needed, and making sure mom does not hold baby's head to the breast so he can let go in mid flow. A little more head extension than usual can also make breathing easier (like people throw their head back when they chug a drink). Bottles are unlikely to be easier for the baby. Some babies with cardiac issues do better with supplementary oxygen during feedings (by nasal cannula). And they often get better at coordinating swallowing and breathing with practice, even if their physical condition remains challenging. Catherine Watson Genna, BS, IBCLC NYC *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome