Babies with laryngomalacia are at an increased risk of developing
gastroesophageal reflux, thought to occur as a result of the more negative
intrathoracic pressures necessary to overcome the inspiratory obstruction. This can cause
wide swings in intrathoracic and abdominal pressures that overcome the
antireflux barrier. They have a tendency to swallow air as they struggle to
regulate swallowing and breathing. Some babies feed better in a prone or semi-prone
position and may require a mechanism to pace the feeding. Some mothers find
that a nipple shield controls the fast flow of milk during let down or with a
very full breast. These babies should be held in an upright position for 30
minutes following feedings and not be fed lying down. They often sleep and
breathe better when prone.
Marsha Walker, RN, IBCLC
Weston, MA
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