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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