Jessica writes:
I would like some informal feedback on any of you working with babies with
Laryngomalacia. Did they all breastfeed? Did any look like they were
feeding, but somehow not transferring normal amounts of milk? Did they need
supplement? How was breathing during the feed? Was it always bad, or only
towards the end?
Any information will be helpful. I am just trying to get a range here. I
have had three babies with poor milk transfer +/- 15 cc, copious milk
supply and an ENT who felt this may be a suction strength issue more than a
breathing issue- but then another doc who thought that made no sense.
~~
Hi Jessica, and all,
`It's good you are looking for a range because that is exactly what I've
noted over the years. Some babies are fine until they start to fatigue and
then the narrowed airway sounds kick in. Others its very mild and mom only
hears it if baby if flat on their back. Some babies have trouble feeding,
fatigue very rapidly, have loud uncontrolled swallows with less than adequate
transfer, others are loud, but can make it through the feeding if mom leans
way back, and latch is optimized, but may need to feed more frequently (
sometimes every hour or so) to get what they need. If their WOB ( work of
breathing) is high, they are almost burning as they are eating it seems, so
they need a mom to have a lot of patience. Skin-to-skin can help because it
means they are more homeostatically stable and have to expend less energy
on other things and can devote it to feeding and growth and development.
I've seen babies able to breastfeed and grow well. Some are totally
overwhelmed by bottles, even slow ones. Other can't get enough without the
off-breast assist. It can also help moms to know that babies who feed adequately,
and keep a nice pink color, just need time and patience. I personally have
not worked with a baby who became cyanotic, or needed corrective surgery
though they exist of course. It also helps moms to know that that sternal
retraction they see may be mild or not, and the sounds often get louder after
the first few weeks as breath power increases, but it doesn't mean the baby
is getting worse. I've heard moms say their baby sounds like a seal or a
dolphin, they are often relieved to know what that sound is and what it
means. I work with a lot of doctors who tell the parents "oh all babies are
noisy, it's nothing, don't worry about it" but of course they do because they
are not stupid. They see their babies struggling and are usually glad to get
to understand why and have some strategies for helping them. Also these
"malacia" issues are often in constellation with frenulum restrictions, high
palate, reflux, and other midline issues, I notice.
Hope that's helpful.
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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