When babies are agitated and miserable about feeding it is often from a 
swallowing disorder. How about a videoflouroscopic swallowing study for 
this baby?
You don't mention anything about his coordination of swallowing and 
breathing. Low tech things that can be done include cervical 
auscultation (put a stethescope under his chin or on his neck to listen 
to his swallow. Listen for delays in swallowing, gurgly/bubbly sounds 
that mean that the pharynx is not clearing (incomplete swallow), stridor 
that means either penetration (milk coming into the area of the vocal 
folds suddenly) or narrowing of the airway; or increasing congestion 
that means that milk is getting into either the nasopharynx or 
hypopharynx. Lousy swallowing can be from poor bolus control due to a 
tongue tie, or structural issues, or functional/neurological issues. 
Many of these are genetic.

Noisy rapid breathing after a few sucks means a cardiorespirtory 
inefficiency. Panting is a severe sign, often babies with undiagnosed 
cardiac problems pant after a suck or two.

Also assess for color changes, especially around the lips and in the 
hands and feet. A healthy baby remains pink during feeding.

Look at the baby's fingers. Sometimes slight differences in the hand 
goes along with cardiac malformations.

Once we have some idea what's happening, we can sometimes figure out 
ways to help. Certainly helping the baby control the flow of the feeding 
is one place to start.
Catherine Watson Genna, IBCLC  NYC

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