The baby described has multiple issues and more than just laryngomalacia
needs to be managed. But speaking just about laryngomalacia (and a bit about
reflux)... I know the books all say nurse in upright positions, but you
could experiment with side-lying with a very extended head position.   I've
had good results with this.  The excellent postural support provided by a
firm mattress helps increase the stability for feeding.  Placing the baby in
an extended, open body position prevents increased abdominal pressure
resulting from being flexed across the tummy or having the diaper waistband
jammed into the gut.  This helps prevent reflux episodes from occuring
during the feeding.  The open throat position facilitated by an extended
head position helps the baby maintain the structural stability of the throat
and facilitates better, SAFER, breathing and swallowing. I think the baby
feels more in control and not so worried about being overwhelmed.  It may
even be that the lack of attention to pacing techniques is CAUSING some of
the reflux behavior by causing too much chugging, choking, etc.

  When well supported, relieved of excessive abdominal pressure, and allowed
to pull off and self-pace, babies with laryngomalacia can enjoy some
breastfeeding.  Whether they get enough to grow just breastfeeding needs
verification by test weights and careful growth monitoring. Often refluxing
babies self-limit their intake. And
because this is a baby with really serious respiratory issues (collapsed
lung!) it is wise to take it as a GIVEN that babies with respiratory
compromise are not dependable feeders.  Their respiratory disability
compromises both their energy for feeding and makes them wary and defensive
of rapid flow rates.  They tend to fall asleep early into the feeds both as
the result of low energy and as a strategy to get a "breather".  Teaching
pacing techniques for all the alternate methods of feeding are very
important so that in trying to get food into the baby the parents don't
create increasingly more serious feeding aversions.

Tip:  Mom can also harvest the hind milk (cream) with a good pump.  The
cream has a higher specific gravity, which makes it better for the reflux
and may make it just slightly easier to swallow. Again, it is critical to
deliver it with pacing techniques. I have quite a bit of video of paced
bottle feeding which I've accumulated over the years and it is technique
that is adaptable to cup or finger feeding.

A final thought:   Defects in the throat are, like clefts etc. considered to
be mid-line defects.  Mid-line defects can be part of syndromic clusters and
there can be multiple things going wrong.  This makes management of feeding
extra complex.

PLEASE NOTE NEW EMAIL ADDRESS:  [log in to unmask]

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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