Annette Liebovitz asks for input in the case of a 3 month old with
laryngomalacia.
I didn't quite understand where the meds for gas came in, so I am
speculating here.  The number one source of air bubbles in the digestive
tract is swallowing air when crying.  A baby with laryngomalacia may be more
distressed than other babies during feeds, and thus swallowing more air,
leading to more distress from the resultant gas pains.

Therefore, a strategy to make feeding more pleasant would seem to be the
best choice.  Sometimes side lying works fine, and other babies need to be
more upright in order to avoid being overwhelmed by milk flow that is hard
to coordinate breathing around.  You just have to try different positions.
Annette helped mother to find a position baby liked, he fed well and then
slept for the longest stretch in his life.  Sounds like they are already on
the trail to the solution.

It also sounds as though the docs advising this mother on how to handle the
problem (feed less, thicken feeds) are giving advice for suspected reflux,
not laryngomalacia.  I can't quite grasp what they expect to achieve by
bottle feeding expressed milk.  Except for the watch and wait part, I would
ignore those other suggestions and concentrate on positions that are
comfortable for the baby, both during breastfeeding and otherwise.  A lot of
these babies can not sleep on their backs either, because they simply can't
breathe in that position.  They get panicky and cry when placed supine if
the laryngomalacia is very pronounced.  

They will outgrow it, usually well before one year, and most babies show
gradual improvement along the way.

I was amused to see how fast this baby is growing.  The one baby I have seen
with laryngomalacia that even the pediatrician believed in, was the same
way.  Mother referred herself to our clinic because the baby had such
difficulty feeding, and problems breathing in the supine position.  She came
in with what looked like a baby that had been zapped with some kind of
growth enhancing radiation - a three month old the size of many one year
olds!  He was enormous and apparently thriving, despite having real problems
coordinating suck and swallow in most positions.

Rachel Myr
Kristiansand, Norway

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