Any time an infant has a cardiac or respiratory issue that interferes 
with good oxygenation, feeding and particularly swallowing can be 
stressed. Babies need more oxygen during feeding to support the work of 
feeding (feeding is aerobic exercise). If the baby has difficulty 
meeting this oxygen need, there may not be sufficient energy to feed well.

Wolff Parkinson White syndrome is caused by the existence of extra 
tissue that passes signals to cause the ventricles to beat in addition 
to the atrioventricular node (AV node). The accessory pathway may 
conduct signals faster than the av node, or it may have a shorter 
refractory period (it may "recharge" faster). This can cause the 
ventricles (the large chambers of the heart) to beat much faster than is 
healthy, and often before they are optimally filled with blood. The 
result is usually low blood pressure, and low perfusion (ability of 
blood to get to all the cells to oxygenate them). This can cause 
exhaustion and dizziness in the baby, which also makes it difficult to feed.

Babies often compensate for cardiac inefficiency by breathing harder 
(increased effort of respiration) or faster (increased respiratory 
rate). Babies must close their airway for a fraction of a second in 
order to swallow. You can see how increasing the amount of breathing the 
baby needs to do reduces the time available for swallowing; and that 
swallowing will reduce the amount of breathing the baby is able to do. 
Healthy babies are well able to tolerate the respiratory pauses of 
breastfeeding, but ill babies given the choice between food and oxygen 
choose oxygen!

Now, when an ill baby is trying to sneak in a very quick swallow so he 
can go breathe again, the swallow is often stressed and imperfect. Lots 
of things need to move in order to swallow safely, and this coordination 
is harder when you are trying to do it in a hurry. So rapid heart and 
respiratory rates also degrade skillful swallowing.

Ways to support babies with these issues include ultra frequent short 
breast feeds (giving baby unlimited access to the breast by skin to skin 
carrying (slings work well to support the baby), having mom recline 
during feeding so baby is prone and "uphill" and can allow milk to fall 
out of his mouth as needed, and making sure mom does not hold baby's 
head to the breast so he can let go in mid flow. A little more head 
extension than usual can also make breathing easier (like people throw 
their head back when they chug a drink).

Bottles are unlikely to be easier for the baby. Some babies with cardiac 
issues do better with supplementary oxygen during feedings (by nasal 
cannula).

And they often get better at coordinating swallowing and breathing with 
practice, even if their physical condition remains challenging.

Catherine Watson Genna, BS, IBCLC  NYC

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