Many babies with laryngomalacia can breastfeed with their heads extended
strongly to reduce upper airway resistence.  Mom can recline a bit to
allow milk to fall to the front of the baby's mouth to give her a few
extra microseconds to organize a bolus for safe swallowing.

Too bad the videofloroscopic swallowing study was not done while the
baby was breastfeeding.  A little barium can be placed on moms nipple,
which mixes with the milk that is ejected, and can be followed the same
way the thinned formula is on the xray.  This would tell us if
conditions can be made safe for this baby to breastfeed.

80% of babies with laryngomalacia also have reflux, because the
increased work of breathing leads to increased intrathoracic pressure,
which puts pressure on the lower esophageal sphincter, which makes it
leak.  Some babies aspirate milk on the way down (during swallowing),
others on the way back up (during reflux), so it is important to
distinguish between the two.

It does sound like this baby needs to be tube fed as things now stand.
If the mom is not comfortable with the doctor's dismissal of surgery for
the laryngomalacia, she can always get a second opinion.
Catherine Watson Genna, BS, IBCLC   NYC

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