The baby with the breathing problem could have laryngotracheal malacia.  It's
a congenital condition in which the tracheal rings are too flexible.  The
child has stridor when breathing (the noise is inspiratory, not expiratory as
in asthma).  Most cases are mild and the child outgrows it, but it can be more
severe.  There is a surgical technique used in severe cases in which the
collapsible tracheal rings are braced using cartilege from another area.  A
severe case could cause the baby to spend so much effort trying to coordinate
breathing and suckling that he/she could have problems feeding adequately.
The management plan suggested seems quite good--continue breastfeeding with
use of optimal positioning; pump to obtain hindmilk and give hindmilk to the
baby as a supplement.  Spoon, cup, or eyedropper feeding might work to give
the supplement.

 If this is what the infant has, then the breastfeeding will be protective
against severe RSV infection; RSV (croup/bronchiolitis) could be a very
horribly severe problem in an infant with laryngotracheal malacia.  There is a
RSV immune globulin (Synergis) just made available for IM administration.
It's expensive and generally indicated for preemies and cardiac patients who
are at most risk from RSV, but this child might well qualify for RSV
prophylaxis.

Hope this helps.

Linda L. Shaw MD FAAP
Altoona PA