Laryngomalacia and breastfeeding

Laryngomalacia, also known as “floppy larynx”, is a congenital condition where tissues are softer around the voice box and collapse in, partially blocking the airway. These babies tend to present first with feeding difficulties, struggling to transfer milk, and as such, lactation consultants are among the first health professionals to notice it. It may not be until around 2 months that the characteristic squeaky breathing becomes a noticable pattern. I have seen this condition quite a bit in the last few years (and most likely missed this in my first few years of being an LC), I write this article to share my experience as I have found it difficult to find information on the internet that specifically pertains to how breastfeeding looks in these babies.

What to look for:

  • Squeaky noise when breathing in.
  • Noisy when feeding or during sleep or when lying on their backs.
  • Low weight gain.
  • Poor milk transfer (breast and/or bottle); lots of pauses when feeding; long inefficient feeds.
  • Spilling or choking or coming off the breast to breathe.
  • Mouth breathing (babies should breathe through their nose).
  • Pale skin.
  • Weakness eg. floppy arms.
  • Chest retractions – skin sucking in around ribcage eg tracheal tug – when the skin sucks in at the bottom of the neck, between the collar bones.
  • Reflux is common

Breastfeeding can be challenging for these babies, as they understandably prioritise breathing over feeding. They may seem stressed when breastfeeding, stop feeding before taking a full feed and struggle to gain weight. Some babies do better when feeding from a bottle, though others struggle with bottlefeeding too; taking a long time to feed and needing to pause often. Mothers benefit from support from an IBCLC experienced in this area. We have tools to assess milk transfer and can support you with a feeding plan. It can be helpful to do a 24 milk production assessment; weighing the baby before and after feeds for a day, to work out how much extra milk baby needs. Some mothers end up predominantly pumping their milk for their baby. Though, some babies will gain enough weight with smaller, very frequent feeds. Upright positioning or any position that ensures the babies neck is extended (to open the airway) is often better in these babies.

It is important to see a doctor for diagnosis. A GP will likely refer to an ENT (ear, nose, throat) doctor. Most babies improve with time, the condition is usually outgrown during the first year of life. For babies with mild to moderate laryngomalacia, treatment is usually to wait and watch, weighing baby regularly to ensure the baby is taking enough milk to thrive, though I have worked with a few babies with severe laryngomalacia who needed to be hospitalised or have surgery.

Have you breastfed a baby with laryngomalacia? Please feel free to leave a comment below to share your breastfeeding journey so that other mothers may benefit from your experience.

3 thoughts on “Laryngomalacia and breastfeeding”

  1. Jane Daly shares her experience of breastfeeding a baby with laryngomalacia here:
    “My baby coughed and seemed to choke and had what is called “inspiratory stridor” which is a whistle sound when gasping for air. The doctors suspected laryngomalacia and we had to have some swallow assessments with a speech pathologist at the hospital and see an ENT for assessment. I had a strong let down too so had to feed lying down or pump a little first before a feed with a haaka so the strong let down wouldn’t be so hard for him. We were advised to try expressing milk and adding a thickener but I couldn’t pump and my baby wouldn’t take a bottle so we managed to keep breastfeeding with care and still going at 16 months. He grew out of it and it got better with time. We had to add thickener to his water when he started drinking water and gradually reduce it.

    As well as laying down to feed I also offered frequent and flexible breastfeeds to my baby to take the pressure off any one feed. He gained weight well and there were never any concerns about his weight gain. I wouldn’t wait until he cried out for a feed, I would just offer the breast every so often and see if he wanted a little feed. I did this all day long. I took a picnic rug in the bottom of the pram and found a grassy spot to feed him on walks laying down on the ground. He struggled the most feeding in my arms so I avoided that. Laying down for every feed wasn’t always convenient but I managed to do it. I even put my picnic blanket on the carpet in baby change rooms and would lay on the floor to feed him there. At home it would be in bed or on a floor mat. Now he’s 16 months and he can feed in any position.


  2. Thanks for the article. I have a 3month old. She’s been diagnosed by a paediatrician and on reflux medication. It really helps with her ability to feed and her general well being. I am mostly pumping and she drinks from the bottle well. We still try and get a couple of breast feeds in each day for the connection which she loves. She often falls asleep at the breast before getting enough milk so the bottle feeds are important. My son was also diagnosed (he’s now 4) and I only breastfed him initially. He had too many dry nappies at around 4 months and I tried to pump and realised I had no milk left. I think this was because he wasn’t able to suck hard enough or long enough to maintain supply.
    This time round I am using a nipple shield when breastfeeding as my daughter has trouble keeping a latch which causes me nipple damage.
    Pumping is working well for us atm. Hopefully i can maintain it!


    1. Thanks for sharing your story Lisa – wow I can’t belileve you had two babies with laryngomalacia! Well done for all the pumping efforts!


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