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.
- Rapid breaths or long pauses when feeding
- Nasal flaring
- Baby looks stressed when feeding (frowning, splayed fingers) or looks fatigued (closes eyes quite soon into the feed)
- Poor milk transfer (breast and/or bottle); long inefficient feeds
- Low weight gain
- Spilling, coughing or coming off the breast to breathe
- Mouth breathing (babies should breathe through their nose)
- 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. 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 babies will gain enough weight with smaller, very frequent feeds. Mothers may resort to predominantly pumping their milk for their baby – some babies improve their weight gains with bottlefeeding, though it can be equally challenging for some babies to bottlefeed. Baby may still take a long time to feed and need to pause often on the bottle.
Upright positioning, laid-back breastfeeding (mum laid back and baby lying on top) or any position that ensures the baby’s neck is extended (to open the airway) is often better in these babies. As much as possible keep baby calm. An activated nervous system (fight or flight) will speed up breathing which negatively impacts feeding. Babies with laryngomalacia may also have other issues that are contributing to breastfeeding difficulty and discomfort eg tongue tie, birth trauma, and cranial nerve dysfunction so consider bodywork like craniosacral therapy alongside lactation support to optimise feeding and decrease stress and body tensions. Reflux is often associated with cows’ milk protein intolerance so seek support if you think this might be relevant for your baby.
It is important to see a doctor for diagnosis of laryngomalacia. 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. I have worked with a few babies with severe laryngomalacia who needed to be hospitalised or have surgery.
If you know or suspect your baby has laryngomalacia and would like breastfeeding support, contact me to book an appt. Online appts via zoom are available if you are not in Perth.
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.
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.
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!
Thanks for sharing your story Lisa – wow I can’t belileve you had two babies with laryngomalacia! Well done for all the pumping efforts!
My baby diagnosed with laryngomalacia around 5th week noticed.
This type of health issues baby will Suck the bottle nipple or mother nipple in faster way pumping. It’s common. Another symptom noticed that, while laying down or when detach from drinking bottle makes a noisy. This noisy comes from larynx (sound box). In order to reduce this take on your shoulder lap with upright position and walk in bright light or medium and light wind. Outside environment. This will help to calm down and then they will sleep.
Another way, baby will cry like anything in high pitch.. generally what happen acid reflux will take place. So what happen this will feel burning sensation at the larynx tissue level. Hence they cry. This lead to high pitch sound… to avoid and bring down calm once again take on your shoulder in upright position and walk…for 20 min. During this time. Baby will do noisy and scream. Try to burp it. Then after 20 min use reflux medicine like collacaid use 0.5ml. This will reduce acid around the sound box it takes 1 min to 2 min to bring calm then lay down on the swing bed…do swing either horizontal way or vertical way, in this case they will come down quickly and fall in sleep…this is proved practically.