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.