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).
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. Many mothers end up predominantly pumping their milk for their baby. Though, a few 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.
Cranio is a holistic, gentle treatment that supports the nervous system to down-regulate, which triggers the body’s own self-healing mechanism. Because it is so gentle, it is perfect to use with babies. Plus babies systems are so potent and ready to shift easily back to balance – some just need a little cranio support.
Because cranio is not well known, parents may not know the kinds of things that cranio is good at addressing. Here are the top six issues I see in my cranio/lactation practice:
1. Your baby had significant bruising around their head after birth
Some babies complete their birth journey looking pretty beat up!
Check out the squashed nose and facial asymmetry on this little bub, I had the pleasure to treat. He was not able to latch onto the breast without a shield and had issues transferring milk (before cranio).
And that bruise on his head -ouch!
If after birth, your baby had significant bruising, forceps marks, chignon from vacuum extraction, a cephalohematoma or other abnormal head shape, it is a sign that baby has undergone some difficulty during birth and would benefit from cranio. Hospital staff are used to these kinds of injuries and often dismiss it, knowing that superficially these marks do disappear over the following weeks to months. But there can still be underlying physical and emotional tensions that are not yet integrated. These stress imprints remain in the tissues in obvious and less obvious ways. Babies may be very sensitive to touch on their head and may react strongly to clothes being pulled over their head. Other infant interventions like suctioning or fetal scalp monitors may also impact the tissues, in less obvious ways but may still be held in the system.
Cranio can find these holding patterns in the body and facilitate their system to gently release, leaving a sense of peace in the baby’s system.
2. Labour was prolonged or very fast
Babies have their own experience of birth, often linked to their mothers, but with their own unique pressures and stresses. If they have felt stuck for any reason or under a lot of pressure for a long amount of time this can influence their bodies, in particular the nervous system and the neck. They may have felt scared or panicked. If a prolonged labour ended up in emergency c-section then the baby may also feel disoriented, this can show as arching at the breast or pushing with the feet, the baby can feel stuck in the birth sequence of pushing from the uterine walls.
On the flip side, a fast birth may be a shock to the baby and can show up as activation in their nervous system.
Cranio acknowledges the birth experience and allows these physical and emotional tensions to release leading to happier well-adjusted babies.
3. You have been told your baby has a tongue tie
There is much controversy around tongue tie recently. Research is lacking around posterior tongue ties and lip ties, but that doesn’t mean they don’t exist. It helps to have bodywork before undergoing a tongue tie release. Cranio is a form of bodywork that can address other issues that may mimic the symptoms of tongue tie such as, cranial nerve dysfunction, tight fascia or general nervous system activation. If a couple of cranio treatments improves breastfeeding then the tongue tie procedure may be avoided; if it doesn’t, then the parent can feel confident that the procedure is necessary. It is also recommended to schedule a cranio treatment within 48 hrs of the tongue tie release, to optimise function and to reset the nervous system.
4. Your newborn has difficulty latching to the breast
Newborn babies have natural instincts to latch themselves to the breast after birth, if they can’t then there is usually a good reason for it. Often the mum feels like she is doing something wrong, but it is actually because the baby is in pain, tense, stressed or medicated from birth. Perhaps there is a tongue tie or tight jaw muscles? Cranial nerve function can be impeded due to compression of cranial bones which can affect tongue function and sensation. The earlier cranio treatment is given the better in these circumstances.
5. Your baby cries a lot
Babies cry to communicate and once that need is met usually stop crying. If your baby cries inconsolably or with a high pitch then they may need some cranio support. Some babies have musculoskeletal pain or discomfort from birth. Others have a strong need to tell their birth story through memory crying. I have successfully treated babies who have cried excessively since birth. Cranio provides deep listening as well as addressing any physical tensions and may help get to the root cause of their suffering.
6. Baby has a head preference/torticollis or breastfeeding is painful on one side
This gorgeous little guy needed a few cranio sessions for torticollis that was affecting latch at the breast and also causing him discomfort.
Babies with a stiff neck tend to have trouble with positioning and latch. Tight inutero environments and/or asynclitic positions during birth may impact the neck/shoulders and jaw and other parts of the body. This can cause breastfeeding difficulties which tend to be slow to resolve on their own. Cranio helps the body let go of these restrictions and then breastfeeding often becomes easier.
Birth is a formative experience. Its impact is imprinted in the tissues of the body and can influence the health and wellbeing of the person from infant to adulthood. Early cranio treatment can prevent future difficulties such as headaches, anxiety and more.
As the twig is bent, so grows the tree
Often an hour or so of skin to skin after birth helps the mum and baby to integrate the birth experience and let go of any held tensions; sometime this doesn’t happen, sometimes it does – but bub needs more support.
Occasionally I am asked to do an antenatal breastfeeding consult. This is a great idea for all women planning to breastfeed, but particularly for mothers having subsequent babies with a history of difficult breastfeeding issues; those that did not breastfeed for as long as they had planned. There is also a huge benefit of this personalised care for women with specific medical problems who suspect there may be supply issues, Having the right information and resources up front can help to optimise milk supply and breastfeeding success.
Forming a relationship with a lactation consultant beforehand makes it that bit easier to obtain help post-partum. Mums can be overwhelmed, exhausted and in pain and can be shocked to find out that there is not a lot of support within the system. This varies depending on place of birth or whether there is a free lactation clinic within the bounds of their locality. Child health nurses do their best but are often time poor and their breastfeeding education varies from individual to individual. Dads/ partners are often the ones to call private lactation consultants when they have reached a dead-end of support for their partners. For this reason it is often recommended that partners also attend breastfeeding education consults so they have the information and tips to provide support.
Having a basic understanding of the physiology of breastfeeding and what to expect from a breastfeeding newborn can make a huge difference to stress levels of new parents. Some private health funds do cover antenatal lactation consults. For a slightly cheaper option the Australian Breastfeeding Association does some great group classes on weekends – I used to teach these myself. Unfortunately you cannot rely on many hospital based breastfeeding classes – the information is minimal and sub par (please correct me if things have improved since I had kids).
If this sounds like it would be helpful, please get in touch to set yourself up for a smoother breastfeeding experience – $130 for 1.5hr consult.
My second son was super unsettled. I remember it being one of the most difficult seasons of my life; looking after a screaming, unhappy baby and a toddler. I became suspicious that something I was eating was causing his discomfort. Apart from the constant crying, the only other symptom he had was constant nasal congestion (and significant cradle cap) – no blood in the stools, no rashes. I was quickly dismissed by doctors; told its normal for babies to cry.
Now I know that it was cows’ milk protein that was the issue! I want to share my story as someone who tried and failed to cut dairy from my diet (as a breastfeeding mother) and continued to breastfeed my son for over 2 years. Also to share what worked to lessen symptoms for my son (who is now ten years old, still eats dairy and no longer suffers from chronic nasal congestion). I know this information is helpful to all the breastfeeding mothers and babies that I frequently work with who are navigating this path. There can be a temptation to wean to formula, but formula itself is derived from cows’ milk protein and special formulas are often expensive, taste terrible and may be hard to access.
Cows’ milk allergy (CMA) is taken more seriously by doctors, than cows’ milk protein intolerance (CMPI). CMPI causes discomfort and often the baby is reported to be “thriving” because they are gaining weight. Whereas, CMA has more serious consequences (eg low infant weight gain, skin rashes, hives). And what about lactose intolerance? Is that an issue in babies? Lactose is the sugar component of milk. It is plentiful in human milk too. Eliminating lactose from the diet will not eliminate lactose from breastmilk. It is very rare for babies to have primary lactose intolerance, it’s often not the lactose that’s the problem, but the protein (casein, whey).
There is a lot of misinformation and confusion, even among health professionals. Amidst this confusion, parents of babies with CMPI are unsupported by the medical system. The burden lies with the mother who suffers through those precious early days, her heart breaking over not being able to help her unhappy baby and often no one in the family getting much sleep. In my case, health professionals were quick to offer me treatment in the form of antidepressants, which I refused. With a background in mental health nursing, I knew it was a situational crisis – the answer lay in finding the root cause of my son’s discomfort (and now it’s a passion of mine to encourage all mothers to do this!).
When he was a few weeks old, I decided to trial cutting out dairy from my diet and failed miserably! I normally eat like a bird, so reducing a major food group left me feeling more tired, stressed and miserable than I was already (and hungry!). I would do fine for days then demolish a large bar of chocolate – feeling really guilty. I really craved my morning cup of tea (with milk). I do feel I am strong willed by nature, but not in this department. Joy Anderson* (Dietitian and IBCLC) who specialised in this area, makes mention that the more addicted you are to a food, the more likely it is to be the offending substance.
Time passed and the intensity of those first few months faded as his attention was directed more at the outside world and less on internal sensations. Still the nasal congestion didn’t go – he was a really snotty kid with frequent ear infections (often babies will grow out of their food sensitivities, but my sons stuck around). I was told by another doctor that he had hayfever. It wasn’t an environmental sensitivity, it was food. My maternal gut instincts were confirmed, when at the age of six he told me “Mummy every time I drink milk, I get snotty”.
I am now reflecting on what has worked to reduce nasal congestion for my son over the years (he also found it unrealistic to give up dairy) as I currently implement this strategy in order to treat my dermatitis. If you are finding that dairy is contributing to your baby’s symptoms and are freaking out at the thought of giving it up. Here’s what I found in our case:
A2 milk is a lifesaver! My son may get a little bit snotty but he is able to clear it. I feel regular milk causes inflammation (aswell as mucus) that makes nasal passages difficult to clear. A2 milk has a protein that is better tolerated by those who are sensitive to A1 protein (found in most milk products).
Butter and cream are mostly fat, with a little bit of milk protein and may be tolerated.
Avoid processed foods with milk products in them (e.g. milk solids, skim milk powder).
Eat chocolate that is dairy free (e.g.dark chocolate or raw chocolate).
Cheese and yoghurt can be less troublesome for sensitive folk (with my son its hit and miss). The addition of enzymes (in cheese) and the fermentation process (in yoghurt) change the structure of the protein making it easier to digest for some.
Cutting out dairy for 2-3 weeks is often first line strategy for suspected cows milk sensitivity. For some mothers it is easy, for others its impossible. Some mothers may be able to get away with a low dairy intake.
*This is my story of my journey and what I have learnt along the way but it may not work for everyone. For more support there are dietitians who work with breastfeeding dyads who can provide individualised advice.
Please contact me if you suspect your baby has a cows milk sensitivity. As someone who has walked the path personally, and worked with lots of breastfeeding mothers with sensitive, unsettled babies, I can support you in working out the cause of your baby’s discomfort. Phone consults, clinic and home visits available.
After 4.5 years at Baby Steps Health Centre, I have made the decision to leave so that I can focus fully on building Flow Cranio & Lactation. I have thoroughly enjoyed my time working there and am grateful to the team for their support and expertise.
But all good things must come to an end.
If you first met me through Baby Steps please let your friends and family know to book me for lactation support through my business rather than the clinic.
If you, or your baby, have benefited from my lactation or cranio support – please tell your family or friends or other mothers at mothers group. Or consider writing a google or Facebook review.