Laryngomalacia is a common congenital condition affecting an infant’s airway. This condition occurs when the soft tissues of the voice box, or larynx, are floppy and collapse inward during inhalation, leading to noisy breathing known as stridor. While typically a benign condition that resolves on its own as an infant grows, often by 12 to 24 months of age, it can sometimes present challenges, particularly concerning feeding. Parents frequently seek guidance to ensure their infant can feed safely and effectively despite this condition.
Understanding Feeding Difficulties
Feeding can be challenging for infants with laryngomalacia. The floppy laryngeal cartilage can partially obstruct the airway during inhalation, leading to noisy breathing, or stridor. This is often noticeable during feeding, crying, or when the infant is lying on their back. The primary difficulty arises from the infant’s struggle to coordinate sucking, swallowing, and breathing.
This discoordination can manifest through several observable signs during feeds. Infants might exhibit coughing, choking, or gagging, indicating difficulty managing milk flow. Other signs include arching their back, prolonged feeding times, or excessive spitting up. Parents might also notice poor milk transfer, rapid breaths or pauses during feeding, nasal flaring, or signs of distress such as fussiness and sweating. Gastroesophageal reflux is frequently associated with laryngomalacia, which can further exacerbate feeding difficulties and airway irritation.
Practical Strategies for Feeding
Implementing specific feeding strategies can significantly improve comfort and safety for infants with laryngomalacia. Positioning the infant upright during feeds is a widely recommended approach, as gravity can help keep the airway open and reduce the collapse of laryngeal tissues. This can include holding the infant in a football hold, seated upright, or in a semi-reclined position. Maintaining a calm feeding environment also contributes to less agitated breathing and more effective feeding.
Pacing feeding sessions is another important strategy to prevent overwhelming the infant and allow them sufficient time to breathe. This involves offering frequent, shorter feeding sessions and incorporating breaks. Observing for signs of distress, such as increased stridor, gulping, coughing, or milk dripping from the mouth, indicates a need for a pause. If bottle-feeding, selecting an appropriate nipple flow is important; slower flow nipples are generally advisable to help the infant manage the milk flow without being overwhelmed.
For breastfeeding infants, managing the flow of breast milk can also be addressed through positioning. Laid-back breastfeeding, where the mother is reclined and the infant lies prone on top, can help manage a faster milk let-down. Upright nursing positions are also beneficial in these cases. If the initial milk flow is particularly strong, briefly pumping before nursing can help reduce the initial rush of milk, making it easier for the infant to coordinate sucking and swallowing.
Thickening feeds can be a strategy to improve swallowing and reduce aspiration, particularly if recommended by a medical professional. This approach should only be implemented under direct medical guidance. Frequent burping during and after feeds can also help reduce discomfort by minimizing swallowed air.
When to Seek Additional Support
While many infants with laryngomalacia experience mild symptoms that resolve over time, certain indicators suggest the need for additional medical support. Parents should contact their pediatrician or a specialist if their infant shows signs of poor weight gain or dehydration. Frequent choking episodes during feeds, or signs of respiratory distress such as increased work of breathing, chest or neck retractions, or pauses in breathing (apnea), warrant immediate attention. A bluish discoloration around the lips or skin (cyanosis) is another serious symptom that requires urgent medical evaluation.
Extreme fussiness or refusal to feed suggests the need for professional assessment. Recurrent aspiration pneumonia, resulting from food or liquid entering the lungs, is a significant concern that requires medical intervention. Medical professionals who can provide specialized support include pediatricians, ear, nose, and throat (ENT) specialists, speech-language pathologists (SLPs), and feeding therapists. These specialists can conduct comprehensive evaluations, such as flexible laryngoscopy or instrumental swallow studies, to assess swallowing. For severe cases, specialized feeding therapies or surgical intervention, such as supraglottoplasty, may be recommended to improve both feeding and breathing.