FEEDING DIFFICULTIES & LARYNGOMALACIA CASE STUDY

Laryngomalacia is a congenital disorder (babies are born with it), that usually resolves by 1 year of age. It generally involves soft/ “floppy” tissues above the vocal cords that causes partial blockage of the baby’s airway. Stridor is the main symptom of laryngomalacia, which is noisy breathing, but babies can also suffer from reflux (known as GERD, or  gastroesophageal reflux disorder).

Feeding difficulties, faltering growth, choking, apnea and aspiration may also occur. A dietitian can help with advice on growth monitoring, nutritional supplementation, appropriate foods and weaning modifications.

A baby girl recently presented to Alchemy in Motion to see the dietitian for advice on safe weaning foods for Laryngomalacia. She had a history of moderate stridor that seemed to be improving with age, but she still had a difficult time coordinating the suck swallow breath sequence needed for feeding. She had a medical history of multiple hospital admissions primarily due to chest infections.

The most recent blood tests and chest X ray were all normal, but the bronchoscopy showed signs of ongoing laryngomalacia. Fortunately, her weight was stable on the 50 th percentile since birth, due to mum persisting with liquid feeds and some purees introduced from around 6 months of age. Though investigations were normal, there was clinical suspicion of GERD. Increasing feed volume therefore was difficult.

The goal of nutritional management was to increase the variety of solids in the baby’s diet and ensure normal neurodevelopmental outcomes. Mum had already decided to formula feed and the type and feed volumes were recommended. She tolerated the formula well and after a specialised feed thickener was added to the evening bottles, showed no further signs of reflux or GERD. No reflux medication was required. The dietitian advised on how to introduce new textures and foods to the child in a safe and controlled manner. Further, due to a family history of allergic disease, the dietitian also discussed appropriate ways in which mum could introduce potential food allergens in a stepwise approach.

A plan was designed to introduce eggs, fish, dairy, wheat, sesame, crustacea (such as prawn, crab and lobster), peanut and tree nuts. Mum was also educated on signs of allergic reaction and advised to keep a food and symptom diary, watching for reactions for up to 72 hours after each new allergenic food was trialled. The focus was on good sources of iron rich foods that could be added in puree form to ensure that neurodevelopmental growth was not delayed as a result of the condition and associated feeding conditions.

As the baby’s condition improved with age, the dietitian continued to work closely with mum to monitor the child’s growth and development, and broaden the range of finger foods and family foods in the child’s diet. Mum felt supported and reassured and the child continued to do well.

If you require individualised support for your child during the weaning period, please contact our friendly admin staff to make an appointment with our dietitian.

 

References:
1. Simons JP, Greenberg LL, et al. Laryngomalacia and swallowing function in children. Laryngoscope. 2016 Feb;126(2):478-84. 2. Landry AM, Thompson DM. Laryngomalacia: disease presentation, spectrum, and management. Int JPediatr. 2012;2012:753526. 3. Ayari S, Aubertin G, et al. Management of laryngomalacia. Eur Ann Otorhinolaryngol Head Neck Dis. 2013 Feb;130(1):15-21. 4. Fattah HA, Gaafar AH, Mandour ZM. Laryngomalacia: Diagnosis and management. Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 2011;12(3):149-53. 5. Kusak B, Cichocka-Jarosz E, Jedynak-Wasowicz U, Lis G. Types of laryngomalacia in children: interrelationship between clinical course and comorbid conditions. Eur Arch Otorhinolaryngol. 2017 Mar;274(3):1577-1583.

Disclaimer: The World Health Organization (WHO)* has recommended that pregnant women and new mothers be informed of the benefits and superiority of breastfeeding, in particular, the fact that it provides the best nutrition and protection from illness for babies. Mothers should be given guidance on the preparation for and maintenance of lactation, with special emphasis on the importance of the well-balanced diet both during pregnancy and after delivery. Unnecessary introduction of partial bottle feeding or other foods and drinks should be discouraged since it will have a negative effect on breast-feeding. Similarly, mothers should be warned of the difficulty of reversing a decision not to breastfeed. Before advising a mother to use an infant formula, she should be advised of the social and financial implications of her decision. *See: International Code of Marketing of Breast Milk Substitutes, adopted by the World Health Assembly in Resolution WHA 34.22, May 1981.