Difficulty feeding and gasps or chokes during feeds. Baby’s skin between the ribs and in the neck is being sucked in with every breath. She would also suck for a few seconds, then gasp and just hold the nipple in her mouth along with the milk. Trouble gaining weight. Cannot tell if the stridor is present at rest, as the video starts when infant is already at breast and sucking. Stridor is an abnormal breathing sound that resembles wheezing or creaking. A couple of important points about stridor: While most parents get used to the sound of their baby’s stridor, it might cause concern in others. It is more common in children but can happen in anyone. This blog does not provide medical advice, diagnosis, or treatment. Upon examination, an inspiratory stridor was noted. Sign up to get new blog updates delivered to your email. My mentors have taught me that: The feedings started taking a very long time and by 4 weeks it would take an hour or two to take 2 ounces. Cystic Hygroma. I  describe what I hear,  in the setting of that infant’s/child’s unique history and comorbidities, and my ENT and neonatology friends tell me that helps them. Most children outgrow laryngomalacia by about 9-18 months old, once the tissue in the larynx has grown stiffer. She would eventually spit the milk out. When the nipple flow was too fast the milk obstructed his airway causing a high pitched whistling sound. I am also seeing a very shallow latch. Learn More », 3333 Burnet Avenue, Cincinnati, Ohio 45229-3026, © 2009-2020 Cincinnati Children's Hospital Medical Center. The obstruction typically worsens in the supine position as gravity pulls the tongue farther back.1 Micrognathia is a classic feature of Pierre-Robin syndrome (Figure 1), Treacher Collins syndrome and Hallermann-Streiff syndrome. Stridor present at rest often will be exacerbated with the aerobic demands of feeding, both at breast and bottle. The first 3 days of life were uneventful. Cannot see if there are suprasternal and/or supraclavicular refractions present at rest or, if they are seen, are they seen during feeding only. However, 15-20% of infants end up needing surgery. Laryngomalacia is a common condition that occurs when the tissue above the vocal cords is floppy and falls into the airway when a child breathes in, which causes noisy breathing (called stridor). Of course we don’t diagnose airway problems as SLPs. It is surprising  how often it can go apparently unnoticed so to speak prior to our noted concerns, despite worrisome or adverse effects on feeding (intake, co-occurring physiologic stress and apparent swallowing safety). I will be looking at fat pads and tethered oral tissues. Contrast that with stridor that occurs only during feeding. If a baby will require surgery to treat the laryngomalacia, we will usually know by the time the baby is about 12 months old—give or take a few months because each baby is different. Newborns tend to have an irregular breathing pattern that alternates between fast and slow, with occasional pauses. The stridor in the video sounded biphasic, suggesting a fixed airway obstruction (subglottic stenosis, paralyzed vocal cord(s)—as the airflow moves past a constant obstruction on inhalation and on exhalation – that leads to the biphasic stridor. The stridor itself is not the main cause for concern. Stridor may be exacerbated by crying or feeding. The first 3 days of life were uneventful. The stridor gets worse if the infant has an upper respiratory infection. Sorry, your blog cannot share posts by email. Upon examination, an inspiratory stridor was noted. A cystic hygroma is a collection of lymphatic sacs that contain clear, colorles… Most babies who have laryngomalacia start to show symptoms at or shortly after birth. Any process that causes airway narrowing can cause stridor. So much possibility for why we are hearing stridor. When do you hear it (asleep, awake)? Problem-Solving: A Feeding “Window” for NICU Infants? That may suggest either swallow-breathe incoordination, due to  the tendency to inhale after the swallow, or indeed attempts of the airway to close in a protective maneuver due to bolus mis-direction from above and/or below. Knowing more may assist with our problem-solving on the list serve, and as the SLP seeing the infant, inform a initial differential that allows the SLP to advocate from an informed perspective. Micrognathia. If your child has stridor that comes back, he or she may have trouble eating and drinking, and poor weight gain. Is there apparent mandibular hypoplasia that might be leading to an ineffective tongue-palate seal and poorly controlled bolus?