Incoordination of sucking, swallowing, and breathing as an etiology for breastfeeding difficulty

This case report describes an infant who presented with coughing and choking during breastfeeding. Comprehensive clinical evaluation of these difficulties included assessment of sucking, swallowing, and breathing. Stridor and difficulty interspersing breaths during sucking bursts were observed, although sucking mechanics were normal. Further evaluation of airway structure revealed asymmetric laryngomalacia. This structural problem, exacerbated by the breastfeeding position, impeded respiration and resulted in poor coordination of sucking, swallowing, and breathing. This case underscores the need to include respiratory function and coordination in the evaluation of breastfeeding difficulties.