I was hopping you would watch this video of my son eating and let me know what you think. He will be having a swallow study soon and I read in another post that you have been involved in many of theses.

The first part shows Sebastian doing this head shaking thing that he has recently started. He used to put his left ear to his shoulder and do a little spasm type thing. He does not do that much anymore but has started shaking his head. He does it most times when he eats and he will do it randomly throughout the day.
The second part is the "glurpy" nose he makes when swallowing. He does not do this all the time. Probably about 90% of the time. He only does it when eating solids not with the bottle.

You can not really hear it on the video, but he also gets very "rattly" sounding in his chest after he eats solids.

To view the video: click on the link and then click on "Sebastian Eating Video" on the top left corner.

http://katey.neptune.com (http://katey.neptune.com/)

I would really appreciate any feedback you could give me. I have not had a chance to show the video to my GI yet, but will at his next apt.

Hi Katey:

As you probably understand, it is difficult for me to evaluate your precious son Sebastian from a few seconds of video. However, I was able to observe some important things that I have questions about.

1. Does Sebastian have nasal congestion after he eats or does he sound “snorty?”
2. Does Sebastian have a history of frequent upper respiratory/ear infections?
3. You mentioned he does not have problems with his bottles. Are they thickened with cereal or a commercial thickener?
4. Was this segment filmed at the beginning, middle, or towards the end of a feeding?
5. Is he eating stage # 2 foods only or has he progressed to # 3 and table foods? Do you thicken his purees with cereal?
6. Does he receive breathing treatments? If he does, do you see improvement with his respiratory status or is there no change at all?

Some of the mannerisms you describe could be reactions to food going into the wrong places. Specifically, your physician is ordering a modified barium swallow study to rule out aspiration, or when food enters the trachea (windpipe) and goes into the lungs. An uncoordinated swallow can also cause food to go up into the nasopharynx, or nasal sinus. We call this nasopharyngeal reflux. Both nasopharyngeal reflux and aspiration do not feel good! You have had milk go up your nose or liquid/food “go down the wrong pipe” as we say. That is typically when we see little ones exhibit these mannerisms such as head shaking, crying, or refusing to eat.

I cannot say for sure that Sebastian is aspirating from the film segment I observed, however, I did notice a couple of things. Sebastian did clear his throat a few times in between bites of food. This can indicate that a child is experiencing reflux, pooling food or liquid over the airway, or aspirating. I also heard the high-pitched squeaky sound, which would go a long with what I just mentioned. I also observed that he was increasingly congested towards the end of the segment. My question to you is does he typically clear out after 15-20 minutes after a meal, or does he remain congested for some time?

I think you are smart to take Sebastian for a MBS study. It may just be an uncoordinated swallow that can be addressed with rehabilitation techniques from an OT or speech therapist. If it is aspiration, typically foods and liquids are thickened to a safe consistency to help protect the airway and strengthen the over 50 muscles we use to swallow with. Hope this helps! Please write back.

Robynne

Thank you so much for taking the time to watch the video and for responding. In response to your questions:

1. Does Sebastian have nasal congestion after he eats or does he sound "snorty?" Sebastian has had a lot of nasal congestion since he was born. In the beginning they said that it was mucus from birth that he had to clear, and now when I bring it up to the ped he says he has a bit of a cold. It clears off and on during the day, so I always assumed it was a reflux thing.

2. Does Sebastian have a history of frequent upper respiratory/ear infections? No, we have been really lucky. He has never been sick at all. He had one nasty cold that lasted about a week, but that has been it. He has never had a fever or been on an antibiotic.


3. You mentioned he does not have problems with his bottles. Are they thickened with cereal or a commercial thickener? No, I tried thicken when he was about three months old and he hatted it. He would fight the bottle more and only take an ounce or so. I gave up after about a week.


4. Was this segment filmed at the beginning, middle, or towards the end of a feeding? The first part where he does a lot of head shaking was right about the middle of his dinner. After that he went on to eat about another ½ jar of second foods. The second part was towards the end of breakfast. He does not eat a lot at a time so an average meal lasts about 7-10 min.

5. Is he eating stage # 2 foods only or has he progressed to # 3 and table foods? He has had a lot of problems tolerating new foods. I have not been able to get him to eat anything new since he was five months. He currently only eats: Bananas, Carrots, Pears, Squash, and Oatmeal. For that reason I have not tried any of the stage 3 as they all have foods he does not eat in them. As for table foods, I have only given him soft cooked carrots and bananas and he mostly just plays with them and squishes them up. He will put a little it in his mouth, but not really eat it. He will not let me put bites in him mouth. The few times he has swallowed it he chokes and gags and twice he threw up with in a few min on eating tinny pices of food he got of the kitchen floor. Do you thicken his purees with cereal? No, I recently reintroduced rice cereal and I mixed it with his pears, because it made him a bit constipated in the past. He at it really well a few times, but now he wont touch it. normally he eats about a 1/4 cup of oatmeal and a ½ - 1 jar of second food. For breakfast and dinner. I have been trying to add a lunch, but he usually refuses it and only wants the bottle.


6. Does he receive breathing treatments? If he does, do you see improvement with his respiratory status or is there no change at all? He has never had any breathing treatments.


My question to you is does he typically clear out after 15-20 minutes after a meal, or does he remain congested for some time? I have not really paid attention to how long it lasts. I don’t think it lasts longer then ½ an hour or so. He gets "rattly" sounding off and on through out the day. I always notice it after eating solids, but as I said he only eats breakfast 7:30 am and dinner 4:30 pm. I will notice it often after a bottle, but sometimes he will just be playing and get really ‘rattly’ sounding for a half hour or so and then it will go away.

Thank you so much for your help. I know it does not replace a consultation with you in ‘real life’, but it is nice to have an idea of what could be going on and what my options are.

Katey:

One thing I failed to mention is that some degree of aspiration is normal. Everyone aspirates occasionally. Our normal response as adults is to cough the aspirated food or liquid out of our trachea as soon as it happens. We then spend the next 15 minutes clearing our throat to get the rest out. Our little ones, however, can silently aspirate too. This means they can aspirate without a coughing response. Sometimes they get a "deer in the headlights" look, their eyes water, they sound like they are breathing in deeply, and they often sound like Darth Vader after a feeding. Our silent aspiraters get better with time and neurological maturity. If Sebastian has been aspirating, he has definitely been protecting his airway, which is fantastic. Again, he may just have an incoordinated swallow. He definitely is texture sensitive like many of our reflux kiddos. Keep him on his medications until he transitions through his food textures. Please let me know the results!

Robynne