Ok, so let me preface this by saying I'm an occupational therapist who works in a specialty hospital where we wean people from mechanical ventilators daily, so I'm pretty well acquainted with the whole aspiration picture. That said, here's my dilemma:

I feel that my son is showing some signs of possible aspiration (or maybe penetration or pooling?) as he frequently has wet vocal quality after a bottle, sneezes every time I lay him down to change a diaper or his clothes, and every few nights I'll hear him reflux up into his throat and then he'll cough. While these symptoms have gotten slightly better with the increased Zantac dosage, they are still present. We have a laryngoscope scheduled Monday with the ENT to diagnose his laryngomalacia (I also think he has laryngopharyngeal reflux) and I've called to inquire about the possibility of bringing along a Speech Therapist friend to evaluate his swallowing and aspiration risk while we've already got the flexible scope in place. Now I'm beginning to wonder if I've turned into the neurotic mom that everyone thinks I have or if I'm justified in my concerns and an just taking control of the situation and trying to get my son what he needs since the doc's are so doggone pokey! After a while, though, you begin to question yourself after you hear everyone say "Oh, he's gaining weight and looks so healthy" or "Oh, listen to those cute squeaky noises he makes" It's all I can do to not say "Yes, listen to those cute squeaky noises he makes when his larynx collapses and he quits breathing momentarily. Aren't they adorable?" Ok, enough venting - main question is do you think I'm on the right track or am I just going to tick off my ENT?

By the way I moved this to the asthma and breathing issue board.


Yes, you are on the right track. I had dr after dr tell me carson was just fine when his bronchial washings showed he was aspirating food. Heck... he had e-coli in his lungs at one time (that was a 2 week hospital stay.) Carson has laryngo-tracheomalacia along w/ gerd, and at his worst when he ate he was rattling and needed suction and breathing treatments. I would ride the drs back and get the reflux under control at all cost! If you don't like one dr's view get a second oppinion, we fired several dr's.

I hope that helps.... I feel your pain! they would always make remarks about his cute squeeky sounds.

I definitely think you should investigate all of this. You know the risks of aspiration, I don't have to go there for you. Given the symptoms you describe, this certainly sounds like he is refluxing into the pharynx and pooling at the very least is occurring. I don't think you are out of line. In fact, I would push for a swallow study in this case as well. Good luck with the ENT. One thing, out of professional courtesy, you might call ahead and see if it's ok with the doc rather than just bringing along a "surprise consult." That might avoid ticking off your ENT.

I actually had called the ENTs office already this morning and inquired about the possibility of bringing along a personal speech therapist to complete a FEES while we are there. I'm still waiting to hear. I'm hoping they call back before we head to our 2 mos. appointment this afternoon. If they haven't, I guess I'll push for a modified barium swallow study and then if the ENT says it's ok, we'll have two tests instead of one, which is probably actually a more realistic clinical picture anyway since any one study is really only applicable for that particular moment in time it was performed. I'm fairly certain he doesn't aspirate all the time, so one test may be negative while the other one shows something. Thanks for the advice and support. :ird:

I think you have a great plan in place. I'm really not convinced that he's aspirating, just refluxing into the pharynx. I think you would have had some sort of pulmonary infection or at least multiple coughing episodes (not to mention nice gurgly breath sounds) by now if he were truly aspirating. I still think it is a good plan to investigate the whole situation. Good luck at you 2 mo checkup today! I forgot to ask, are you thickening his feedings (or breastfeeding, I can't remember)? If not, a little rice may help with the refluxing and decrease the likelihood of aspiration.

I actually wondered about that. I know with my patients that they usually have spiked a fever or have developed worsening lung sounds within 24 hours of aspirating. So far he's been healthy in that regard, so it may just be that he's got some pooling or penetration from his reflux vs. feedings. We are currently formula feeding with Nutramigen and have not thickened his formula any because I've had three different doctors tell me that there are new studies linking the introduction of rice cereal before 4 mos of age and an increased incidence of juvenile diabetes. We have some family history of diabetes already, so unless it's absolutely necessary to thicken his feedings, we're trying to avoid that. The GERD and laryngomalacia is plenty to deal with on their own :-)

Oh, I totally understand. We held off on the rice due to increased risk of developing allergies if introduced too soon. Brenna was already MSPI, so I didn't want to push it. We added rice at 5 months due to impending FTT. The Nutramigen was just so thin that she barfed 70% of everything she ate. I know Simply Thick and Thick-It have worked well for others and now come in easy-to-use packets. I think they are tapioca based, so probably have the same concerns, though.

I actually wondered about that. I know with my patients that they usually have spiked a fever or have developed worsening lung sounds within 24 hours of aspirating. So far he's been healthy in that regard, so it may just be that he's got some pooling or penetration from his reflux vs. feedings. We are currently formula feeding with Nutramigen and have not thickened his formula any because I've had three different doctors tell me that there are new studies linking the introduction of rice cereal before 4 mos of age and an increased incidence of juvenile diabetes. We have some family history of diabetes already, so unless it's absolutely necessary to thicken his feedings, we're trying to avoid that. The GERD and laryngomalacia is plenty to deal with on their own :-)


Where are those studies? That actually scares me bc both carson and wyatt had rice cereal to thicken their feedings at age 1-2 weeks per their drs. I would like to read up on that

Ang, try a Medline search.

I think you have a great plan in place. I'm really not convinced that he's aspirating, just refluxing into the pharynx. I think you would have had some sort of pulmonary infection or at least multiple coughing episodes (not to mention nice gurgly breath sounds) by now if he were truly aspirating. I still think it is a good plan to investigate the whole situation. Good luck at you 2 mo checkup today! I forgot to ask, are you thickening his feedings (or breastfeeding, I can't remember)? If not, a little rice may help with the refluxing and decrease the likelihood of aspiration.


Remember though aspirating cereal can do more damage than aspirating on formula alone.

I confess that I haven't actually looked for those studies, just took the docs at their word. One of them was a pediatric surgeon at the University of Kentucky Medical Center and he cited the study but there was enough going on that day that I confess it went in one ear and out the other. The Medline search should turn it up, though.

Myles doesn't seem to be throwing up or spitting up as much as he was prior, so I think his increased age has helped some with that despite the thinness of the Nutramigen. I'm hoping for a PPI added to his meds as I think that would best control the reflux at this point. We'll see what I can coerce the ped. into today. Hopefully we'll come home with a PPI and a GI referral. Oh, and the ENT office just called and said they'd paged the ENT - he's in surgery - to inquire about bringing in a speech therapist during his laryngoscopy. Being a pushy mom pays off sometimes :yahoo:

Good job!!!:drinkalot:

I just did a quick PubMed Medline search and couldn't come up with anything. Maybe it's a study being conducted at University of Kentucky currently and hasn't been published? All the docs that told us about it were in Lexington, so maybe it's just something going on here so far. I wouldn't stress out too much if your little one had thickened formulas. Diabetes, especially Type I juvenile, has a very strong genetic predisposition.

I wouldn't stress out too much if your little one had thickened formulas. Diabetes, especially Type I juvenile, has a very strong genetic predisposition.

Exactly, that's kind of like crying over spilled milk at this point. People have been adding rice to babies' bottles for generations. Fortunately, we don't have a strong history of diabetes in our family, but if we did, I would be concerned. Thanks for the heads up!

we actually do have a strong family history of diabetes though... it will just be something to watch for.

How are things going? Have you got any answers from the doctors yet? (hoping for good news??!!

The pediatrician continues to drag his feet because, naturally, when we were at the doc's office, Myles was happy as a little lark, all grins and smiles. He's up to 12 lb 5 oz and 24 inches long, so they think things can't possibly be that bad. He did agree to up his Zantac, still a low dose per what most of the rest of you have your kids on, to 0.8 mL b.i.d. We see the ENT tomorrow for a laryngoscope and I'm going to ask him for a GI referral. Myles has been less fussy this weekend, so I think the upped Zantac is helping at least for the time being. Thanks for inquiring!

No problem. Our ENT doctor was the one who refered us to the GI specialist, so that may give you a glimmer of hope.. keep us updated!

We are currently formula feeding with Nutramigen and have not thickened his formula any because I've had three different doctors tell me that there are new studies linking the introduction of rice cereal before 4 mos of age and an increased incidence of juvenile diabetes. We have some family history of diabetes already, so unless it's absolutely necessary to thicken his feedings, we're trying to avoid that. The GERD and laryngomalacia is plenty to deal with on their own :-)

I was a bit worried about this too, and so was my SIL who has a big history of diabetes in her family. She is quite a diligent researcher and found that if you use brown rice cereal, you have a better option since brown rice is lower on the glycemic index than regular rice cereal. We used Earth's Best Organic Brown Rice Cereal, and it was great for us. Very smooth and fine, with no additives. Some of the other cereals add soy, which is bad for our MSPI kiddos.