[Dysphagia] something else to consider

[scohen at larabida.org (Cohen, Stephanie)]

I'm not sure how old this infant is, or if this point has already been
mentioned in the current discussion, but along with considering the
reflux aspect of the picture, before thickening or making other changes
to a child's feeding status, shouldn't we also be exploring the child's
ongoing respiratory status? i.e., if the child has theoretically been
aspirating small amounts for any period of time (as Irene has repeatedly
explained that we all do), have they sufficiently tolerated it and
remained "healthy?" Or does the child have a history of chronic lung
disease with frequent exacerbations? Has the child had chest x-rays to
investigate the status of lung tissue, etc. at different points? I think
that a major part of the decision-making should be tracking the child's
ability to handle the aspiration and what, how much, how often, etc., as
Irene has written about many times on this list, and maybe continuing
unthickened formula/breastmilk po along with careful, scheduled
evaluation of respiratory status could be the way to go, especially
(again, as Irene wrote) without sound research to draw from about how
much aspiration is "safe." I think we'd have to consider that route for
a family who wants to continue feeding their baby as they have in the
past. 
 
Stephanie
 
Stephanie C. Cohen, M.A., CCC-SLP
Speech-Language Pathologist
La Rabida Children's Hospital
E. 65th Street at Lake Michigan
Chicago, IL 60649
(773)363-6700 x489
scohen@larabida.org