[Dysphagia] Cleft soft palate/aspiration/VF/breast milk

[brenda.liddle at mahc.ca (Liddle, Brenda)]

I am posting this question for a colleague regarding her niece: 

The baby is approx 10 weeks old with an isolated cleft of the soft
palate (it may run slightly into hard palate, but they weren't sure and
surgeon didn't seem to indicate that it really made a difference). No
other medical issues are involved. Mother is pumping breast milk and
feeding via Haberman (I think). 
Baby is thriving well and with excellent weight gain. I think sx is
planned for btwn age 6-12months (?). The baby is coughing and sputtering
a bit during feeding, but there have been no respiratory complications.
OT involved is pushing for doing a Videofluoroscopy (not sure of
reasoning) and thickening breast milk to Nectar consistency. Mother is
concerned re "junk" in the thickening agent (Simply Thick) and
unnecessary exposure to radiation.
 
I don't work at all with Pediatrics, but my Ax/Tx questions for the Mom
to pose to the OT were:
1) Re: coughing and sputtering during feeding - Wouldn't the first item
on the list be to try to slow the flow on the nipple? (Not sure what
flow rate options there are)
2) Even if you assume the infant is penetrating/aspirating any quantity
of breast milk, why do a VF if there are no respiratory complications to
date? 
In lieu of this, are there any other respiratory consults that could be
conducted to perhaps check SpO2 levels during feeding to ensure no
significant apnea risk?
3) Would breast milk not be tolerated (if aspirated) and presumably
cleared without incident by an otherwise healthy infant? (i.e. Instead
of thickening with a foreign agent? Isn't this infant at less risk since
it is breast milk vs formula?)
4) What else would the clinician be looking for on a VF that they could
not ascertain in a feeding evaluation given this particular case?
 
Can anyone provide further information on these concerns?
Thanks!

 

 

Brenda Liddle MSLP, S-LP(C), Reg. CASLPO

Speech-Language Pathologist

Muskoka Algonquin Healthcare

Huntsville District Memorial Hospital Site

100 Frank Miller Dr., Huntsville ON, P1H 1H7

brenda.liddle at mahc.ca

(705) 789-0022 x 317