The Feeding Saga Continues . . .

A picture doesn't always tell the whole story, does it?  Cade recently went for a follow-up barium swallow study.  My nine year old niece asked me how he did.  When I told her that he didn't do so great, she didn't understand how that could be possible.  She said, "but Cade likes to eat now."  

He does like to eat now.  We are so thankful that he does.  He doesn't even have problems with most textures.  He'll eat almost anything.  The problem lies in what happens when he swallows the food that is in his mouth.  For him, each bite or drink has to somehow manage to go into his stomach rather than his lungs which is known as aspiration.  Aspiration is very dangerous; it can lead to further lung damage and/or aspiration pneumonia.  The pneumonia he had in May could have been caused by this.

We went to Dell for his swallow study.  It's quite a big deal; a speech therapist, a doctor, a nurse, and a radiologist were all present.  They mix barium into his bottle and into his food.  They then set him in a chair in the middle of the x-ray machine.  I fed him as they watched through x-ray where the food or drink was going.  During the study, he aspirated two times - when he was drinking through a straw and when he was using a faster flow nipple on his bottle.  In both cases, he was getting too much liquid too fast.

Remember that Cade only has one working vocal cord.  When we all swallow, both of our vocal cords close, and if that doesn't work, then our epiglottis blocks things from going into our lungs.  If that doesn't work, we have a very effective cough using both vocal cords again to expel what is going the wrong way.  Cade does not have all these lines of defense.  (Side note: when Cade coughs, he sounds like an old smoker.  He has to try to cough with just one vocal cord closing.  The result is people staring at us when we are out in public as if I have brought my deathly ill child out and about.  When I ignore his cough because I know it is just how he coughs, people look at me like I'm a terrible mother ignoring her very sickly child.  It's far too long of a story to explain to them that is just how he coughs, so I just walk on or continue shopping.)

The recommendations from Dell were to use only slow flow nipples, no straws, and all sippy cups must have the stopper in them.  He did fine with thin liquids with a slow flow, so we do not have to thicken the Pediasure.  He also did fine with solid food.  It's not the worst news we could have heard.  It did however make me feel bad that we unknowingly were allowing him to aspirate by using a faster flow nipple.  Of course, now with every cough, I wonder if he is aspirating.  It is not a good feeling. 

So if you see my son at three years old still drinking from a bottle, do not judge.  We have worked so hard just to get to that point.  Actually, the speech therapist said that over time, he should get better at controlling his swallow. 

And to finish, here are some more cute pictures of my kids eating.  They love spaghetti - mostly, I think they like making a mess!