Question:

I’m looking for some insight on where to begin with this case:
The child’s age is 4 Months (Preemie Baby – 35 Weeks, will be 5 months soon). Aspiration pneumonia, G-Tube and Nissen Fundoplication, nothing by mouth.
Issues with swallowing – risk of saliva entering to lungs – can’t give him pacifier, reflux, and unknown genetic abnormality/corpus callosum. Any help would be appreciated!

Catherine’s Answer:

Sounds like he is a late preterm who is going to be 5 months soon and would then be not quite 4 months adjusted age.​ The neurologic co-morbidities (absent corpus callosum) suggest at least part of the etiology for the abnormal swallowing and that often results in altered oral-pharyngeal reflexes that underpin feeding. There may be other components of his history that might further inform a differential to guide a plan of care. I would suspect there might have been a VFSS early on in the NICU unless he was so neurologically devastated that the team determined a VFSS would not change his management and proceeded with a G-Tube/Nissen; or if he did not swallow his saliva, we would likely not do a VFSS. High risk for altered postural control so will benefit from neurodevelopmental treatment to facilitated base for supporting motor learning. Oral-sensory-motor intervention will be key to support learning to swallow saliva; this often involves using a pacifier as one component. When cautiously and thoughtfully utilized, it can help facilitate the intrinsic tongue control for swallowing saliva and oral-motor organization.

To start problem-solving, it will be helpful for me to understand what you see clinically, especially related to postural and oral-pharyngeal tone, oral-pharyngeal reflexes, interest in own hands to face/ mouth, need for suctioning and response to suctioning, any spontaneous swallows observed, any ENT consult results.

Very challenging patient with multiple complex issues that are likely to be enduring and progress likely to be slow.

I hope this is helpful.