Video 3 - Abnormal swallowing resulting in delayed aspiration. (Occasional aspiration)

This 6-month-old infant was referred for VFSS because of concerns related to vomiting during and apart from feedings as well as choking and coughing during nipple feeds. History was significant for intrauterine drug exposure that included cocaine and methamphetamine throughout the pregnancy. He has been in foster care since the newborn period. Thickened feeds had not helped reduce vomiting. An UGI examination 2 weeks prior to this examination revealed nonobstructive upper GI with gastroesophageal reflux.

He was positioned for bottle feeding and lateral view with foster mother presenting his formula with milk bottle nipple used at home. His suck-to-swallow ratio varies from 1:1 to 3:1, which is basically efficient for taking sufficient volume to meet caloric needs. Note that when he sucks multiple times before swallowing, the liquid is seen deeper in his pharynx (to the pyriform sinuses) resulting in a brief delay in initiation of a pharyngeal swallow. When that pattern is seen, one gets suspicious for potential aspiration as an infant continues to suck and swallow. Therefore it is important to observe more than just a few swallows with bottle feeding. By the 16^th swallow, aspiration occurred as he was initiating a swallow. There was no cough. He continued to suck and swallow, with additional aspiration events. Near the end of this section, the nipple was removed and you can tell that he produced a delayed cough, but he did not clear his airway.