Yesterday, we went to Children's Hospital for our repeat Swallow Study. Colton isn't allowed to eat 3 hours before our appointment, so I had to wake him up from his nap to feed him earlier than normal. Poor baby! When we got to the Radiology Department, I was glad to see that we had the same Speech Pathologist as last time. His name was Drew. I think he remembered me...but not Colton. Colton's gotten rather large since our last visit at 2 months old. Hehe.
First, we went to a room to discuss Colton's current feeding schedule. I told him that we began introducing baby food once a day and he's been doing really well with it, but I wanted to make sure he wasn't aspirating on it. I told him that we thicken his bottles to Stiff Honey and I explained my current concoction of formula, rice cereal, and Thick It 2. He said that everything looks like it's working so far because he's obviously gaining weight and he hasn't had any respiratory illnesses which would be a result of aspirating.
Next, we went back to the X-Ray room. We strapped Colton in his highchair next to the machine. He was very cooperative and interested in what we were doing.
The X-Ray is on the right side and it shows his profile as he drinks a bottle. You can see the liquid entering his mouth and going down his throat because it has Barium in it. If he aspirates, you can see it go into the airway and we stop feeding him, immediately.
We started out using the Nuk bottle I brought from home. This is the bottle they recommended at our first Swallow Study because it has a flat-based nipple which is good for a low tone tongue. His tongue doesn't have to cup the nipple as much as a regular round nipple. They gave him Nectar thick formula. This is pretty thin, so he had trouble keeping up with the swallowing and did aspirate on it. So then we moved to Honey thick formula. He actually did pretty well on the Honey, compared to last time. He did swallow a good amount of it, but occasionally, he'd have a deep penetration (it would get into the yellow zone, which means it was headed to the airway, but he didn't always aspirate). After a little while of sucking, he finally did have an aspiration. However, he coughed when he aspirated. This is a good thing because at his last Swallow Study, he had silent aspirations....which can be very scary. This time, he noticed something wasn't right, so he coughed. His cough did not completely clear the airway, but he tried. We then tried Honey again with a different bottle and nipple (the MAM brand). This nipple also has a flat-based nipple, but it's not as big of a nipple so it's better for transitioning to a straw sippy cup. He did aspirate a little on the Honey thick, so we decided to stop the study. Drew said that he wasn't comfortable switching him to Honey just yet because he was having some deep penetrations and a few aspirations. I told him that this was completely fine with me. We've been doing Stiff Honey for awhile now and we are all used to it. He's doing well, he's not sick, he's gaining weight. If it ain't broke, don't fix it. So...we will stay at Stiff Honey.
We also discussed what this means when he turns 1 and leaves the bottle. We will have to thicken all of his liquids to Stiff Honey. Luckily, at age 1, we can change thickening products. He is currently using Thick-It 2, which does upset his tummy without the rice cereal. So, at 1, we can switch to Simply Thick (you have to be over the age of 1 to use this product). Simply Thick is a gel packet that you squeeze into liquids and shake/stir. The good thing about Simply Thick is that it's easier to carry around with you because it's in these little individual packets. Thick-It 2 is a big tub of Splenda looking powder.
Also, Simply Thick stays the same consistency throughout the day. You can mix it into apple juice in the morning and it will stay the same thickness all day long. With Thick-It 2, it continues to thicken until you have a nasty paste in the bottom of your bottle/cup. I can't make bottles too early or they will get way too thick to eat and I have to dilute it with water. My PCP can send a prescription for the Simply Thick to a nearby Nutrition Store and they will mail the product to my house, monthly. It's so nice and easy for me! We actually were getting too much Thick-It 2, so I had to call them and ask them to stop for a few months so that we could use what we had, first. It's been so easy! Hallelujah!
During the study, we also fed Colton some applesauce with Barium in it. He swallowed the applesauce just fine. He did not aspirate on it, so I was really happy to see that. Drew said that some of the baby foods are thinner than others, so if I'm concerned it's too thin, I can always add some Thick-It 2 to the food and stir. It might slightly alter the taste, but not too much.
We will go back for another study in 10-12 months. We are hoping by then, Colton won't have to thicken to Stiff Honey anymore. He will eventually outgrow this aspirating thing, but sometimes it just takes time. I told Drew that I'm still paranoid about starting solids with him. I was with Weston, too, because I HATE choking babies. It freaks me out! But with Colton, I'm especially anxious because I don't want him learning bad eating habits that can cause more speech problems in the future. Drew said that maybe I can have him reevaluated for Speech Therapy now that he's getting ready to start solid foods. I'm gonna ask about that next week at Access. Children with DS can have issues with tongue lateralization, which can make eating solids more difficult. Plus, he doesn't have any teeth yet. Drew said that a lot of kids with DS will put a solid on their tongue and swallow it whole because they don't know what to do with it. Another learning curve for us, but we will figure it out. We always do!
God, thank you for a baby that is eating well, gaining weight, and not suffering from any respiratory illnesses!
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