'Choking' on liquids

Assembly_Reqd

Here's another question I have.

Nate is still using a nipple based sippy. (yes, I know) He will drink away and then on the last swallow he holds the liquid in his mouth and eventually chokes/coughs on it. It's like he forgets that he has to swallow that last bit before taking a breath.

I could see how this could be behavioral, but who enjoys choking on their milk?

Anyone have an insight? To be perfectly honest, I have been avoiding a swallow study like the plague. I am afraid they will put him on thickened liquids and I am not looking forward to that at all. (yes, I suck. I am not expecting the mommy of the year award)

adge1119

interestingly xavier has never had a swallow study.  i too avoided it like the plague (because i was anti-g-tube).  we saw the feeding disorders clinic at KKI and they mainly based their swallow study on whether he had significant choking and multiple illnesses that would equate to aspiration (and i was/am very thankful we were able to come to the g-tube decision on our own, they were never pushy and i feel like they really gave him a chance).  we did thickened liquids on our own and at their suggestion to try it.  it's really not that bad honestly-as long as you do the gel thickener and not the powder IMO.  like you said, it may just be behavioral though because i know plenty of kids (niece included) who do tend to cough when drinking from their sippy cup; especially if they go to town on it.

Florak8

I am a powder gal (b/c DS prefered it). It is really not that bad, and his respiratory problems have disappeared since he is not aspirating. The swallow study is easy and quick, too. DS is getting better and down to half-nectar thickness now. Might as well give it a shot and see what the study shows!

JaysonandKristin

This is just my theory...  

If it's not causing REAL choking, nor any respiratory issues (ie- aspiration pneumonia, etc), I wouldn't push for any kind of swallow study.

It could just be an incoordination issue that may correct itself.  We went through it for about 6 months, he never got sick, but would constantly choke/cough (nothing serious). 

I guess my advice is to set your limits.  What are you willing to accept and for what kind of timeline are you willing to accept it?

BUT, you need to make sure that you're honest with yourself.  If he really needs help you're supposed to be his advocate. 

ToastieSimons

We had a swallow study done when DS was like 2 months old.  He used to drink bottles fine and then towards the end choke on it.  It was a really easy procedure and doesn't require any sedation.  They just drink out of their normal bottle/sippy/cup basically in front of an x-ray machine.

He still does this (and he's still on a bottle so I can't chastise you for the nipple based sippy).

Does/did Nate have reflux?  DS1 still has pretty severe reflux (we use prevacid and thicken all liquids).  It seems that when he drinks quickly or without a lot of pauses, towards the end of his bottle it starts coming back up and then he has that awful feeling and struggles on the last bit and coughs.  He's not really choking because it only makes him slightly cough.  If he really chokes on it, it makes his eyes water and he coughs for quite a time.  I think the cough is more because it's uncomfortable to swallow.

Assembly_Reqd

I honestly do not believe he is aspirating and that is why I have not pushed the swallow study. I think it is left over poor suck swallow skills. He only coughs/chokes about twice. Rarely is any eye watering that I notice, but the kid's eyes are always watering..**shrugs** (see post about tear ducts)

He had pretty bad reflux as a baby, but we were never medicated for it. I think he was barfing all over because of poor muscle tone at the top of his stomach. He never showed any signs of pain or discomfort. It sucked and the barfs lasted until about 11 months followed by another 7 months or so of drool.

Our insurance is changing "big time" according to DH next year (deductible) and I am just trying to follow through on some of those "I wonder" type procedures.

MaxandRuby

DS2 has had 2 swallow studies. The first was to ensure he was not aspirating on solids. The second, which was done a month or two ago, was to see how he was doing with liquids (we tested with his regular sippy, a straw cup, and an open cup) and to ensure he would not aspirate with open cup drinking.

The test is pretty easy in and of itself. They put barium (a cream or powder depending on what you are testing) with the regular food or water. They eat/drink in front of an X-Ray machine (make sure they have the appropriate seating available), and they video tape it while it is happening. At the end, they either tell you what they saw and/or show you what you saw and then you go from there (I always asked for a copy of the report to be mailed to me in addition to the doctor). 

Personally, I'd do the swallow study. I didn't think DS2 was actually aspirating either, but I wanted it confirmed so I didn't have to worry or think "what if" or "should we have done that test", etc.

annibes

A good swallow study is going to take a look at aspiration risk, how the child moves the bolus (bite or sip) from lips to esophagus, and how quickly it empties into the esophagus. Some will get a look to see of there is any reflux from the stomach, but I know if all will do that. It might be able to tell you why that last sip is causing the cough- it might not necessarily mean LO needs thickened liquids. It might indicate smaller, more frequent meals, a different positioning, a verbal or tactile cue to swallow the last sip, a different nipple flow, etc. I'm not diagnosing here, of course, but if LO is tolerating thin liquid for most of the Sippie and then coughing only at the end, I'm not sure that thickening the liquids will prevent the cough unless fatigue is causing increased risk for aspiration (at which point you would discuss smaller amounts/more frequently vs thickener).  

Assembly_Reqd

annibes:

A good swallow study is going to take a look at aspiration risk, how the child moves the bolus (bite or sip) from lips to esophagus, and how quickly it empties into the esophagus. Some will get a look to see of there is any reflux from the stomach, but I know if all will do that. It might be able to tell you why that last sip is causing the cough- it might not necessarily mean LO needs thickened liquids. It might indicate smaller, more frequent meals, a different positioning, a verbal or tactile cue to swallow the last sip, a different nipple flow, etc. I'm not diagnosing here, of course, but if LO is tolerating thin liquid for most of the Sippie and then coughing only at the end, I'm not sure that thickening the liquids will prevent the cough unless fatigue is causing increased risk for aspiration (at which point you would discuss smaller amounts/more frequently vs thickener).  

Thanks!