Sara Is a 4-Year-Old Girl Who Has the Diagnoses of Prematurity

Sara is a 4-year-old girl who has the diagnoses of prematurity, cerebral palsy, global developmental delay, chronic lung disease, and seizure disorder. She presents with low muscle tone in the trunk and increased muscle tone in all four extremities. She is unable to sit without support and uses a wheelchair that places her upright with hips at a 90-degree angle, and her head, neck, and trunk are well supported. Given her motor impairments, Sara primarily uses a suckle pattern with bottle-feeding and takes purées by spoon. She is dependent for self-feeding and is held by her mother for meals. She occasionally takes some higher textures such as soft dissolvables. An occupational therapy evaluation finds Sara functioning at an 18-month level for fine motor and cognition. Oral phase swallowing characteristics include an elevated and retracted tongue, slow bolus formation, and lack of tongue mobility. Sara loves to eat but vomits frequently. Her mother reports coughing and occasional choking during meals. There has been slow weight gain, and weight has now plateaued.
-If you are recommending a modified barium swallow study, what specific information would you provide the physician?

A) Vomiting pattern (i.e., volume related, texture related, time of day)
B) History of upper respiratory infections, chronic congestion, and low-grade fevers
C) Episodes of coughing and choking on thin liquids by bottle and lumpy puréed food by spoon
D) All of the above