Modified Barium Swallow

Procedure done: 01/08/2007

Procedure: Modified Barium Swallow

Notes: D is a 17 month old infant male who has a diagnosis of congential bilateral perisylvian syndrome, polymicrogyria, and infantile spasms. He is presently recieving out patient OT/PT and speech. D was referred by OT for a modified barium swallow (MBS) to rule out aspiration and assess swallowing safety. Mom reported that Daniel presently eats baby food (stage 2 and some 3's), thick liquids and mashed potatoes. He will eat crackers that will melt in his mouth but nothing that requires mastication. Mom reports that D does not demonstrate any side to side movements with his tongue. D was evaluated this pm before radiology for a MBS. His mother was present. D was positioned upright in the red tumble form feeding chair for the assessment. He was offered the following foods mixed with barium.
Milk via a bottle: D demonstrated severe oral motor dysfunction with the bottle. He demonstrated lingual cupping and stripping of the tongue. He is able to compression and express milk from the bottle. However noted increased spillage from his oral commissions along with increased drooling. Noted consistent protrusion beyond the labial border with a wide jaw excursion. Quality of his suck is poor, but functional for him. No penetration or aspiration noted.
Sweet Potatoes mixed with cereal via a spoon: oral motor central remaining the same as above with no penetration or aspiration noted.
Cheese puff and meat stick: D was given a small (cheerio-sized) piece of meat stick and cheese puff on the lateral sides of his oral cavity. Noted slightly better mobility of the food when placed on the Right vs. the Left. Ability to manipulate the bolus with his tongue and gums is poor. However, he is sensorily aware of the bolus. Oral transit time is significantly delayed. NO penetration or aspiration noted.
Impression: D is a delightful 17 month old little boy with significant oral motor dysfunction. His mother has done an excellent job working with him at home. He receives outpatient OT/PT a& speech and has made gains (per his mother) Mom has a home program that she with with D on.
Recommendations: Offer D thick liquids and pureed foods, soft mechanical diet, soft semi-solid foods to work on mobility lip function and facial tone.
Increase OT oral motor therapy to 2-3x per week