“Her eyes are watering again.”
“She coughed six times during that feed.”
“She sounds wet, like she needs to cough or clear her throat.”
“I can feel the vibration of it going down the wrong pipe.”
These are all comments I shared with my husband during and after many of my baby’s feeds around the 8 month mark.
At 4 months old, a swallow study was ordered by our daughter’s ENT due to her laryngomalacia diagnosis and reflux. Despite an SLP observing one of her feeds and saying it looked great, they wanted to be extra sure everything was safe — which I absolutely appreciated.
By 5 months old, it was swallow study time.
If you are unfamiliar with what takes place during a swallow study, I will explain it here in some detail. You bring your baby’s empty bottle — the exact bottle they normally use, with the same nipple size and vent system (if applicable). The hospital uses this bottle to prepare the barium mixture your baby drinks during the study. Barium is a liquid that lights up on the X-ray machine, allowing the SLP and radiologist to watch how your baby swallows in real time and determine whether their swallow is safe.
You should also bring a bottle prepared with your baby’s usual formula or breast milk, or be prepared to breastfeed shortly afterward, because your baby will definitely be hungry after the test. They do not consume all of the barium, but they do drink enough to complete the study.
At this age, babies are typically not expected to try other textures or foods during the exam. When they are older, however, you may be asked to bring things like dissolvable snacks, purées, straw cups, and other feeding supplies. Your child’s SLP will provide specific instructions ahead of time so you feel prepared.
During the study, your baby is seated upright in a specialized chair while the test is performed. Depending on the hospital, they may briefly discuss preliminary findings with you afterward and even show you what they observed. At the very least, you are usually told whether airway penetration was seen, though they will explain that they still need to thoroughly review the study before finalizing their report. Results are often uploaded directly into your child’s online portal, and the ordering physician will typically follow up to explain the findings.
At my daughter’s 5-month swallow study, she passed with flying colors. The hospital SLP stated that her airway remained very safe and protected throughout the entire test.
We were so relieved.
One less thing to worry about.
Well… things changed.
Months later, my daughter began showing all of the symptoms I described above. I brought her to her private pediatric occupational therapist, who specialized in feeding therapy, and explained my concerns. She acted quickly and connected me with their SLP. From there, another swallow study was ordered for my 8.5-month-old baby girl.
The hospital was booked out, and the soonest available appointment was nearly two months away.
By the time the study finally arrived, aside from her eyes watering occasionally, she appeared — from an outside perspective — to be feeding wonderfully. The only thing that seemed unusual was how quickly she was consuming her bottles, which was another reason her private care team wanted the swallow study repeated. She was drinking about an ounce per minute, which is VERY fast.
This time, we brought all the feeding supplies.
During the study we kept hearing:
“Penetration.”
“Penetration.”
“Yup, penetration with that too.”
“And that too.”
SCARY.
I remember thinking, “Maybe that doesn’t mean what I think it means. Maybe it’s not as bad as it sounds.”
Nope.
It was pretty bad.
Approximately 75% of her swallows showed either deep or shallow penetration. Every instance involving thin liquid resulted in deep penetration. Many instances involving mildly thick liquid also resulted in deep penetration, and even moderately thick liquids occasionally caused shallow penetration.
Knowing how thin her formula had been at home made me feel awful, realizing this had likely been happening outside of the study as well.
Her private care team explained that deep penetration is essentially “a breath away” from aspiration. The liquid was entering her airway and sitting directly on top of her vocal cords. If she happened to take a breath during that moment, she would aspirate.
We were told we needed to begin thickening her feeds immediately and that she had oropharyngeal dysphagia.
After receiving very specific instructions from her SLP on how to thicken feeds using Gelmix, we quickly noticed major improvements. Her feeds slowed down significantly, and the watery eyes disappeared completely.
Honestly, had the swallow study happened two months earlier — when we first noticed all of her concerning symptoms — I would not have been shocked by the results at all. But by the time the “urgent” test was finally performed, the only remaining symptom was occasional eye watering.
We were shocked.
I wanted to share this experience because it was incredibly eye-opening for us. Symptoms can come and go, yet the underlying problem may still exist. Babies can adapt and compensate in ways that make things appear improved, even when they are still struggling internally.
Not only had my daughter’s first swallow study been completely clear, but by the time she underwent the second one, she barely had any obvious symptoms left at all.
The only other symptom we had assumed was simply reflux was her screaming. She would scream constantly in a deep, raspy voice and make frequent throat-clearing sounds. She looked frustrated — almost like she was trying to get something out but could not.
After thickening her feeds, that stopped completely.
The Patient Mama 