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Dear Savvy Auntie,

My niece had trouble with motor skills from very early on, couldn't use her left hand for things and wouldn't eat with it. At first, doctors thought she had a mild case of cerebral palsy. Finally, at about a year, she was caught up on the major motor skills like crawling, walking, pincher grasp with both hands. Her speech is coming along and she's learning new words, but she really isn't as far along as maybe she should be.

My sister noticed a few weeks back that she is choking a lot when eating and drinking. She was taken for a swallow study. The doctor that my sister saw at first for the cerebral palsy concerns wasn't very attentive and sort of brushed off my sister's concerns - which might be why this swallowing issue was not caught sooner.

My sister has a master’s in special education and taught preschool for special needs children for years, so she's had a lot of exposure and experience with delays. That can make her overly sensitive, but it also makes her very astute to what is happening with her own child. She is just trying to find a doctor to look at the whole picture and help her put these pieces together and take her seriously.

Seeking Medical Advice

Dear Seeking Medical Advice,

Dr. Stephanie Lichten, emergency pediatric physician:

It sounds like the right steps are being taken. From what I gather, your niece would benefit from speech or occupational therapy greatly and it seems a bit of a coordination issue but it is difficult for me to say without meeting her or seeing the studies that have been done. I would recommend speech or occupational therapy and developmental therapy and go from there.

Rhonda Davis, speech-language pathologist:

It is great that your sister was so observant and insisted on getting the swallow study for your niece. The combination of a speech therapist and an occupational therapist helping your niece sounds ideal.

Feeding therapy, otherwise known as Dysphagia Therapy, may include working on the muscles involved with swallowing, identifying the best posture and positions for your niece when she is eating, and monitoring the texture and consistency of foods and liquids presented. From other information you've provided, it sounds like they have already identified important diagnostic information such as that your niece has a delayed swallow and that she aspirates on thinner liquids.

Published: February 8, 2011