Roberto was born at 30 weeks’ gestation and is now 25 months old. His parents’ and extended family’s main concern is that he is difficult to feed. “He cries and refuses to eat when offered meals, even those with his favorite foods.”

The registered dietitian nutritionist (RDN) who consults at the early intervention program meets with the family, assesses Roberto, and reviews his medical records. The first step by the RDN is to observe Roberto's feeding by his mother and to evaluate his growth pattern and nutritional intake. The nutritionist and occupational therapist are concerned that Roberto is choking so easily, and recommend he undergo a swallowing study. Roberto does not attend the early intervention program for the next three weeks. The swallowing study indicates he is aspirating some of his liquids into his lungs and so oral feeding is not safe for the moment. He requires a gastrostomy for tube feedings. His parents learn how to feed him a specialized formula through the gastrostomy tube.

Nutrition services provided in the early intervention program are now documenting his growth as adjustments are made in his gastrostomy feeding schedule. Roberto gains weight over the next six months and becomes more interactive with the staff at the early intervention center. He begins to progress in his walking and speaking skills. The occupational and speech therapist work with his oral motor skills. A repeat swallowing study will be conducted in the near future. The goal is for Roberto to consume all of his nutrition by mouth once his swallowing is normalized and he is no longer at risk of aspirating his feedings.

What are the indications that Roberto needed to have a swallowing study?