health department

Shoghi has had a cough since at least last November - maybe longer. I kept asking about it, first at the naturopath, then several times at our visits to the pediatrician. They checked him out, but there were no signs of asthma or pneumonia, but still the cough persisted. It's possible that we're going to have a little gap in health insurance starting in September, so I thought it was time to get to the bottom of it.

We started with three possibilities: airway irritation, reflux, or a swallowing disorder causing him to inhale some of his food/milk/saliva. As you know, we had a long battle with reflux when he was tiny - it was so bad right after I brought him home that the acid was causing him to choke. Formula or breastmilk would pour out of his nose, and he would and stop breathing - he was re-admitted to the NICU where he was diagnosed, then he came home with an apnea monitor so that I could sleep without fear that he would choke. He stayed on the zantac until this winter, and I hadn't noticed any changes after discontinuing it, so I didn't really think it was going to be reflux that was causing the cough.

Last month, we decided to rule out the airway irritation issue with a two-week trial of albuterol. Wow, that was fun. Changing squirmy Shoghi's diaper or clothes is already a sweat-inducing workout these days - getting him to allow me to hold a mask over his nose and mouth while I pumped out 2 puffs of the inhaler, and then holding it on for 10 seconds... well, that was pretty much a nightmare. I persisted, though, and his cough did not improve. Back to the drawing board.

So, last week, I brought Shoghi to the hospital to see a speech therapist to determine if he has a awallowing issue. Sure enough, for the first time, he coughed in front of one of our doctors while 1) drinking his bottle, 2) eating pureed foods, and 3) munching some cheerios. I actually haven't noticed an increase in coughing while he's eating, so I was very surprised and grateful that he "performed" for the doctor to see. The doc took it all in stride and told us it would be best to return for a barrium swallow - a radiological procedure that takes a live x-ray video of him eating, drinking, and most importantly, swallowing. We went in yesterday, and sure enough, you could see some of his milk back right down his airway while he drank!

So, of all the things that could have been causing this cough, it's (in my opinion) the best one. This little issue can be fixed by thickening up his milk for a while with, of all things, baby food bananas. He didn't have that inhalation issue with any of the foods, so it's that simple - thicken up his milk, and give him a few weeks like this, and his airway shoudl re-sensitize itself. I should start to notice less coughing overall, as he will re-learn how to swallow in a way that won't allow milk, or other liquids like saliva, to enter his trachea. When we come back from Massachusetts, we'll go back to the doctor, and by then we should be able to start decreasing the thickness of his milk. Voila!

I'm really grateful that it's this simple. After listening to the poor kid cough for so many months, it's good to know what the source of it is, and know that there's a simple fix.