We stopped Nathaniel's oral feedings at the end of July. For the first few weeks, he would grab at our food or sign 'want' when he saw his puffs container. I tried very hard to schedule the needed swallow study as soon as possible so that he did not lose his desire to eat or lose the skills we worked so hard to develop while we waited for the test.

Nathaniel was seen by therapy services at the children's hospital for a swallow study in January 2014. At the time, the evaluating speech and occupational therapists felt his eating skills were too premature to conduct the test. We were sent home with instructions to work on eating. By late spring Nathaniel had improved, but he coughed and vomited every time he ate orally. Our weekly occupational therapy sessions worked on feeding as instructed, but never addressed the coughing and vomiting. We sought an occupational therapy evaluation with a different therapist who strongly suspected that Nathaniel was aspirating. Precious time lapsed in waiting for the second evaluation, waiting for that report to be sent to the doctor, waiting for the doctor's order to be submitted for a new swallow study, and waiting to schedule the study.