Difficulty in swallowing, with aspiration pneumonia in infancy.

Difficulty in swallowing, starting soon after birth and resulting in aspiration pneumonia, may be due to: pharyngeal incoordination; cerebral palsy; familial dysautonomia; poliomyelitis with bulbar palsy; agenesis of bulbar nuclei; or myasthenia gravis. Pharyngeal incoordination mainly affects premature babies and usually lasts from two to four weeks (Avery, 1964; Scott-Brown, Ballantyne, and Groves, 1965), though a case with pharyngeal incoordination, proved by cineradiography, which lasted much longer, was reported by Benson (1962). Cerebral palsy may cause difficulty in swallowing, especially during the first year of life. The diagnosis is suggested by a stormy perinatal history, and is later confirmed by the characteristic clinical picture of cerebral palsy, often with athetosis (Woods, 1957). Familial dysautonomia is a rare syndrome characterized by areas of paraesthesia, the absence of lacrimation, mental subnormality, and muscular incoordination. Agenesis of the fungiform and vallate papillae of the tongue is a consistent and pathognomonic finding (Riley, 1957; Smith, Farbman, and Dancis, 1965). Poliomyelitis during the newborn period, and agenesis of the bulbar nuclei affecting the mechanism of swallowing, are very rare (Brain, 1962; Ford, 1960; Nelson, 1964). Newborn infants of myasthenic mothers may present with difficulty in swallowing, but this is usually transient and responds well to cholinergic drugs (Macrae, 1954). The view that difficulty in swallowing may be due to hypotonia of the pharyngeal musculature has also been expressed (P. Sandifer, 1963, personal communication).