Aspiration due to Difficulty in Swallowing N. MATSANIOTIS, J. KARPOUZAS

swallowing. The swallowing mechanism after a propyliodone ('dionosil') swallow was studied in 44 infants, aged 6 days to 6 months, who were admitted during a 6-month period to the Paediatric Clinic of Athens University because of choking spells during feedings or persistent vomiting. Twenty-three infants showed aspiration of the opaque material into the tracheo-bronchial tree. The incidence of aspiration was very high. It declined, however, with increasing age, indicating that it is a benign condition which might be related to neuromuscular immaturity in early life. Mothers occasionally note that their infants have choking spells during feedings. This usually occurs only once or twice. In some cases, however, it is repeated several times and can even lead to aspiration pneumonia. We have previously reported 5 cases of aspiration pneumonia in infants with difficulty in swallowing and have produced evidence that this may result from hypotonia of the pharyngeal musculature (Matsaniotis, Karpouzas, and Gregoriou, 1967). Suspecting that aspiration occurs in otherwise normal infants with choking spells during feeding or persistent vomiting, much more frequently than is generally believed, we decided to examine all such infants, aged 6 days to 6 months, admitted to our clinic. Materials and Methods During a 6-month period 393 full-term infants aged 6 days to 6 months were admitted to the Paediatric Clinic of Athens University. 44 infants had a history of choking spells during feedings or persistent vomiting. These infants were given a full physical examination and were studied radiologically after the administration of a radiopaque feeding. Mothers were questioned about their girth during pregnancy, and the quantity of amniotic fluid. In each infant the gag reflex, muscular tone, and tendon reflexes were assessed. Auscultation of the thorax during swallowing of the radiopaque material was also carried out. Received 24 May 1971. An aqueous solution of propyliodone 50% ' and benzyl alcohol 1-15 % ('dionosil ' aqueous) was used as radi