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Ethan- Complete Session with Nonnutritive Stimulation, Passy Muir Valve Trial, and Dipped Tastes Ethan is a 4-month-old with VACTERL, left renal agenesis, primary ciliary dyskinesia, and pulmonary hypoplasia currently admitted to the PICU for chronic respiratory failure with hypoxemia and hypercarbia. Ethan is status post trach, g-tube, and resection of large thoracic myelomengocele. He remains in chronic respiratory failure and has successfully transitioned to a Trilogy home ventilator while in the PICU. Ethan demonstrates oropharyngeal dysphagia and aphonia and is working on goals to: 1) accept optimal PO nutrition/hydration safely and efficiently. This includes tolerating intraoral stimulation with a variety of textures and dry utensils (dry spoon, pacifier, NUK, gloved finger, teething toys) and tolerating pacifier dips without overt signs and symptoms of distress or airway compromise. 2) Demonstrate prelinguistic skills for positive language development. This includes tolerating PMV trial for up to 45 minutes and maintaining physiologic stability and without signs of distress. Video submitted by Connecticut Children’s Medical Center. observation notes

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