This sounds very challenging, but, as I have posted on this child before, 
there is nothing normal or simple about what is going on.  Normal children 
do not aspirate.  The baby sounds as if it's been injured (with evidence of 
facial asymmtetry, discoordinated tongue movements, poor feeding and now 
aspiration) or has something equally or much more serious going on.  This 
child also, as you had previously posted, had colored emesis.  I would 
guess, with evidence on swallow study that the baby is aspirating, that the 
cyanotic episode was not just reflux and that this child has difficulty 
protecting the airway.  I would urge you to be cautious in your 
recommendations until the underlying cause of this baby's problems is more 
aggressively investigated.

Jenny Thomas, MD, FAAP, IBCLC
www.drjen4kids.com

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