Hi all, 
I'm new to the list and am a speech language therapist working in paediatrics. I find this list fascinating and really useful, and have learnt so much already. 

The identification of an absent or hyposensitive gag reflex in isolation does not immediately indicate enteral feeding. 

Arvedson, J., C. and Brodsky L. (2002). Paediatric Swallowing and Feeding, Assessment and Management. state that 'There is no direct relationship between the presence or absence of a gag reflex and swallowing ability.' 

Also, Wolf and Glass (1992). Feeding and Swallowing disorders in Infancy, highlight the following: 
'Eliciting a gag response is uncomfortable for an infant and therefore can interfere with observations of the baby's normal feeding function. In evaluating feeding function in babies who are apparently normal neurologically, it is generally not necessary to elicit a gag response.... Many clinicians suggest that is is not safe to feed babies who show minimal or no gag reflex. It should be emphasized that the purpose of the gag is to protect the digestive system from large objects and, hence, protect the airway from blockage... As coughing is the mechanism that provides protection to the airway from aspiration of liquids, the presence and effectiveness of the cough, not the gag, should be the primary consideration in decisions regarding the safety of infant feeding. An absent or diminished gag, however, may indicate decreased responsivity of the pharyngeal receptors... In some infants an absent or diminshed gag may be a clue to inadequate triggering of swallow. While an absent or diminished gag reflex does not mean that oral feeding should be excluded, it does suggest that the feeding specialist should proceed with caution if oral feeding is pursued.'


I do not generally try to elicit the gag reflex when I am assessing babies' swallowing, but rather observe the presence/absence of other reflexes (rooting, sucking etc), and suck-swallow coordination and the cough. If this baby has feeding issues, they need a feeding assessment and possible investigations for neurological abnormalities, but oral feeding ideally may be able to continue. 

Alexandra Cave, SLT, New Zealand 

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