I have seen babies with no and/or a very delayed or weak gag reflex that were able to swallow safely. *But* if a baby has no gag I would most likely want a very experienced SLP to do a videofluoroscopic swallow study (or modified barium swallow study or whatever your facility calls it) to confirm that the baby is able to swallow safely. It is absolutely an indicator of some sort of neurological dysfunction, but does not necessarily mean that the baby can't eat by mouth. More than once I have been the first one to check the gag (and realize it was abnormal) after baby had been eating PO for some time. There are many other mechanisms built into infant anatomy and the physiology of the infant swallow that are designed to protect the airway. I wouldn't rule out eating by mouth just because there is no gag. 

Let us know what happens with this baby. 

-Laura Wasielewski MS, CCC-SLP, IBCLC
Los Angeles, CA

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