Paediatricsmiddle twist
A 5-year-old boy with spastic quadriplegic cerebral palsy is reviewed in a community clinic. His mother says every meal now takes 45 minutes, that he coughs and his eyes water whenever he drinks thin fluids, and that he has needed two courses of antibiotics for chest infections in the past six months. His weight has crossed from the 25th centile to below the 3rd over a year. His chest is clear today and he is afebrile, and his seating and hand function are unchanged. Which one of the following referrals should be made first?