Tracheoesophageal Fistula/Esophageal Atresia (TEF/EA)
Wesley Strawbridge of Atmore is a chubby-cheeked toddler who enjoys farm animals, getting his hands dirty and making his toy cars go “Vroom! Vroom!” He loves to eat – his favorite foods are scrambled eggs, cheese and pickled beets. And he’s also excited about becoming a big brother in a few months. To look at him, you would never guess he had ever been sick a day in his life. But when Wesley was born on October 25, 2013, he was diagnosed with a previously undetected birth defect called tracheoesophageal fistula/esophageal atresia (TEF/EA). EA occurs when the upper part of the esophagus does not connect with the lower esophagus and stomach. TEF is an abnormal connection between the upper part of the esophagus and the trachea or windpipe. TEF/EA is a life-threatening condition, so Wesley had surgery to close the fistula and connect the upper and lower portions of his esophagus when he was just days old. Despite the successful surgery, Wesley continued to have problems eating. He also had numerous unexplained respiratory attacks that resulted in trips to the local emergency department. “We felt that we were not getting anywhere with trying to have Wesley’s acute ‘croup’ and cough symptoms treated,” says his mother, Jennifer Strawbridge. “So, finally we turned to the Aerodigestive Clinic at Children’s of Alabama. “Children’s discovered that ‘the croup’ was instead a chronic issue with aspiration. (Aspiration, which can cause pneumonia, occurs when liquid enters the air pipe and the lungs.) I am not sure this would have been detected without the procedures the Clinic was able to provide.” When Jennifer contacted Children’s in September of 2014, Aerodigestive Clinic Coordinator Ashley Chapman, RN, collected information from her about Wesley’s symptoms. “She also talked to the family to prepare them for the visit to our clinic,” explains Tom Harris, MD. Dr. Harris is a pediatric pulmonologist and medical director for the Aerodigestive Clinic, the only aerodigestive program in the state and one of very few available nationally. The Clinic team, which currently follows about 250 patients, includes pediatric subspecialists in ENT, Gastroenterology, Pulmonary Medicine, Radiology and Surgery, as well as nurses, speech therapists and nutritionists. The team meets twice a month to evaluate and discuss patients’ medical needs. If a diagnostic procedure is required, team members view the results together and discuss treatment options. Usually, a comprehensive evaluation and treatment plan will be available to the family within two or three days. After the team had discussed Wesley’s case, an endoscopic evaluation was performed the following day with the pulmonologist, otolaryngologist and gastroenterologist in attendance. “We were able to visualize the larynx (voice box), bronchi (breathing tubes) and esophagus (swallowing tube),” says Dr. Harris. “Although the surgical repair Wesley had shortly after birth was still intact, he had actually aspirated and also had bronchitis. “We were able to tweak his medications and adjust the consistency of his formula, and that has really helped him a lot,” he adds. “This is a good example of how a well-planned, well-coordinated approach can transform healthcare delivery – and, for parents, alleviate a lot of the uncertainty and fear they may have for their child.” Looking back, Jennifer says Wesley was much more ill than she and her husband had realized when they first brought him to Children’s. “Dr. Harris identified a few issues that have made such a remarkable change in our son’s well-being and quality of life,” she says. “We are so grateful to the Aerodigestive team for responding to our needs at such a critical time. We are, without a doubt, better for Children’s investment in the lives of children – especially in the life of our child.”
