A 5-year-old boy is brought to your office because of difficulty in swallowing. His mother, an intensive care unit nurse, states that he gags so vehemently that she is afraid he is going to aspirate. He had difficulty swallowing as an infant, but the problem was not severe enough to bring to the attention of a physician. He seemed to get much better as he got older, having had no swallowing problems as a toddler. He has had five such episodes recently, the last two being the most severe. In addition, he is a very slow eater. His mother wonders if his tonsils are so large that they are obstructing his throat.

On examination, the boy is at the 25th percentile of both height and weight. (Both parents and his older sister are between the 50th and 60th percentiles of height and weight.) His pulse is 72 beats/min and respirations...

You do not currently have access to this content.