Diagnosis: Hypopharangeal dysfunction, coloboma/partial blindness of left eye, submucousal cleft palate, bilateral mild hearing loss, G/T tube/Mickey button, infarcts to basal ganglia, failure to thrive. Ethan had his trach performed at 2 1/2 months of age. We were able to use a Passy-Muir valve with much success, and were working toward decannulation. He had his trach capped on July 8th. He aspirated during a nap on July 23. He was 14 months old.