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Abstract Objective Knowledge of the breastfeeding swallow is limited by practical challenges. Radiation exposure to both mother and infant and the radiolucent properties of breastmilk make videofluoroscopy an unsuitable imaging modality. Furthermore, ultrasound is not ideal for capturing the complex 3‐dimensional functional anatomy of swallowing. In this study we explore the feasibility of using real‐time MRI to capture the breastfeeding swallow. Methods Prospective observational study: Review of imaging from 12 normal infants (

Button (Disc) battery impaction in the esophagus is a time critical presentation with significant associated morbidity and mortality. We present the case of a 15-month old boy with an unwitnessed foreign body ingestion, and who was subsequently found to have two ingested lithium button batteries, which were lodged at the upper esophagus, distal to cricopharyngeus. We discuss the “macaroon sign” of two button batteries lying parallel to one another, with both positive poles facing each other, as this may be an unusual barrier to urgent identification of the impacted foreign body as batteries.0.25% acetic acid was used as a neutralising agent at the time of button battery removal (8 h after ingestion), based on published evidence that this effectively decreases tissue pH and mitigates the severity of the injury in animal models, whilst not increasing ambient tissue temperature as once thought [4]. Our patient had a significantly better clinical outcome than predicted from the severity of the burn at time of button battery removal, suggesting acetic acid used topically is a safe adjunct treatment of impacted ingested button batteries and may reduce the likelihood of serious long term sequelae. Keywords: Button battery, Caustic ingestion, Esophageal injury, Foreign body ingestion, Electrical injury, Acetic acid

Otitis media (OM) is a major reason for antibiotic consumption and surgery in children. Nasopharyngeal carriage of otopathogens, Streptococcus pneumoniae and nontypeable Haemophilus influenzae (NTHi), is a prerequisite for development of OM, and increased nasopharyngeal otopathogen density correlates with disease onset. Vaccines can reduce or eliminate otopathogen carriage, as demonstrated for pneumococcal serotypes included in pneumococcal conjugate vaccines (PCV). The 10-valent PCV (PCV10) includes an NTHi carrier protein, and in 2011 superseded 7-valent PCV on the New Zealand Immunisation Program. Data are conflicting on whether PCV10 provides protection against NTHi carriage or disease. Assessing this in otitis-prone cohorts is important for OM prevention. We compared otopathogen density in the nasopharynx and middle ear of New Zealand PCV7-vaccinated and PCV10-vaccinated otitis-prone and non-otitis-prone children to determine PCV10 impact on NTHi and S. pneumoniae carriage. We applied qPCR to specimens collected from 217 PCV7-vaccinated children (147 otitis-prone and 70 non-otitis-prone) and 240 PCV10-vaccinated children (178 otitis-prone and 62 non-otitis-prone). After correcting for age and day-care attendance, no difference was observed between NTHi density in the nasopharynx of PCV7-vaccinated versus PCV10-vaccinated otitis-prone (p = 0.563) or non-otitis-prone (p = 0.513) children. In contrast, pneumococcal nasopharyngeal density was higher in PCV10-vaccinated otitis-prone children than PCV7-vaccinated otitis-prone children (p = 0.003). There was no difference in otopathogen density in middle ear effusion from PCV7-vaccinated versus PCV10-vaccinated otitis-prone children (NTHi p = 0.918; S. pneumoniae p = 0.415). When pneumococcal carriage was assessed by vaccine serotypes (VT) and non-vaccine serotypes (NVT), there was no difference in VT density (p = 0.546) or NVT density (p = 0.315) between all PCV7-vaccinated versus all PCV10-vaccinated children. In summary, PCV10 did not reduce NTHi density in the nasopharynx or middle ear, and was associated with increased pneumococcal nasopharyngeal density in otitis-prone children in New Zealand. Development of therapies that prevent or reduce otopathogen colonisation density in the nasopharynx are warranted to reduce the burden of OM.