The nurse cares for a client with a form of spinal muscular atrophy. Which priority nursing intervention should be included in the plan of care?

Spinal muscular atrophy (SMA) is a progressive neuromuscular disease caused by degeneration of anterior horn cells, resulting in proximal muscle weakness. As the disease progresses, weakness of the pharyngeal and laryngeal muscles compromises swallowing coordination and airway protection, placing clients at significant risk for aspiration of food, liquid, and secretions. Continued assessments for possible aspiration represent the priority nursing intervention because aspiration pneumonia is the leading cause of morbidity and mortality in children with SMA. Prompt recognition of aspiration risk allows the care team to implement protective measures such as thickened feeds, upright positioning, and gastrostomy tube placement when needed. Corticosteroids are not a standard treatment for SMA and would not reverse the neurodegenerative process. While scoliosis can develop secondary to muscle weakness and may eventually require surgical stabilization, this is not universally applicable as a priority intervention for all forms of SMA. Strength training is contraindicated in neuromuscular diseases because high-resistance exercise can accelerate muscle breakdown rather than improve strength. Airway and aspiration safety therefore remain the highest-priority clinical concern across all stages of this disease.