Assessment of a school-age child with guillain-barré syndrome reveals absent gag and cough reflexes. which problem should receive the highest priority during the acute phase?

Neffective breathing pattern related to neuromuscular impairment.
Explanation: 
Ineffective breathing pattern caused by the ascending paralysis of the disorder interferes with the child's ability to maintain an adequate oxygen supply. Therefore, this nursing diagnosis takes precedence. Additionally, as the neurologic impairment progresses, it will probably have an effect on the child's ability to maintain respirations. Risk for infection related to an altered immune system is not involved with Guillain-Barré syndrome. Although impaired swallowing and incontinence may occur with the ascending paralysis of this disorder, oxygenation is the priority.