Management of Pediatric Dysphagia (original) (raw)
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Children
Dysphagia is any impairment of swallowing that compromises the safety, efficiency, or adequacy of nutritional or liquid intake. It is common in children, especially in some clinical populations, and may result in failure to thrive and respiratory problems due to pulmonary aspiration. Swallowing disorders have a severe impact on children’s health, growth, and development, and on the quality of life of the child and family. Clinical evaluation cannot validly predict aspiration, which is mostly silent. A team management approach is advocated, including instrumental swallowing assessments. FEES has been proven to be safe and valid and is increasingly used in children of all ages. It allows the identification of structural abnormalities, assessment of the child’s diet with real-life food and liquids while the child holds the optimal or preferred position, examination during breastfeeding, and assessment of fatigue and treatment strategies. FEES is carried out following a protocol that co...
Oropharyngeal dysphagia, an underestimated disorder in pediatrics
Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva, 2015
Oropharyngeal dysphagia is a rather frequent clinical entity in patients with neurological problems that can lead to serious complications such as aspiration pneumonia and other disorders like dehydration or malnutrition due to feeding difficulties. It should be suspected in children with splitting of food intake or prolonged feeding, coughing or choking during feeding, continuous drooling or repeated respiratory symptoms. For the diagnosis, apart from the examination of swallowing, additional tests can be run like the water-swallowing test, the viscosity-volume test (which determines what kind of texture and how much volume the patient is able to tolerate), a fiberoptic endoscopy of swallowing or a videofluoroscopic swallow study, which is the gold standard for the study of swallowing disorders.It requires a multidisciplinary approach to guarantee an adequate intake of fluids and nutrients with minimal risk of aspiration. If these two conditions cannot be met, a gastrostomy feeding...
Children
Feeding and swallowing disorders (FSD) are common during childhood, with a prevalence of 85% in children with neurodevelopmental disorders. A comprehensive screening is essential to identify FSD and improve health outcomes in a clinical setting. This study aims to develop a new Pediatric Screening tool capable of identifying FSD. This screening tool was developed in three steps: selecting variables based on clinical experience, searching the literature and finding agreement between experts with a two-round Delphi study. This process, which reached 97% of agreement between experts, led to the development of the Pediatric Screening–Priority Evaluation Dysphagia (PS–PED). PS–PED comprises 14 items divided into three main domains: clinical history, health status and feeding condition. We also carried out a pilot test for measuring internal consistency, as measured with Cronbach Coefficient alpha. Concurrent validity, as measured with Pearson correlation coefficient, was tested using a v...
International Journal of Pediatric Otorhinolaryngology, 2017
Objective: Whereas the literature is replete with reports on complex children with dysphagia (DP), the parameters characterizing non-neurologically impaired (NNI) children have been underreported, leaving a substantial knowledge gap. We set to characterize a consecutive cohort of NNI children, their management, and outcomes. Methods: We undertook a retrospective case series. Children (<18 years old) attending a tertiary multidisciplinary swallowing clinic were eligible. Patients with neuro-developmental, neuromuscular, or syndromic abnormalities were excluded. Primary outcomes included demographics, co-morbidities, presentations, McGill score, swallowing and airway abnormalities (and their predictors). Secondary outcomes were interventions and management response. Results: From 171 consecutive patients (37-month period), 128 were included (69 males, median age 6.6 months (0.5-124.2)). Significant clinical presentations included recurrent pneumonias (20), cyanotic spells (14) and life-threatening events (10). Swallowing assessments revealed laryngeal penetration (67), aspiration (25). Other investigations included overnight oximetry (77), airway (70), and gastrointestinal endoscopy (24); revealing laryngomalacia (29), laryngeal mobility disorder (8), and subglottic stenosis (8). Non-surgical interventions involved oral diet modifications (85) and enteral nutrition (15). Surgical interventions included supraglottoplasties (18), endoscopic laryngeal cleft repair (14), and injection (19). 119 patients received intervention and at last follow-up (median 5.2 months (0.3-88.8)) 94 had improved. Of those treated 116 were on an unmodified oral diet, and 24 on a modified diet. ALTE and snoring predicted airway abnormalities, recurrent pneumonia predicted swallowing abnormalities, and age and airway lesions predicted the McGill score. Conclusion: a significant proportion of NNI children with DP harbor airway and swallowing abnormalities warranting endoscopic and instrumental assessment.
CoDAS, 2015
Purpose: To verify the accuracy of clinical evaluation compared with videofluoroscopic swallowing studies in the detection of isolated laryngeal penetration and laryngeal aspiration in children with suspected dysphagia; to identify clinical signs and symptoms associated with isolated laryngeal penetration and laryngeal aspiration; and to determine the sensitivity and specificity of the clinical signs and symptoms identified. Methods: Retrospective analysis of data from clinical and videofluoroscopic evaluations carried out in 55 children from 1 month to 7 years and 11 months old. For clinical assessment, the Protocol for Clinical Assessment of Pediatric Dysphagia was used. The sensitivity, specificity, and positive and negative predictive values of clinical evaluation were analyzed. For statistical analysis, the Fisher's exact and χ2 tests were used. Results: Clinical evaluation showed, in general, a sensitivity of 86% and a specificity of 32%. For isolated laryngeal penetration...
Oral and Pharyngeal Dysphagia in Infancy
Pediatric Clinics of North America, 1967
At term birth human infants, like those of other mammals, are developmentally prepared for suckle feeding. Swallow is present in viable prematures. 32 The development of the motions of suckling affords familiar indices of neurologic development in the premature infant and determines the manner of his feeding. These oral and pharyngeal feeding functions of the infant, along with his cry and other respiratory actions, sensitively reRect his general response state as well as his disturbances. Accordingly, failure of the feeding action is a common nonspecific indication of illness, pain, or interpersonal disturbance in the mother-infant pair. These occasional and minor disruptions of feeding are clinically benign and will not be considered here. This review is concerned with the more persistent and severe disabilities of suckle feeding commonly associated with abnormal laryngeal or nasal penetration. In infants with suckle dysphagia, currently available methods are of value in distinguishing malformations of the palate, pharynx or tongue from primary disorders of skeletal muscles in the oral and pharyngeal area and from disorders of the medulla and midbrain 25 , 26 (Table 1). These methods also distinguish oral and pharyngeal dysphagia from that due to atresia or other disturbances of the esophagus. 31 With more adequate demonstration and classification of feeding disabilities in the mouth and pharynx, we are able to recognize the basis of some of their subtler manifestations, such as recurrent aspiration pneumonia and failure to thrive. Patterns of oral and pharyngeal disability can be an early clue to a general neurologic abnormality or,
Aspects of the assessment and management of pharyngoesophageal dysphagia
Annals of the New York Academy of Sciences, 2020
Swallowing complaints are common and may have significant consequences for nutrition and pulmonary health. Etiology varies and different aspects of the deglutitive system may be affected. A thorough assessment from the oral cavity to the stomach will provide physiologic information that enables specific targeted management plans to be devised. Although the swallow trajectory bridges anatomic areas, there has previously been a tendency to compartmentalize assessment and treatment by arbitrary anatomic boundaries. It is now clear that this approach fails to appreciate the complexity of swallow mechanics and that systems (oral, pharyngeal, esophageal, and pulmonary) are intertwined and codependent. Swallowing specialists from different backgrounds and with complementary skill sets form a multidisciplinary team that can provide insight and address multiple areas of management. With the advent of new tools for instrumental evaluation, such as manometry, targeted rehabilitative strategies can be informed by physiology, increased in precision and breadth, and assessed quantitatively. Surgical approaches have evolved toward endoscopic techniques, and food technology is expanding options in dietary management. The multidisciplinary team is core to managing this varied and often neglected patient population. This review is for clinicians treating swallowing disorders and will explore the selected aspects of the assessment and management of pharyngoesophageal swallowing disorders.
Schoolchildren With Dysphagia Associated With Medically Complex Conditions
Language, Speech, and Hearing Services in Schools, 2008
S chool-based speech-language pathologists (SLPs) are increasingly facing the need to be knowledgeable about swallowing and feeding problems in children. Improved survival of preterm infants with very low birthweight, infants with major cardiorespiratory conditions, and children with neurological insults has resulted in more children with medically complex conditions who have swallowing and feeding problems in the schools. These children vary in their manifestations of swallowing deficits and more generic feeding difficulties such as behavior-based feeding problems, "picky" eating in the presence of adequate skills, and delayed development of oral skills without true swallowing deficits. Essential activities of daily living for all children include safe swallowing and functional skills for oral feeding.
Senses and Sciences, 2021
Background: The Functional Oral Intake Scale (FOIS) is a seven-point observer-reliable, valid rating scale that can be used without adding to the patient's workload. It was designed for stroke patients but is now used by adults and children. For newborns, a special scale was created. Toddlers are the transition from infant to adult swallowing. So the current study's goal is to assess the screening accuracy of the FOIS as an objective indicator of dysphagia in toddlers. Methods: A cross sectional study of 123 toddlers attending dysphagia clinic in phoniatrics unit, Otorhinolaryngology (ORL) department, Alexandria main university hospital. Swallowing assessment of these patients was conducted by bedside swallowing assessment including functional oral intake scale and instrumental evaluation by videofluoroscopy. Another 123 healthy toddlers were assessed by FOIS as control. Two experienced clinicians scored the toddlers twice for each form of FOIS. VFSS was performed to assess swallowing of these patients. Results: Both Intra rater and inter-rater reliability were high with ICC= 0.984* and 0.946* respectively. Chi-square test showed a statistically significant difference of FOIS scores between cases and control group. There was a strong negative correlation between FOIS and PAS score in fluids with Pearson correlation coefficient (r=0.293 at p<0.001 while for semisolids and solids equally (r=0.424) while no correlation between FOIS score and total residue score. The cut off point for detection of aspiration at ≤5 using FOIS had high sensitivity 71.1 % in predicting aspiration of fluids with 43.6% specificity Adel, Gaafar, Fasseeh et al. Senses Sci (Educ Sci Tech) 2021; 2: 1230-1249 (AUC=0.617), with semisolids and solids 42.1 Positive predictive value (PPV) and 72.3 negative predictive value (NPV), (AUC= 0.754) with higher sensitivity than fluids (84.6%) and lower specificity (40.9 %). On the other hand, FOIS was very poor in predicting pharyngeal residue. It was highly sensitive in detecting the oral phase dysphagia 91.3 but low specificity 19.5, (AUC = 0.715*) (95% CI of 0.618-0.812). Conclusion: FOIS has high screening power of oropharyngeal dysphagia in toddlers, with high prediction of fluids and semisolids aspiration but not pharyngeal residue. It was also highly predictive of oral phase dysphagia.