Clinical Characteristics of Dysphagia in Children with Down Syndrome

Abstract

Aspiration is an often unrecognized comorbidity in children with Down syndrome with serious medical consequences. This retrospective chart review of swallow study reports characterizes oral and pharyngeal phase dysphagia and diet modifications on videofluoroscopic swallow studies (VFSS) in a large cohort of children with Down syndrome. A total of 158 pediatric patients (male=95; female=63; mean age 2.10years, SD 3.17years) received an initial VFSS at a pediatric teaching hospital as part of their medical care. A total of 56.3% (n=89) children had pharyngeal phase dysphagia with aspiration and deep laryngeal penetration occurring most frequently. Of the 61 patients who aspirated, 90.2% (n=55) did so silently with no cough or overt clinical symptoms. In 76.7% of cases of pharyngeal phase dysphagia, a functional feeding plan, with use of thickened liquids or change in feeding system to control flow rate and/or bolus size, was able to be established, which allowed children to continue eating by mouth. Thickened liquids (76.7%, n=46) were the most effective adaptation, with change in feeding system alone effective in only 8.3% (n=5) cases. Oral phase dysphagia was reported in the majority of patients (63.8%, n=88/138); however, this was not predictive of pharyngeal phase dysphagia. Age, sex, and reason for referral, including prior clinical symptoms, did not have a statistically significant impact on the presence of dysphagia. This comprehensive review has application to clinical understanding and management of dysphagia in children with Down syndrome.