Abstract
Children can present with a wide range of swallowing impairments. This may affect from neonates, infants,toddlers, young children to early teens. The most serious outcome of a severe swallowing impairment is gross aspiration leading to violation of airway and its consequences such as recurrent aspiration pneumonias, sepsis, poor weight gain, failure to thrive and long term developmentalsequel. Assessment of swallowing is done in children using perceptual clinical swallowing assessment by a speech and language therapist. This isa subjective assessment and may not clearly identify the defective phase of swallowing and may miss silent aspiration. Instrumental swallowing assessment is a method to identify swallowing impairment by objective evaluation of the entire swallowing process. This would identify the phase and quantify the severity of the impairment. It is mainly done in two ways. i.e. the Functional Endoscopic Evaluation of swallowing (FEES) and Video Fluoroscopic Swallow Study (VFSS). Both are valuable methods as they separately assess different phases of swallowing. The results are invaluable in further treatment of these children to overcome or mitigate their impairment. FEES involves inserting a fibro-optic pediatric laryngoscope in the child’s pharynx via the nose and simultaneous observation of swallowing mechanism while feeding orally. VFSS involves fluoroscopic viewing of the swallowing process while giving food mixed with a radio opaque substance. VFSS is further helpful in intra proceduralpositional maneuversand change in food consistencies to overcome the given impairment.
Highlights
IntroductionPaediatric swallowing disorders are common and the incidence is increasing
Increased survival rates of children with histories of prematurity, low birth weights and complex medical conditions might explain the recent increase in paediatric dysphagia 8
Children and infants can present with swallowing difficulties
Summary
Paediatric swallowing disorders are common and the incidence is increasing They occur approximately in 1% of children in the general population 1. Paediatric dysphagia occurs commonly with multiple and complex medical and developmental disorders [2,3]. In this population the incidence is estimated to be from 33 to 80% 4,5.A large number of these children are born prematurely. The epiglottis touches the soft palate and the larynx is opened to the nasopharynx 9 Swallowing requires both voluntary and involuntary coordination and classically is divided in to 3 phases. They are oral, pharyngeal and oesophageal phases. Subjective assessment fails to identify the level of impairment accurately and does not confirm or exclude silent aspiration
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