SWALLOWING DISORDERS IN CHILDREN WITH BRAIN DAMAGE

Abstract

Most children with severe mental retardation may present severe swallowing disorders. These disorders, although sometimes fatal, have been understimated because of the lack of accurate diagnostic methods. The introduction of swallowing ultrasonographic and fluoroscopic videorecording has recently given an impulse to the role of radiology in the diagnosis and therapy of such disorders. The aim of our study was to define,by ultrasonographic videorecording, motility abnormalities of oral phase of swallowing in children with brain damage. We studied 25 children (8 males, 17 females; mean age ± SD: 4 ± 2.2; range:1 months - 15 years) affected by severe mental retardation (I.Q.< 35) referred for symptoms suggesting swallowing disorders. Symptoms in these 25 patients were: dysphagia for liquids in 20 (80%) and\or for semi-solid food in 20 (80%), nasal regurgitation in 17 (68%), vomiting in 12 (48%) choughing attack during the meal in 15 (60%), and anorexia in 18 (72%) patients. Each patient underwent ultrasonographic videorecording of swallowing using a G. E. RTX200 sonographic equipment with a 5 MHz sector trasducer and a JVS S-VHS videorecorder with slow motion, freeze and rewind device. Sagittal scans, through the submental acoustic window, were achieved with the patient sitting and stretched out. The study was achieved giving liquids and semisolid foods to the children. RESULTS: We found in 20/25 (80%) children an abnormal oral phase of swallowing: 10/25 (40%) showed incoordinate movements of tongue, 10/25 (40%) had contracted and rigid tongue with abnormal formation of bolus, 9/25 (36%) had reflux in the sovraglottis space, 6/25 (24%) showed delayed propulsion of bolus to the oropharynx. The 9 patients with reflux in the overglottis space presented at the same time coughing and\or apnea, maybe due to penetration of food in the respiratory tract. Four of these 9 patients underwent videofluoroscopic recording of swallowing which confirmed in all subjects laryngeal aspiration. CONCLUSIONS: Children with severe mental retardation may be affected by severe alterations of the oral phase of swallowing. These disorders could be responsible of malnutrition and of chronic pulmonary aspiration, often present in these group of subjects.