Pediatric Dysphagia Research Articles

Updates on pediatric feeding and swallowing problems

There is increased recognition in the range of feeding and swallowing problems that occur in conjunction with congenital and acquired pediatric conditions. Differential diagnosis and management of these problems is often not straightforward and requires consideration and collaboration between multiple disciplines that are involved in the care of this special population. This article reviews recent investigations across disciplines regarding the cause and evaluation of pediatric feeding and swallowing issues, intervention efficacy, and available evidence to guide clinical practice. Knowledge of the basis for feeding issues associated with a variety of causes has advanced. Recent investigations of specific feeding and swallowing issues accompanying prematurity, selected diagnoses, and congenital syndromes are described. Significant advancements in the objective analysis of nonnutritive sucking have been made and provide increased understanding of the precursors for transition to oral feeding. Preliminary evidence regarding the effectiveness of selected clinical interventions to treat feeding and swallowing issues is highlighted. Research is increasingly available to guide practitioners in evidence-based evaluation and management of pediatric feeding and swallowing issues. These continued advancements increase our understanding of the causes of pediatric dysphagia, the efficacy of treatment, and underscore the opportunities for continued research for best practice in clinical evaluation and management.

Return to a Chinese Orphanage

Return to a Chinese Orphanage

The Aerodigestive Clinic: Multidisciplinary Management of Pediatric Dysphagia

Abstract The purposes of this article are (a) to explore the relationship between pediatric upper airway obstruction and dysphagia and (b) to highlight the benefits of using a multidisciplinary approach when assessing infants and children with upper respiratory and swallowing disorders. The functions of breathing and swallowing are tightly coordinated in infants and young children, and pediatric upper airway disorders can often adversely affect the swallowing mechanism and may even predispose the individual to aspiration. Some of the more common causes of pediatric airway obstruction seen in this setting are laryngomalacia, vocal fold paralysis, laryngeal cleft, and Pierre Robin's sequence. In the setting of all of these disorders, associations may also exist with gastroesophageal reflux (GER) and laryngopharyngeal reflux, and this topic is also reviewed. In the multidisciplinary assessment of young children with aerodigestive disorders, fiberoptic flexible endoscopic evaluation of swallowing has gained traction as a useful test for simultaneous evaluation of pediatric upper airway obstruction and dysphagia and has provided complimentary information to the more traditional pediatric videofluoroscopic swallowing evaluation. A representative case study is provided that illustrates the relationship between pediatric upper airway obstruction and dysphagia and demonstrates the effectiveness of a multidisciplinary approach.

Development of Swallowing Function Along the Prenatal to Postnatal Continuum

Abstract Developmental information is the cornerstone of diagnosis and intervention in pediatric dysphagia. Ongoing research has refined specific parameters of growth and development of the swallow from the prenatal through the postnatal period. The intent of this article is to review the latest findings regarding normal development of feeding/swallowing from the time the fetus is in utero through the postnatal period. This information may provide clinicians valuable tools to make adaptations within the clinical decision making process.

An Overview of Pediatric Dysphagia

Difficulty swallowing or dysphagia can be present in children and adults alike. Pediatric dysphagias have long been recognized in the literature. Certain groups of infants with specific developmental and/or medical conditions have been identified as being at high risk for developing dysphagia. Still others may present with a swallowing or feeding problem as their primary symptom. Left untreated, these problems in infants and children can lead to failure to thrive, aspiration pneumonias, gastroesophageal reflux, and/or the inability to establish and maintain proper nutrition and hydration. Awareness of the prevalence of pediatric dysphagia in today's population and the signs and symptoms of this condition aids in its treatment. Early detection of dysphagia in infants and children is important to prevent or minimize complications. This article provides a review of symptoms, etiologies, and resources available regarding management of this condition to help the primary care physician and the families of young children and infants in its management.

Family Perceptions of Facilitators and Inhibitors of Effective School-Based Dysphagia Management

This qualitative study focused on the perceptions of family members of children with dysphagia by asking what the family-identified factors are that facilitate or inhibit effective school-based management of pediatric dysphagia. Semistructured interviews of 7 family members of 6 children with dysphagia, ages 2 through 11 years, were conducted. Collective case study and cross-case analyses were conducted. The findings were confirmed through triangulation, respondent validation, and member checking. Interviewees identified 5 facilitating factors that enhance school-based dysphagia programs: (a) setting, (b) therapist and/or program, (c) capitalizing on positive child characteristics, (d) home-school interactions, and (e) external supports. Four factors that inhibit effectiveness also emerged: (a) setting, (b) therapist and/or program, (c) limiting child characteristics, and (d) home-school interactions. Practitioners may consider addressing the factors that were identified as facilitators of effective programs. More research is needed concerning (a) factors promoting effective parent-professional relationships, (b) methods for increasing professional preparation in pediatric dysphagia, and (c) the efficacy of school-based pediatric dysphagia management programs.

Managing Dysphagia in the Schools

Purpose This epilogue summarizes the contribution of the articles in the clinical forum, “Managing Dysphagia in the Schools” and discusses future trends in pediatric dysphagia and the need for clinical practice and research. Method The contribution of each of the 10 articles that make up the forum is summarized briefly. Conclusion This clinical forum provides a discussion of numerous issues that need to be considered by clinicians working with children who exhibit swallowing and feeding problems and their families in school settings. Current and future challenges exist for clinicians, children, and families dealing with dysphagia. Discussion of current issues and strategies for successful treatment outcomes are provided.

The use of pulse oximetry as a screening assessment for paediatric neurogenic dysphagia

Purpose: Early screening and intervention for dysphagia is crucial to offset potential outcomes such as compromised nutrition or reduced respiratory function. Current paediatric dysphagia screening tests are subjective with poor sensitivity and specificity. The present study examined whether an objective method, pulse oximetry (measuring oxygen saturation (SpO2) levels), could differentiate between children with and without dysphagia, in relation to (1) Average pre-feeding baseline SpO2 levels; (2) Average feeding SpO2 levels; (3) Average post-feeding SpO2 levels; and (4) The number of events of oxygen desaturation pre-, during and after feeding.Methods: Nine participants with chronic neurological disability (CND) (7 F, 2 M) (9;7–15;11 years) and nine control participants matched for age (9;5–16;0 years) and sex were assessed using a clinical bedside evaluation (CBE) and pulse oximetry.Results: A statistically significant difference was found in SpO2 levels between the two groups (p < 0.001) during oral feeding only (sensitivity, 88.9%; specificity, 88.9%). Only three children with dysphagia experienced ‘events’ of SpO2 desaturation during feeding.Conclusion: Pulse oximetry may provide a useful adjunct to the CBE for dysphagia screening, with average SpO2 levels during feeding predicting those with and without dysphagia with moderate levels of sensitivity and specificity. The finding of individual variation in desaturation ‘events’, however, warrants the provision of further data on large homogenous populations to provide definitive criterion for pathological SpO2 levels associated with dysphagia during oral feeding.Propósito: El estudio y la intervención temprana de la disfagia es crucial para tener potencial offset resultados tales como la nutrición comprometida, o la reducción de la función respiratoria. Las pruebas de estudio de la disfagia en pacientes pediátricos son subjetivas y con una especificidad y sensibilidad pobres. El presente estudio evaluó sí un método objetivo como la oximetría de pulso (midiendo los niveles de saturación de oxígeno(SpO2) podría diferenciar entre niños con y sin disfagia, en base a: 1. Promedio de los niveles baasales de SpO2 antes de la alimentación. 2. Promedio de los niveles de SpO2 durante la alimentación. 3. Promedio de niveles de SpO2 después de la alimentación. 4. El número de eventos de desaturación de oxígeno antes, durante y después de la alimentación. Métodos: Se evaluaron a nueve participantes con una discapacidad neurológica crónica (CND) (7F, 2M)(9;7 A 15;11 años) y a nueve participantes de grupo control de igual género y con edades similares (9;5 a 16;0 años); usando una evaluación clínica para pacientes encamados (CBE) junto con la oximetría de pulso. Resultados: Se encontró una diferencia estadísticamente significativa en los niveles de SpO2 entre los dos grupos (p < 0.001) solamente durante la alimentación oral (sensiblidad, 88.9%; especificidad, 88,9%). Solamente tres niños con disfagia experimentaron “eventos” de desaturación de SpO2 durante la alimentación. Conclusión: La oximetría de pulso puede ser útil para la evaluación de la disfagia en CBE, utilizando el promedio de los niveles de SpO2 durante la alimentación, y prediciendo con niveles moderados de sensibilidad y especificidad quienes cursarán con disfagia y quienes no. El resultado de variaciones individuales en los “eventos “de desaturación, asegurará la obtención subsecuente de datos en grandes poblaciones homogéneas y brindará los criterios definitivos para determinar los niveles de SpO2 patológicos asociados a disfagia durante la alimentación oral. Palabras claves: Discapacidad neurológica, discapacidad intelectual, niño, disfagia, alteraciones en la deglución, oximetría de pulso

Recent International Trends in Rehabilitation of Pediatric Dysphagia

Recent International Trends in Rehabilitation of Pediatric Dysphagia

Assessment of pediatric dysphagia and feeding disorders: Clinical and instrumental approaches

Assessment of infants and children with dysphagia (swallowing problems) and feeding disorders involves significantly more considerations than a clinical observation of a feeding. In addition to the status of feeding in the child, considerations include health status, broad environment, parent-child interactions, and parental concerns. Interdisciplinary team approaches allow for coordinated global assessment and management decisions. Underlying etiologies or diagnoses must be delineated to every extent possible because treatment will vary according to history and current status in light of all factors that are often interrelated in complex ways. A holistic approach to evaluation is stressed with a primary goal for every child to receive adequate nutrition and hydration without health complications and with no stress to child or to caregiver. Instrumental swallow examinations that aid in defining physiological swallowing status are needed for some children. Successful oral feeding must be measured in quality of meal time experiences with best possible oral sensorimotor skills and safe swallowing while not jeopardizing a child's functional health status or the parent-child relationship.

Pediatric Dysphagia: The 10th Anniversary Issue

It has been a decade since Joan Arvedson and Maureen Lefton-Greif edited an invaluable two-part series on Pediatric Dysphagia for Seminars in Speech and Language (Volume 17, Number 4 and Volume 18, Number 1). At that time, it was one of Seminars' most frequently completed activities. In the decade since the publication of that series, treatment of children with dysphagia has continued to evolve; it continues to be a pressing health issue for which many practicing speech-language pathologists (SLPs) urgently seek guidance. Thus, it is fitting that we re-address and update this important area of practice, which has grown in scope and complexity.

Managing Dysphagia in the Schools

Managing Dysphagia in the Schools

Can we breathe and swallow at the same time?

The article by Samson et al. ([7][1]) in this issue of the Journal of Applied Physiology raises new issues concerning the regulation of nonnutritive swallowing (NNS) and breathing during sleep. The past 10 years have seen a large increase in interest in this field ([2][2], [3][3]). Clearly, NNS is

The Role of Oral Sensorimotor Therapy in the Treatment of Pediatric Dysphagia

The Role of Oral Sensorimotor Therapy in the Treatment of Pediatric Dysphagia

Conference Explored Vocal Pathologies, Dementia, and Pediatric Dysphagia

Conference Explored Vocal Pathologies, Dementia, and Pediatric Dysphagia

Clinical progression and outcome of dysphagia following paediatric traumatic brain injury: a prospective study

Objectives: To provide a preliminary clinical profile of the resolution and outcomes of oral-motor impairment and swallowing function in a group of paediatric dysphagia patients post-traumatic brain injury (TBI). To document the level of cognitive impairment parallel to the return to oral intake, and to investigate the correlation between the resolution of impaired swallow function versus the resolution of oral-motor impairment and cognitive impairment.Participants: Thirteen children admitted to an acute care setting for TBI.Main outcome measures: A series of oral-motor (Verbal Motor Production Assessment for Children, Frenchay Dysarthria Assessment, Schedule for Oral Motor Assessment) and swallowing (Paramatta Hospital’s Assessment for Dysphagia) assessments, an outcome measure for swallowing (Royal Brisbane Hospital’s Outcome Measure for Swallowing), and a cognitive rating scale (Rancho Level of Cognitive Functioning Scale).Results: Across the patient group, oral-motor deficits resolved to normal status between 3 and 11 weeks post-referral (and at an average of 12 weeks post-injury) and swallowing function and resolution to normal diet status were achieved by 3–11 weeks post-referral (and at an average of 12 weeks post-injury). The resolution of dysphagia and the resolution of oral-motor impairment and cognitive impairment were all highly correlated.Conclusion: The provision of a preliminary profile of oral-motor functioning and dysphagia resolution, and data on the linear relationship between swallowing impairment and cognition, will provide baseline information on the course of rehabilitation of dysphagia in the paediatric population post-TBI. Such data will contribute to more informed service provision and rehabilitation planning for paediatric patients post-TBI.

Advances in the evaluation and management of pediatric dysphagia.

Feeding and swallowing problems in the pediatric population, commonly referred to as pediatric dysphagia, are often complex. Multiple disciplines are frequently involved in both the evaluation and the management of symptoms exhibited by an increasing number of infants and children. The efficacy of commonly employed diagnostic and treatment strategies has been largely unexplored, although there has been a steadily increasing amount of research specific to pediatric dysphagia. Recent research efforts are reviewed which contribute data necessary for development of evidence-based evaluation and management methods. Research contributions over the past year have included continued work in the classification and categorization of the widely varied causes of pediatric dysphagia. Research efforts have also focused on objective data of swallowing mechanics by use of diagnostic tools such as videofluoroscopy, endoscopy, and electromyography. Recent advances in approaches to the management of pediatric dysphagia symptoms secondary to achalasia and eosinophilic esophagitis are discussed. Research that contributes to the base of knowledge regarding diagnosis and treatment of pediatric dysphagia has been consistently accumulating in recent years, yet much work remains to be done. Continued research studies, both retrospective and prospective in nature, are clearly needed to continue to build evidence-based evaluation and treatment protocols for pediatric dysphagia.

The pros and cons of videofluoroscopic assessment of swallowing in children

In the last 20 years there has been increasing use of videofluoroscopy (VFSS) as part of the assessment and management of oropharyngeal dysphagia in children. It is from and during these assessments that management is often trialled and planned. A critical review of the literature was undertaken to examine the pros and cons of VFSS assessment in children. The aim was to determine what evidence existed for the use of VFSS in the diagnosis and management of dysphagia in children. There is a large literature concerning the use of VFSS in children and adults. The majority overwhelmingly recommends VFSS as a useful adjunct in the assessment and management of dysphagia. In particular, many published articles focus on how VFSS aids in the identification and confirmation of aspiration. VFSS is a commonly used clinical procedure in paediatric dysphagia. The authors identified 17 original articles that contained patient data and examined the use of VFSS in children. Results revealed that VFSS has not been compared with other investigative procedures (e.g. nasoendoscopy) to determine whether it yields the same or better results or is cost effective in children. Very few studies have sought to examine whether the use of VFSS in children result in better health outcomes. Interpretation of the existing data was affected by small sample sizes, the age range of the children studied and diagnostic groups. Future research priorities are identified.

An interdisciplinary team approach to providing dysphagia treatment in the schools.

The diagnosis and treatment of pediatric dysphagia in school systems are still in the infancy stages. They are being addressed in a variety of ways and by a variety of personnel. Speech-language pathologists (SLPs) in school systems throughout the country are faced with students who exhibit the signs and symptoms of dysphagia; however, there is a lack of organized procedures for the diagnosis and treatment of dysphagia in the schools. In some cases, SLPs are asked to treat a disorder for which they have no training. In both scenarios there are concerns about the services that students are receiving as well as professional liability. The purpose of this article is to address some of the more pressing issues related to the diagnosis and treatment of dysphagia in the schools and to provide the school-based SLP with some solutions to these problems. The question to be answered is, What is the best way to address dysphagia in the schools?

Acute characteristics of pediatric Dysphagia subsequent to traumatic brain injury: videofluoroscopic assessment.

To document the acute characteristics of swallowing impairment in a group of children post moderate/severe traumatic brain injury (TBI) by means of videofluoroscopy. Eighteen children with moderate/severe TBI. Videofluoroscopy at an average of 27.7 days post-injury. Subjects demonstrated a range of dysphagia severity levels: mild-moderate (n = 8), moderate (n = 6), moderate-severe (n = 3), and severe (n = 1) and had a combination of oral and pharyngeal phase characteristics. More specifically, observable features or physiological impairments that were identified included reduced lingual control, hesitancy of tongue movement, repetitive tongue pumping, the presence of aspiration (including silent aspiration), delayed swallow reflex trigger, reduced laryngeal elevation and closure, and reduced peristalsis. These data highlight the diversity of swallowing deficits and dysphagia severity levels in children following TBI and suggest that the former are consistent with a pattern of oropharyngeal impairments.