Infancy and childhood represent a time of unparalleled physical growth and cognitive development. In order for infants and children to reach their linear and neurological growth potential, they must be able to reliably and safely consume sufficient energy and nutrients. Swallowing difficulties (dysphagia) in pediatric populations can have a detrimental effect on dietary intake and, thus, growth and development. As a result, it is imperative to accurately identify and appropriately manage dysphagia in pediatric populations. This article provides an overview of dysphagia in children, as well as common causes of childhood swallowing difficulties, populations at risk for pediatric dysphagia, techniques used to assess swallowing in pediatric patients, and the current treatment options available for infants and children with dysphagia.

Aspiration is a significant cause of respiratory morbidity and sometimes mortality in children. It occurs when airway protective reflexes fail, especially, when dysphagia is also present. Clinical symptoms and physical findings of aspiration can be nonspecific. Advances in technology can lead to early diagnosis of dysphagia and aspiration, and, new therapeutic advances can significantly improve outcome and prognosis. This report first reviews the anatomy and physiology involved in the normal process of swallowing. Next, the protective reflexes that help to prevent aspiration are discussed followed by the pathophysiologic events that occur after an aspiration event. Various disease processes that can result in dysphagia and aspiration in children are discussed. Finally, the various methods for diagnosis and treatment of dysphagia in children are reviewed.

Additional empirical evidence is warranted to determine the most reliable methods and safest products for thickening infant formula when necessary for effective dysphagia management.

Thickened liquids are a common treatment for dysphagia; however, little is known about their effects in children. The aim of this systematic review was to summarize the state and quality of evidence for the use of thickened liquids on swallowing physiology, oral feeding, weight gain/growth, hydration, and pulmonary health outcomes in children with dysphagia. Another aim was to identify any increased occurrence of adverse effects that may be associated with their use in all children, not just those with dysphagia. A total of 24 electronic databases were systematically searched. Articles meeting the inclusion criteria were evaluated for methodological quality by 2 reviewers and vetted by a third. In total, 22 studies were included. Six studies, with significant methodological limitations, examined the effects of thickened liquids on swallowing physiology or pulmonary health outcomes and reported mixed findings. Sixteen studies examined adverse effects and indicated that among a select pediatric population with gastroesophageal reflux, no significant increase in the rate of adverse effects from the use of thickened liquids was noted. Results of this review highlight the insufficient evidence base for this popular treatment option. Additional experimental research is warranted to understand the efficacy and effectiveness of thickened liquid use in the pediatric population.

Previous research shows that factors such as time, temperature, nutritional make‐up of a liquid, and type of thickening agent can significantly alter the resulting thickness of liquids. This study sought to determine the effect of three distinct mixing methods on the resulting thickness of ready to feed infant formulas mixed to Mildly and Moderately Thick (International Dysphagia Diet Standardization Initiative [IDDSI] Levels 2 and 3) with three different thickening agents. Eight commercially available infant formulas were mixed with three different thickening agents by three different mixing methods. The IDDSI Syringe Flow Test was used to categorize the thickened formulas. Chi square analyses were completed to determine the impact of mixing method on the thickened formulas. The majority (94%) of thickened formula combinations prepared to a target Mildly Thick consistency produced thickened formula that was thinner or thicker than the target. In contrast, the majority (76%) of thickened formula combinations prepared to a target Moderately Thick (IDDSI Level 3) consistency produced thickened formula that was equivalent to the target consistency. A statistically significant relationship was found between mixing methods and resulting IDDSI category for samples mixed to a target of Moderately Thick. The thickening agent and method of mixing must be considered carefully when preparing infant formulas to Mildly and Moderately Thick target IDDSI categories. Based on results of this study, it is recommended that providers utilize a clinical testing method, such as the IDDSI Syringe Flow Test, when attempting to create a Mildly Thick formula consistency.

Purpose Individuals with dysphagia across the age continuum may require dietary modifications of fluids and foods for safe and adequate oral intake. Considerations of this frontline intervention are presented in this clinical forum dedicated to the discussion of dysphagia. Method This clinical focus article reviews the technical challenges of providing modified fluids and foods across the life span as well as the literature specific to its origins, efficacy, challenges and solutions to standardization, and the methods for ensuring quality service delivery. Conclusion Dietary modification is an often-used method of dysphagia management that presents unique challenges to the clinician for successful application. Speech-language pathologists in clinical practice across all settings must remain dedicated to evidence-based practice as they navigate service delivery of this strategy to individuals with dysphagia across the life span.

No abstract

There is little reported evidence regarding the reliability of temporal and physiologic features of infant swallowing from videofluoroscopic swallowing studies (VFSS). The purpose of this retrospective study was to determine a reliable set of temporal and physiologic features from infant swallowing that can be measured from analysis of VFSS. Temporal and physiologic features for testing were determined from review of previously reported features of infant VFSS in the literature. Two novel analysts underwent three training sessions to learn and practice visual recognition of the proposed features. The two analysts then assessed 25 swallows from 10 total subjects' VFSS. To establish inter- and intra-rater reliability, calculation of Pearson's r was used for features that met criteria for parametric analysis and Spearman's rank correlation coefficient was used for the non-continuous features. Percent agreement was used to report on the reliability of the dichotomous features due to insufficient variability for Spearman's rho analyses. Fifteen of the 16 tested features were found to have acceptable inter- and intra-rater reliability measures, with each analyst achieving a correlation of 0.75 or higher. This project identifies 15 variables that can be reliably measured from infant VFSS. This information can be used to assist with determination of normal versus abnormal swallow features and in developing and testing therapeutic strategies for infants with dysphagia.