Associations between age, respiratory comorbidities, and dysphagia in infants with down syndrome

Abstract

Objectives: Children with Down syndrome (DS) have a high risk of dysphagia and the pediatric pulmonologist may be involved in diagnosis and management. The objective of this study is to evaluate the associations between age, dysphagia, and medical comorbidities in young children with DS. We hypothesized that swallow study findings are more likely to change in younger infants and that medical comorbidities may be associated with dysphagia. Study design: Results of videofluoroscopic swallow studies (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) from 2010 to 2016 were collected retrospectively in children with DS with initial swallow study at less than 12 months of age. Results were analyzed for findings and change based on age at initial study, reason for referral, and medical comorbidities. Results: One hundred eleven infants with 247 VFSS and 14 FEES were included. Deep laryngeal penetration and/or aspiration were found in 31.9% of infants less than 6 months and 51.3% of infants 6 to 12 months. Children with initial swallow study performed at greater than or equal to 6 months of age were more likely (80.0%) to have unchanged findings on follow‐up study compared to children imaged at less than 6 months (35.3%). Laryngomalacia, pulmonary hypertension, pneumonia, and congenital cardiac disease were associated with dysphagia. Conclusion: We confirmed that dysphagia is common in infants with DS and comorbidities and provided preliminary evidence that swallow study findings may be more likely to change in children tested under 6 months of age. Providers should consider that results for instrumental swallow studies may change, particularly if the test was completed on a young infant.

Nutritional challenges in children and adolescents with Down syndrome

“…In the cases where aspiration was detected, almost all (90 %) aspirated silently. A recent study found aspiration in 32 % of infants evaluated before 6 months of age, whereas aspiration was detected in 52 % of children between 6-12 months of age (29). In this study, children subjected to swallow assessment after 6 months of age were more likely to have unchanged findings on follow-up, compared to children evaluated before 6 months of age.…”

Down Syndrome and COVID-19: A Perfect Storm?

“…[82][83][84] Dysphagia and aspiration, which are more common in DS, could also increase the predisposition to lung infection in this population. 85,86 In addition to these structural factors, hypotonia can increase the likelihood of proximal airway obstruction and dysphagia in DS. 83,86 Obstructive sleep apnea (OSA), which is very common in people with DS, 87,88 can often cause chronic intermittent hypoxia and respiratory acidosis, which in turn can drive pulmonary hypertension, a condition that is also more common in DS.…”

“…85,86 In addition to these structural factors, hypotonia can increase the likelihood of proximal airway obstruction and dysphagia in DS. 83,86 Obstructive sleep apnea (OSA), which is very common in people with DS, 87,88 can often cause chronic intermittent hypoxia and respiratory acidosis, which in turn can drive pulmonary hypertension, a condition that is also more common in DS. 89,90 Therefore, OSA could indirectly create an additional risk factor for the severity of COVID-19 by accelerating hypoxemia, predisposing to pulmonary hypertension, and decreasing cardiopulmonary capacity.…”

Pneumonia and respiratory infections in Down syndrome: A scoping review of the literature

“…Early in life, infants with DS are at an increased risk for dysphagia and silent aspiration, both of which are risk factors for and can present as pneumonia (Stanley et al, 2019). In the first year of age, pneumonia is associated with dysphagia in children with DS (Jackson, Maybee, Wolter-Warmerdam, DeBoer, & Hickey, 2019). Then, in childhood, pneumonia is the #1 cause of hospital admissions, and lower respiratory tract infections accounted for 40% of admissions (Hilton, Fitzgerald, & Cooper, 1999).…”