Dysfunctional swallowing in the pediatric patient: Clinical considerations

Abstract

Abstract. When caring for the pediatric patient with impaired or dysfunctional swallowing, the clinician must consider clinical issues unique to this age group. These include growth and development of the swallowing apparatus, maturation of feeding behavior, oral feeding and the development of parent-child bonding, and adequate nutrition for growth. This article will review these issues and examine their impact on the evaluation and treatment of the infant and child with dysfunctional swallowing.

Post-traumatic feeding disorders in infancy: Behaviors predicting treatment outcome

“…There is growing awareness of the interplay among various physiological and environmental contributors to infants' swallowing and eating skills and behaviors (Arts-Rodas & Benoit, 1998;Budd et al, 1992;Daws, 1993;Lindberg et al, 1991Lindberg et al, , 1996Lindberg, Bohlin, Hagekull, & Thunstrom, 1994;Tuchman, 1988). Such physiological contributors include (1) regulatory capacity (Benoit, in press-b;Lindberg et al, 1991;Skuse, 1993;Tuchman, 1988;Wolke et al, 1995), (2) oral-motor, oral-sensory, and oropharyngeal functioning (Bazyk, 1990;Ginsberg, 1988), (3) developmental readiness (Arts-Rodas & Benoit, 1998;Skuse, 1993), (4) health history (Arts-Rodas & Benoit, 1998;Bazyk, 1990), and (5) past feeding and "oral" experiences (Arts-Rodas & Benoit, 1998;Bazyk, 1990;Benoit et al, 1997;Chatoor et al, 1988;.…”

“…Such physiological contributors include (1) regulatory capacity (Benoit, in press-b;Lindberg et al, 1991;Skuse, 1993;Tuchman, 1988;Wolke et al, 1995), (2) oral-motor, oral-sensory, and oropharyngeal functioning (Bazyk, 1990;Ginsberg, 1988), (3) developmental readiness (Arts-Rodas & Benoit, 1998;Skuse, 1993), (4) health history (Arts-Rodas & Benoit, 1998;Bazyk, 1990), and (5) past feeding and "oral" experiences (Arts-Rodas & Benoit, 1998;Bazyk, 1990;Benoit et al, 1997;Chatoor et al, 1988;. Environmental contributors may include quality of the caregiver -infant relationship and numerous other psychosocial factors (Chatoor et al, 1988(Chatoor et al, , 1997Lindberg et al, 1996;Sanders, Patel, Le Grice, & Shepherd, 1993).…”

The evaluation of pediatric feeding abnormalities

“…Swallowing in utero has been observed in fetuses as young as 16 weeks gestational age, and it plays an important role in the maintenance of amniotic fluid balance [21,22]. In the second and third trimesters, the infant progressively displays elements of suckling activity, which have been shown by ultrasound to increase towards the end of gestation.…”

“…In turn, the well-being of the child, namely, the integrated functioning of all its organ systems, influences the process of feeding [22]. A thorough history is central to successful evaluation of a feeding problem and must cover all organ systems as well as information on the child's pattern of growth.…”

“…This may manifest itself in many ways; for example, as food selectivity or refusal, gagging or vomiting related to feeding, failure to thrive or weight loss [22,27]. Another frequent cause for referral is suspicion of airway compromise or aspiration because of coughing or choking during feeding, recurrent pneumonias, chronic congestion, recurrent bronchospasm, or apnea [27][28][29].…”