Dysphagia progression and feeding skills following pediatric alkali ingestion injury: two case reports

Abstract

Recovery from dysphagia post-alkali ingestion is protracted and complex. Dysphagia, delayed oral motor skills, and difficult mealtime behaviors may persist secondary to ingestion injury and its associated complications. These cases highlight the importance of considering early referral for feeding assessment and intervention to assist children and families with recovery. Progression through safe and effective oral (per os, PO) intake is needed, as well as provision of support for primary caregivers. Implications for Rehabilitation Pediatric chemical ingestion injury can cause long-term dysphagia and long-term feeding difficulties Initial injury severity does not reliably correlate with eventuating level of aerodigestive impairment. Clinical and instrumental assessment is required to monitor swallow function to enable commencement of targeted rehabilitation when appropriate. Early involvement of a feeding therapist is recommended to minimize the long-term effects on oral motor skill development, progression to age-appropriate diet, and provision of family-centered care.

Papel do fonoaudiólogo na disfagia por ingestão cáustica em crianças: revisão sistemática

“…A partir da revisão foram encontrados cinco artigos 13,14,15,16,17 que preenchiam os critérios para a inclusão final, sendo que não houve divergência na seleção dos estudos entre os pesquisadores. Todos avaliaram crianças de idades que variaram de 11 meses até 12 anos e 3 meses e tiveram como objetivo verificar a eficácia de algum tratamento médico específico para alterações decorrentes da ingestão de agentes cáusticos na função de deglutição.…”

“…Quanto à atuação fonoaudiológica, todos os trabalhos realizaram a avaliação não instrumental da deglutição antes e após o tratamento médico, sendo que, destes, dois realizaram avaliação instrumental da deglutição 15,16 Dehghani, Aldaghi, Javaherizadeh, 2016 (14) Iran da pressão intra-oral e dificuldade de ejeção do bolo alimentar para faringe 27,28 . Acredita-se que na ingestão cáustica acidental, as lesões em cavidade oral, orofaringe e esôfago ocorram com maior proporção devido à característica amarga da substância, fazendo com que seja expelida rapidamente 23 .…”

“…Dehghani, Aldaghi, Javaherizadeh, 2016 (14) Iran Analisar o caso de uma criança internada por estenose corrosiva e relatar o uso de piloroplastia endoscópica e dilatação com balão esofágico.…”

Dysphagia and feeding difficulties post-pediatric ingestion injury: Perspectives of the primary caregiver

“…Instrumental assessment data relating to swallow function was not available for all participants in this study. However, a prospective case study analysis of two children post-ingestion injury which includes this information has been published elsewhere [28]. The telephone interview was administered in two parts.…”

“…It is acknowledged that patients in this study were managed through the same quaternary hospital, and some issues raised, such as access to services, may not reflect the exact experience of children admitted to other centers. However, limited involvement of speech pathology in the care of children with ingestion injuries has been reported as a common occurrence across acute-care facilities servicing this population [51]. Furthermore, there are many features of this research that can be applied to other populations in exploring the impact of complex medical conditions or traumatic injury on families.…”