Isolated bulbar palsy and dysphagia in children with respiratory symptoms

Abstract

Oropharyngeal dysphagia can cause chronic aspiration leading to significant respiratory symptoms. When dysphagia is diagnosed, an underlying cause is sought. We present a case series of 15 children diagnosed aged 6 months to 5 years (mean 2y 5mo; 11 males, four females) over a 6‐year period, who were found to have an isolated bulbar palsy on genioglossus electromyography, with no accompanying neurological or neurodevelopmental disorder. Eight children had dysphagia but a normal EMG. In those with isolated bulbar palsy, management included thickened fluids (n=13), cooled boiled water (n=1), and nasogastric tube feeding (n=1). Follow‐up over 1 to 8 years (mean 5y) showed complete resolution in six children, improvement in four children, and no improvement in five children (including two requiring fluids via a gastrostomy). Eight children no longer had any respiratory symptoms. Isolated bulbar palsy is under‐recognized and has not been reported previously as a cause of significant dysphagia in children.

Dysphagia in Children: Review

“…По данным ряда авторов, до 46% случаев дисфагии у детей составляют пациенты с ДЦП [20,94]. В то же время клиническая картина орофарингеальной дисфагии с хронической аспирацией встречается и при изолированном бульбарном параличе [108]. Таким образом, с пациентами с дисфагией может встретиться врач любой специализации.…”

The effect of stiffness and hole size on nipple compression in infant suckling

“…Infant mammals have highly developed oral sensory abilities at birth, which provides specific input to the central nervous system for efficient and effective suckling. When the sensory connections involved in infant feeding are disrupted, feeding performance is compromised and infants may suffer from illness, malnourishment, and potentially life‐long developmental issues (Adjerid et al, 2021 ; Ballester et al, 2018 ; Catchpole et al, 2020 ; DeLozier et al, 2018 ; Ding et al, 2013 ; Gould et al, 2015 , 2016 , 2017 , 2020 ; Hadders‐Algra, 2018 ; Liu et al, 2018 ; Mayerl, Catchpole, et al, 2020 ; Zimmels et al, 2021 ). Yet, sensory motor integration in human infant suckling is not fully understood, making it difficult to predict how changes to sensory input affect feeding behaviors (Gould et al, 2019 ; Jean, 2001 ; Young et al, 2015 ).…”

“…suffer from illness, malnourishment, and potentially life-long developmental issues (Adjerid et al, 2021;Ballester et al, 2018;Catchpole et al, 2020;DeLozier et al, 2018;Ding et al, 2013;Gould et al, 2015Gould et al, , 2016Gould et al, , 2017Gould et al, , 2020Hadders-Algra, 2018;Liu et al, 2018;Mayerl, Catchpole, et al, 2020;Zimmels et al, 2021). Yet, sensory motor integration in human infant suckling is not fully understood, making it difficult to predict how changes to sensory input affect feeding behaviors (Gould et al, 2019;Jean, 2001;Young et al, 2015).…”