An Overview of Pediatric Dysphagia

Department of Speech-Language Pathology and Audiology, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY 10003, USA.
Clinical Pediatrics (Impact Factor: 1.15). 12/2008; 48(3):247-51. DOI: 10.1177/0009922808327323
Source: PubMed


Difficulty swallowing or dysphagia can be present in children and adults alike. Pediatric dysphagias have long been recognized in the literature. Certain groups of infants with specific developmental and/or medical conditions have been identified as being at high risk for developing dysphagia. Still others may present with a swallowing or feeding problem as their primary symptom. Left untreated, these problems in infants and children can lead to failure to thrive, aspiration pneumonias, gastroesophageal reflux, and/or the inability to establish and maintain proper nutrition and hydration. Awareness of the prevalence of pediatric dysphagia in today's population and the signs and symptoms of this condition aids in its treatment. Early detection of dysphagia in infants and children is important to prevent or minimize complications. This article provides a review of symptoms, etiologies, and resources available regarding management of this condition to help the primary care physician and the families of young children and infants in its management.

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    • "Swallow impairment is associated with several diseases, including stroke (Lindgren & Janzon, 1991; Miller, 2008), Parkinson's disease (Logemann, 2007), myasthenia gravis (Ertekin et al. 1998), pharyngeal myositis (Ertekin & Aydogdu, 2003), DiGeorge syndrome (Eicher et al. 2000), advanced stage Duchenne muscular dystrophy (Nozaki et al. 2007; Aloysius et al. 2008) and oculopharyngeal muscular dystrophy (OPMD) (Taylor, 1915; Victor et al. 1962). Additionally, dysphagia is also associated with ageing (Kawashima et al. 2004; Logemann, 2007; Prasse & Kikano, 2009). Studies from Japan, the Netherlands and the United Kingdom suggest that 11–16% of the elderly have dysphagia (Bloem et al. 1990; Kawashima et al. 2004; Eslick & Talley, 2008; Holland et al. 2011). "
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    ABSTRACT: The inability to swallow, or dysphagia, is a debilitating and life-threatening condition that arises with ageing or disease. Dysphagia results from neurological or muscular impairment of one or more pharyngeal muscles, which function together to ensure proper swallowing and prevent the aspiration of food or liquid into the lungs. Little is known about the effects of age or disease on pharyngeal muscles as a group. Here we show ageing affected pharyngeal muscle growth and atrophy in wild-type mice depending on the particular muscle analyzed. Furthermore, wild-type mice also developed dysphagia with ageing. Additionally, we studied pharyngeal muscles in a mouse model for oculopharyngeal muscular dystrophy, a dysphagic disease caused by a polyalanine expansion in the RNA binding protein, PABPN1. We examined pharyngeal muscles of mice overexpressing either wild-type A10 or mutant A17 PABPN1. Overexpression of mutant A17 PABPN1 differentially affected growth of the palatopharyngeus muscle dependent on its location within the pharynx. Interestingly, overexpression of wild-type A10 PABPN1 was protective against age-related muscle atrophy in the laryngopharynx and prevented the development of age-related dysphagia. These results demonstrate that pharyngeal muscles are differentially affected by both ageing and muscular dystrophy in a region-dependent manner. These studies lay important groundwork for understanding the molecular and cellular mechanisms that regulate pharyngeal muscle growth and atrophy, which may lead to novel therapies for individuals afflicted with dysphagia.This article is protected by copyright. All rights reserved
    The Journal of Physiology 10/2014; 592(23). DOI:10.1113/jphysiol.2014.280420 · 5.04 Impact Factor
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    • "In animals which use a common oropharyngolaryngeal passage for breathing and swallowing, the coordination of each activity is of vital importance to sustaining life and airway protection. Proper synchronization of functionally shared passages is reliant upon common neurological pathways originating from brainstem nuclei (Bolser et al., 2006), with loss of regulation potentially leading to a range of negative sequelae including aspiration, malnutrition, and dehydration (Prasse and Kikano, 2009; Shaker et al., 1992). "
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    ABSTRACT: Herein we compare the effects of perturbations in the Kölliker-Fuse nucleus (KFN) and the lateral (LPBN) and medial (MPBN) parabrachial nuclei on the coordination of breathing and swallowing. Cannula were chronically implanted in goats through which ibotenic acid (IA) was injected while awake. Swallows in late expiration (E) always reset while swallows in early inspiration (I) never reset the respiratory rhythm. Before cannula implantation, all other E and I swallows did not reset the respiratory rhythm, and had small effects on E and I duration and tidal volume (VT). However, after cannula implantation in the MPBN and KFN, E and I swallows reset the respiratory rhythm and increased the effects on I and E duration and VT. Subsequent injection of IA into the KFN eliminated the respiratory phase resetting of swallows but exacerbated the effects on I and E duration and VT. We conclude that the KFN and to a lesser extent the MPBN contribute to coordination of breathing and swallowing.
    Respiratory Physiology & Neurobiology 06/2013; 189(1). DOI:10.1016/j.resp.2013.06.003 · 1.97 Impact Factor
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    • "Immediate appropriate intervention is required for infant dysphagia, because it can cause not only respiratory organ complications such as aspiration pneumonia, but also malnutrition and developmental delays [3,17,18]. Feeding interventions in infants involve position changes, flow rate adjustment, texture modification, oral stimulation, desensitization, nutritional interventions and alternative feeding [18,19]. Accurate identification of the pathophysiology of swallowing abnormalities via VFSS is helpful for determining appropriate feeding interventions [20]. "
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    ABSTRACT: To determine the clinical characteristics and videofluoroscopic swallowing study (VFSS) findings in infants with suspected dysphagia and compare the clinical characteristics and VFSS findings between full-term and preterm infants. A total of 107 infants (67 full-term and 40 preterm) with suspected dysphagia who were referred for VFSS at a tertiary university hospital were enrolled in this retrospective study. Clinical characteristics and VFSS findings were reviewed by a physiatrist and an experienced speech-language pathologist. The association between the reasons of referral for VFSS and VFSS findings were analyzed. Mean gestational age was 35.1±5.3 weeks, and mean birth weight was 2,381±1,026 g. The most common reason for VFSS referral was 'poor sucking' in full-term infants and 'desaturation' in preterm infants. The most common associated medical condition was 'congenital heart disease' in full-term infants and 'bronchopulmonary dysplasia' in preterm infants. Aspiration was observed in 42 infants (39.3%) and coughing was the only clinical predictor of aspiration in VFSS. However, 34 of 42 infants (81.0%) who showed aspiration exhibited silent aspiration during VFSS. There were no significant differences in the VFSS findings between the full-term and preterm infants except for 'decreased sustained sucking.' There are some differences in the clinical manifestations and VFSS findings between full-term and preterm infants with suspected dysphagia. The present findings provide a better understanding of these differences and can help clarify the different pathophysiologic mechanisms of dysphagia in infants.
    Annals of Rehabilitation Medicine 04/2013; 37(2):175-182. DOI:10.5535/arm.2013.37.2.175
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