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Pediatric Dysphagia
Pediatric Dysphagia Defined

Dysphagia is a disorder of feeding and swallowing, and in children may present with the child refusing food, accepting a limited variety of food or amount of foods and liquids, and demonstrating difficulty that may be observed by coughing, gagging or choking during mealtime.

Incidence & Prevalence

25 – 45% of typically developing children demonstrate feeding and swallowing problems 
30-80% of children with developmental disorders present with feeding and swallowing disorders
The prevalence of pediatric dysphagia is increasing due to improved care leading to increased survival rates of babies born prematurely, with low birth weight and with complex medical and health conditions

Signs & Symptoms

The American Speech-Language-Hearing Association highlights the following signs and symptoms of dysphagia which vary based on the age of the child:

Back arching
Breathing difficulties when feeding
Coughing and/or choking during or after swallowing
Crying during mealtime
Dehydration
Difficulty chewing certain textured food
Difficulty initiating a swallow
Frequent respiratory illness
Gagging
Loss of food/liquid from mouth when eating
Prolonged feeding times
Noisy or wet vocal quality noted during and after feeding
Refusal of certain textures
Taking only small volumes; over-stuffing mouth, and/or pocketing food
Vomiting
Weight loss or lack of appropriate weight gain

Causes

Common causes of dysphagia in children according to The American Speech-Language-Hearing Association:

Developmental disability
Neurological disorders such as cerebral palsy, meningitis, encephalopathy, pervasive developmental    disorders, traumatic brain injury, muscle weakness in face and neck
Prematurity, low birth weight
Complex medical conditions such as heart disease, pulmonary disease, gastroesophageal reflux  disease (GERD), delayed gastric emptying
Structural abnormalities such as cleft lip/palate, laryngomalacia, tracheoesophageal fistula, esophageal    atresia, head and neck abnormalities and choanal atresia
Genetic syndromes such as Pierre Robin, Prada-Willi, Treacher-Collins for example
Medication side effects
Sensory issues
Social, emotional and environmental issues

Long term effects for a child diagnosed with pediatric dysphagia (ASHA) include:

Poor weight gain/failure to thrive
Aspiration pneumonia and/or compromised pulmonary status
Food aversion
Dehydration/malnutrition
Ongoing need for enteral or parenteral nutrition

Children with feeding and swallowing disorders very often will require a modified textured diet in order to improve nutrition and decrease risk of malnutrition and dehydration as well as decrease risk/episodes of aspiration which can lead to pneumonia.
Diagnosis

Diagnosing a child with dysphagia requires a team approach.

Members of the team include the following professionals:

A speech language pathologist who specializes in swallowing and feeding
One or more physicians that can be a pediatrician, neurologist, otolaryngologist, pulmonologist, neurosurgeon, cardiologist, gastroenterologist, plastic surgeon
Nurse/nurse practitioner
Occupational therapist
Psychologist
Social worker
Physical therapist
Audiologist

The Evaluation

The evaluation consists of both clinical observation, parent report and several objective test measures including:

Video Fluoroscopic Swallowing Study (VFSS)
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Fiberoptic Endoscopic Evaluation of Swallowing and Sensory Testing (FEESST)

Treatment

The goals of treatment include:

To maintain adequate nutrition and hydration while ensuring safe swallowing
Work together with family to determine dietary preferences
Minimize risk of aspiration and pulmonary complications
Improve quality of life
Help the child eat and drink efficiently and safely to the highest degree possible

Diet Modifications

Diet modifications are made by ensuring consistency and safety and should follow the guidelines outlined by The American Dietetic Association for Modified Textured Diets which have several levels for liquids and solids.

In addition to the texture modification, taste and temperature may be modified for those children who experience sensory issues as well.

USFDA WARNING:

The USFDA has cautioned consumers about commercial, gum based thickeners for use with children because of adverse effects that have been reported.

NOTE: Textured Food Innovation’s products DO NOT contain any type of commercial thickeners .

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