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D'Angelo EC. Clinical Feeding and Swallowing Evaluation for the School-Based Speech-Language Pathologist. Lang Speech Hear Serv Sch 2024; 55:409-422. [PMID: 38029415 DOI: 10.1044/2023_lshss-23-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
PURPOSE From preschool through high school, eating is part of the school day. Children with feeding and/or swallowing issues are now in our neighborhood schools, our responsibility in our care, and require adequate nutrition and hydration to participate in school and access the curriculum. The whole child is in school, including all of their medical, behavioral, social, and educational needs. This clinical focus article describes a holistic process of evaluating swallowing and feeding in the school setting for the school speech-language pathologist (SLP) leading the team supporting the child. METHOD This clinical focus article explores the evaluation process in the educational setting for the school SLP in identification of pediatric feeding disorders (PFDs), which can involve dysphagia. Detailed descriptions of the related U.S. educational law, PFD, assessment processes for the multiple systems relating to eating, and collaboration with an interdisciplinary team are highlighted. Using the four overlapping domains of PFD (medical, psychosocial, feeding skill-based systems and associated nutritional aspects), medical and background history gathering; integration with instrumental results; and the need to consider the complex interaction of developmental, physical, cognitive, social, behavioral, family, and cultural aspects in the evaluation are detailed. CONCLUSIONS School-age children require safe and adequate nutrition and hydration for learning and social participation. The SLP has a lead role in the school team in evaluating swallowing and feeding, and developing a plan for team implementation. A holistic school-based SLP clinical evaluation process is described.
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Affiliation(s)
- Elisabeth C D'Angelo
- Department of Communication Sciences & Disorders, California State University, Sacramento
- Davis Joint Unified School District, CA
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Brooks L, DiStefano CC, Clayton H, Gethers CT. Thickening human milk: the effect of time, temperature, and thickener for infants with dysphagia. Eur J Pediatr 2024; 183:1839-1848. [PMID: 38277000 DOI: 10.1007/s00431-024-05434-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
The aim of this study was to investigate the effect of time, temperature, and thickener on expressed human milk thickened for infants with dysphagia. Thickening agents included raw oatmeal cereal, commercial thickeners (Gelmix, Purathick), pureed fruits, pureed vegetables, yogurt, and pudding. The International Dysphagia Diet Standardisation Initiative (IDDSI) flow test was used to measure the thickness level across samples at various temperatures (40 °F/4.4 °C, 70 °F/21.1 °C, and 98.6 °F/37 °C) and times (0, 5, 10, and 20 min). Statistical analysis included one-way ANOVA with Tukey post hoc test and multiple linear regression. Fruit purees, particularly banana, achieved the thickest mixtures at all temperatures and maintained a similar thickness over time (20 min). Vegetable puree mixtures were minimally effective at thickening, i.e., between 0 and 1 ml on IDDSI flow test, with exception of squash at 40 °F/4.4 °C. Commercial thickener (Gelmix and Purathick) mixtures continued to thicken over time. The yogurt mixture at 40 °F/4.4 °C thickened initially and thinned slightly over time. The pudding mixture at 40 °F/4.4 °C thickened immediately but quickly became a thin liquid. The raw oatmeal cereal mixtures thinned or thickened over time dependent on the temperature of the human milk (40 °F/4.4 °C mixture thinned over time, while the 70 °F/21.1 °C, and 98.6 °F/37 °C mixtures thickened over time). CONCLUSION Time, temperature, and thickening agents have a significant impact on the thickness level when added to expressed human milk. Certain foods such as fruit purees, squash, yogurt, and raw oatmeal may effectively thicken human milk, and the IDDSI flow test can assess if the mixture maintains a similar thickness level over time. These foods could be considered for older infants with dysphagia. When thickening human milk for infants with dysphagia, close physician and clinician monitoring is recommended given the potential positive and/or negative consequences on oral feeding and overall health. WHAT IS KNOWN • Thin liquids can be challenging for infants with dysphagia to safely swallow Human milk is difficult to thicken. WHAT IS NEW • Pureed fruits and pureed squash thicken human milk effectively at various temperatures and maintain thickness level over 20 minutes. • Pureed fruits and pureed squash thicken human milk effectively at various temperatures and maintain thickness level over 20 Raw oatmeal cereal either thins over time or thickens over time depending on the temperature of the base liquid.
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Affiliation(s)
| | | | - Haley Clayton
- Department of Clinical Nutrition, Children's Healthcare of Atlanta, Atlanta, USA
| | - Casiel T Gethers
- Department of Pediatrics, Emory School of Medicine, Atlanta, USA
- Department of Infectious Diseases, Children's Healthcare of Atlanta, Atlanta, USA
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Raynor EM, Wohl D. Tracheostomy-Related Swallowing Issues in Children. Otolaryngol Clin North Am 2024:S0030-6665(24)00030-6. [PMID: 38508881 DOI: 10.1016/j.otc.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Children with tracheostomies have multiple challenges with respect to achieving normal deglutition. These children may have underlying neurologic or genetic conditions that can predispose to dysphagia, but even in children without underlying comorbidities, the presence of a tracheostomy tube impacts the mechanics of swallowing, leading to difficulty with different consistencies as well as management of normal oral secretions. Intubation prior to tracheostomy also impacts sensation in the upper aerodigestive tract increasing the risk of aspiration. Occlusion of the tracheostomy with a speaking valve or cap improves outcomes in swallow and prognosis for oral feeding.
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Affiliation(s)
- Eileen M Raynor
- Department of Head and Neck Surgery & Communication Sciences, Duke Health System, DUMC Box 3805, Durham, NC 27710, USA.
| | - Daniel Wohl
- Pediatric Otolaryngology Associates, 4114 Sunbeam Road, Jacksonville, FL 32257, USA
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Young AE, Hinkes-Molinaro L, Ida J, Valika T, Ghadersohi S, Thompson DM, Hazkani I. Swallowing Function After Epiglottopexy in Children. Otolaryngol Head Neck Surg 2024; 170:560-567. [PMID: 37855629 DOI: 10.1002/ohn.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/15/2023] [Accepted: 09/24/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Epiglottopexy has been an increasingly utilized intervention in children with epiglottic prolapse and airway obstruction. Given the role of the epiglottis in protecting the airway during swallowing and the potential effect of repositioning the epiglottis on the passage of the bolus, we aimed to compare swallowing outcomes before and after epiglottopexy in children. STUDY DESIGN A retrospective cohort study. SETTING Tertiary care children's hospital. METHODS Data were extracted from charts of children who underwent epiglottopexy and had a subsequent instrumental swallowing evaluation between January 2018 and September 2022. RESULTS A total of 93 patients underwent epiglottopexy. Of these, 38 patients met inclusion requirements. The mean age at surgery was 41 ± 47 months. Most patients (n = 37, 97.4%) had significant comorbidities such as secondary airway lesions (n = 33, 91.7%), a genetic or syndromic disorder (n = 25, 69.4%), and dysphagia (n = 29, 76.3%). All patients had a concurrent procedure at the time of epiglottopexy with supraglottoplasty (n = 24, 63.2%) and lingual tonsillectomy (n = 16, 42.1%) being the most common. No changes in initiation or patterns of swallowing were noted postoperatively. A total of 7 (18.4%) patients had worsening swallow function: 2 had new-onset dysphagia, and 5 had worsening pre-existing dysphagia. Liquid or food textures penetrated remained unchanged or improved in most cases. No risk factors for worsening dysphagia were identified in our cohort. CONCLUSION Children with medical comorbidities undergoing epiglottopexy with additional airway interventions may experience new or worsening dysphagia. However, the procedure is generally safe without notable patterned changes in the swallowing mechanism.
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Affiliation(s)
- Ashley E Young
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura Hinkes-Molinaro
- Department of Speech Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Jonathan Ida
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Taher Valika
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Saied Ghadersohi
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dana M Thompson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Inbal Hazkani
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Howe S, Steer K, Johnson M, Adjerid K, Edmonds C, German R, Mayerl C. Exploring the interaction of viscosity and nipple design on feeding performance in an infant pig model. J Texture Stud 2023; 54:936-946. [PMID: 37673688 PMCID: PMC10872838 DOI: 10.1111/jtxs.12797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/30/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023]
Abstract
Infant feeding behaviors are modulated via sensorimotor feedback, such that sensory perturbations can significantly impact performance. Properties of the nipple and milk (e.g., nipple hole size and viscosity) are critical sources of sensory information. However, the direct effects of varying milk and nipple properties on infant motor output and the subsequent changes in feeding performance are poorly understood. In this study, we use an infant pig model to explore the interaction between nipple hole size and milk viscosity. Using high-speed videofluoroscopy and electromyography, we measured key performance metrics including sucks per swallow and suck duration, then synchronized these data with the onset and offset of activity of jaw opening and closing muscles. The combination of a small nipple hole and thick milk resulted in negative effects on both suck and swallow performance, with reduced feeding efficiency compared to the other treatments. It also appears that this combination of viscosity and hole size disrupts the coordination between correlates of tongue and jaw movements. We did not see a difference in feeding efficiency between viscosities when infants fed on the large-hole nipple, which may be the result of non-Newtonian fluid mechanics. Our results emphasize the importance of considering both fluid and nipple properties when considering alterations to an infant's feeding system.
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Affiliation(s)
- Stephen Howe
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Kendall Steer
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- University of Akron, Akron, Ohio, USA
| | | | | | - Chloe Edmonds
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Kent State University, Kent, Ohio, USA
| | - Rebecca German
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Kent State University, Kent, Ohio, USA
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Chen WC, Lin CW, Wu MN, Fong YO, Chen CH, Hsieh SW, Chen CYE, Huang P. Consistencies among miscellaneous scales for evaluation of post-stroke dysphagia. Eur Arch Otorhinolaryngol 2023; 280:4561-4567. [PMID: 37428229 DOI: 10.1007/s00405-023-08101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Post-stroke dysphagia (PSD) is the most common type of dysphagia. Stroke patients with sustained dysphagia have poorer outcomes. The severity of PSD is assessed using miscellaneous scales with unknown consistencies. We aim to investigate the consistencies among miscellaneous scales, which could aid in the assessment of PSD. METHODS A total of 49 PSD patients were enrolled. Functional Oral Intake Scale (FOIS), Dysphagia Severity Scale (DSS), Ohkuma Questionnaire, Eating Assessment Tool-10, and Repetitive Saliva Swallowing Test were performed. FOIS was performed by physicians, and DSS was conducted by both the physicians and nurses; the physicians used either videofluoroscopy (VF) or videoendoscopy (VE) for evaluation; while, the nurses assessed PSD by observation and subjective judgment. RESULTS When using VF (VF-DSS and VF-FOIS) as the gold standard for the evaluation, VE-FOIS (κ = 0.625, 95% CI 0.300-0.950, p < 0.001) has a substantial agreement with VF-FOIS, and VE-DSS (κ = 0.381, 95% CI 0.127-0.636, p = 0.007) has a fair agreement with VF-DSS. The weighted kappa of FOIS to DSS in VE (weighted κ = 0.577, 95% CI 0.414-0.740, p < 0.001) is not lower than that in VF (weighted kappa = 0.249, 95% CI 0.136-0.362, p < 0.001). CONCLUSION For both DSS and FOIS, only VE has a statistically significant agreement with VF. Though VF has been viewed as the traditional gold standard of dysphagia screening, it has the limitations of being invasive and equipment dependent. For PSD, VE could be considered as a substitution when VF is not available or suitable.
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Affiliation(s)
- Wen-Ching Chen
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
| | - Chung-Wei Lin
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Ni Wu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
| | - Yi-On Fong
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
| | - Chun-Hung Chen
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Multidisciplinary Swallowing Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sun-Wung Hsieh
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Yin Elizabeth Chen
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Poyin Huang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100 , Tzyou 1st Road, Kaohsiung City, 807, Taiwan.
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Multidisciplinary Swallowing Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Marshall J, Gosa MM, Dodrill P. Patient-Reported Outcome Measures That Describe the Feeding Skills Domain for Pediatric Feeding Disorder: A Clinimetric Review. J Pediatr Gastroenterol Nutr 2023; 77:137-145. [PMID: 37084340 DOI: 10.1097/mpg.0000000000003798] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
OBJECTIVES Pediatric feeding disorder (PFD) is defined as "impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction." Patient-reported outcome measures (PROMs) are tools that complement clinical assessment, but many have limited clinimetric data. This review aimed to assess PROMs that reported on the feeding skills domain for PFD in children. METHODS A search strategy across 4 databases was conducted (July 2022). PROMs were included in the review if they described elements of the feeding skills domain of PFD, had criterion/norm-referenced data and/or a standardized assessment procedure, description, or scoring system available, and were applicable to children ≥6 months. PROMs were mapped to the PFD diagnostic domains and aspects of the International Classification of Function (ICF) model. Quality assessment was completed using the COnsensus-based Standards to the selection of health Measurement Instruments methodology. RESULTS Overall, 14 PROMs across 22 papers met inclusion criteria. There was variable methodological quality across the tools, with those more recently developed often receiving better scores, particularly where a more rigorous process for tool development and content validity was reported. Most tools captured ICF aspects of impairment (n = 11, eg, biting/chewing) or activity (n = 13, eg, eating a meal), rather than social participation (n = 3, eg, going to a restaurant). CONCLUSIONS Using PROMs with strong content validity, and including some measure of social participation, is recommended as part of an assessment battery for PFD. Consideration of the caregiver/child perspective is an essential component of family-centered care.
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Affiliation(s)
- Jeanne Marshall
- From the Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Memorie M Gosa
- the Department of Communicative Disorders, The University of Alabama, Tuscaloosa, AL
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Fishbein MH, Kronberg J, Alvarado S, Bohm D, Ideran P, Scarborough DR. A Multidisciplinary Approach to Infants With GERD-Like Symptoms: A New Paradigm. J Pediatr Gastroenterol Nutr 2023; 77:39-46. [PMID: 37084339 DOI: 10.1097/mpg.0000000000003802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
OBJECTIVES Infants with gastroesophageal reflux disease (GERD)-like symptoms have been classically defined as having a wide array of symptoms. In these instances, anti-reflux medications are ineffective and overprescribed. Rather these symptoms are more attributable to dysphagia and unsettledness/colic. To address these conditions at our center, both speech language pathologist (SLP) and/or occupational therapist (OT) have contributed to evaluation. We hypothesized that dysphagia and unsettledness/colic are highly prevalent, yet under recognized in this population. METHODS Full-term infants with typical development and under 6 months of age (N = 174) were included. Infants with suspected dysphagia and/or evident colic/unsettledness were evaluated by SLP and OT, respectively. RESULTS GERD-like symptoms were present in 109 infants with attributes of dysphagia in n = 46, unsettledness/colic in n = 37, and combined in n = 26. CONCLUSION A multidisciplinary approach, including SLP and OT, is recommended for the evaluation of infants with GERD-like symptoms.
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Affiliation(s)
- Mark H Fishbein
- From Feinberg School of Medicine at Northwestern University, Chicago, IL
| | | | | | - Diana Bohm
- Northwestern Medicine at Central DuPage Hospital, Winfield, IL
| | - Patricia Ideran
- Northwestern Medicine at Central DuPage Hospital, Winfield, IL
| | - Donna R Scarborough
- the Department of Speech Pathology and Audiology, Miami University, Oxford, OH
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Ayoub N, Balakrishnan K, Meister K, Grimm D, Johnson A, Maida K, Sidell DR. Safety and effectiveness of vocal fold injection laryngoplasty in infants less than one year of age. Int J Pediatr Otorhinolaryngol 2023; 168:111542. [PMID: 37058865 DOI: 10.1016/j.ijporl.2023.111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION Injection laryngoplasty (IL) is commonly performed for unilateral vocal fold immobility (UVFI). However, the safety and efficacy in patients <1 year of age are not widely recognized. This study analyzes the safety and swallow outcomes in a cohort of patients <1 year who underwent IL. METHODS This retrospective analysis evaluated patients at a tertiary children's institution between 2015 and 2022. Patients were eligible if they underwent IL for UVFI and were <1 year at time of injection. Baseline characteristics, perioperative data, oral diet tolerance, and preoperative and postoperative swallow data were collected. RESULTS 49 patients were included, 12 (24%) of whom were premature. The average age at injection was 3.9 months (SD 3.8), time from UVFI onset to injection 1.3 months (2.0), and weight at injection 4.8 kg (2.1). The baseline American Association of Anesthesiologists physical status classification scores were 2 (14%), 3 (61%), and 4 (24%). 89% of patients had improvements in objective swallow function postoperatively. Of the 35 patients who were preoperatively enterally-dependent and did not have medical circumstances precluding advancement to oral feeds, 32 (n = 91%) tolerated an oral diet postoperatively. There were no long-term sequelae. Two patients had intraoperative laryngospasm, one intraoperative bronchospasm, and one with subglottic and posterior glottic stenosis was intubated for <12 h for increased work of breathing. CONCLUSIONS IL is a safe and effective intervention that can reduce aspiration and improve diet in patients <1 year old. This procedure can be considered at institutions with the appropriate personnel, resources, and infrastructure.
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Affiliation(s)
- Noel Ayoub
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA.
| | - Karthik Balakrishnan
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA
| | - Kara Meister
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA
| | - David Grimm
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA
| | - April Johnson
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA; Lucile Packard Children's Hospital Rehabilitation Services, USA
| | - Kelli Maida
- Lucile Packard Children's Hospital Rehabilitation Services, USA
| | - Douglas Ryan Sidell
- Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA
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Abstract
Coronavirus (COVID-19) infection usually causes mild symptoms in children. However, serious complications may occur as a result of both acute infection or in association with the multisystem inflammatory syndrome (MIS-C). Dysphagia may develop as a sequela of COVID-19. We review the limited data on dysphagia associated with COVID-19 infection in children. Children can develop acute respiratory distress syndrome (ARDS) due to severe COVID-19 infection leading to endotracheal intubation and mechanical ventilation. These children can possibly develop post-intubation dysphagia. Screening for the presence of dysphagia, in an effort to minimize aspiration, in children with active COVID-19 infection must be done carefully to reduce the risk of transmission of the virus. Those children diagnosed with persistent dysphagia after COVID-19 infection has resolved will need further evaluation and management by pediatric subspecialists experienced in treating children with this condition. We recommend, this evaluation and treatment be done by a pediatric aerodigestive team.
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Affiliation(s)
- James D Tutor
- Program in Pediatric Pulmonary Medicine, Division of Pulmonology, Department of Pediatrics, University of Tennessee Health Science Center, LeBonheur Children's Hospital, Faculty Office Building, Room 224, 49 North Dunlap Street, Memphis, TN, 38105, USA.
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11
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Miranda PP, Levy DS, Kieling RR. Aspiration in the First Year of Life and Later Tube Feeding: A Retrospective Cohort from a Low-Income Country. Dysphagia 2023; 38:192-199. [PMID: 35476230 DOI: 10.1007/s00455-022-10450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/04/2022] [Indexed: 01/27/2023]
Abstract
The objective of this study is to investigate in infants submitted to videofluoroscopic swallowing study (VFSS) during the first year of life, the association between aspiration and later tube feeding, and to identify potential risk factors related to feeding route outcome. Retrospective cohort study with data from electronic health records was performed. Data were collected from infants < 12 months of age who underwent VFSS during inpatient hospital stay in the period between 2013 and 2018. Patient charts after 24 months of age were reviewed to ascertain the outcome and study factors, including VFSS findings, neonatal data, clinical comorbidities, nutritional status, ICU admissions, and hospital readmissions. Relative risk (RR) for tube feeding was calculated, and a Poisson regression with robust variance was used to identify potential risk factors. VFSS data from 164 patients < 1 year old were retrieved, of whom 112 (68%) contributed with data about feeding route after 2 years of age. Most infants were preterm < 37 weeks (66%), with a median age of 9.28 weeks at the time of the exam. Aspiration occurred in 33% of the patients, with no statistically significant difference between full-term or premature infants (p = 0.173). The relative risk of tube feeding after the age of 2 among infants who aspirated in VFSS was 0.74 (CI 0.25-2.16, p = 0.573). Poisson regression analysis showed that number of hospital readmissions (RR 1.04, 95%CI 1.01-1.07, p = 0.005) and gestational age < 34 weeks (RR 0.26, 95%CI 0.07-0.089, p = 0.032) were associated with later tube feeding. Early VFSS findings have low predictive value regarding later feeding route. Aspiration events should be considered as complementary information for clinical decision.
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Affiliation(s)
- Priscilla Poliseni Miranda
- Graduate Program in Child and Adolescent, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Deborah Salle Levy
- Speech and Language Pathology Service, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos Street, 2350 - Room 1045, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil
- Department of Health and Human Communication, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Renata Rocha Kieling
- Graduate Program in Child and Adolescent, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Marshall J, Buttsworth J, Grandt HDS, Raatz M, Signorini A, Fernando S, Clarke S. Testing and Development of Slightly Thick Infant Formula Recipes for Dysphagia Management: An Australian Perspective. Dysphagia 2023:10.1007/s00455-022-10550-1. [PMID: 36637506 DOI: 10.1007/s00455-022-10550-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023]
Abstract
Thickened feeds may be useful in supporting improved suck-swallow-breath coordination and airway protection in infants with dysphagia. Unfortunately, the stability of thickened feeds for infant formulas is unpredictable, which makes use of this strategy challenging. This study aimed to propose a set of Level 1 (slightly thick) recipes for Australian infant formulas/thickeners. A secondary aim was to test whether formula could be batch prepared. A set of powdered, ready-to-feed, and specialized formulas were mixed with two thickening products (Aptamil Feed Thickener® and Supercol®) and tested at 5-, 10-, 15-, 20-, 25-, 30-, and 45-min intervals using the International Dysphagia Diet Standardization Initiative (IDDSI) Flow Test. Formula/thickener samples were mixed following manufacturer instructions, but recipes were adapted to determine an ideal recipe for Level 1 (slightly thick) consistency that would be maintained over a feed. Samples were refrigerated, reheated after 12 h, and retested. Each combination was tested six times. Overall, 1,353 IDDSI Flow Tests were conducted using 14 formula/thickener combinations. In all combinations, recipe alterations were made using metric spoon measurements as opposed to the manufacturer-provided scoop. All samples were most variable at the 5-min timepoint. Formulas thickened with Supercol® generally reached a more stable consistency by 10 min, whereas formulas thickened with Aptamil Feed Thickener® were more stable by 15 min. Samples tested after 12 h were more variable with Aptamil Feed Thickener®. This study provides practical recommendations for clinicians working with infants requiring thickened feeds for dysphagia management. Further study under controlled laboratory conditions is required.
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Affiliation(s)
- Jeanne Marshall
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Jordyn Buttsworth
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Hannah D S Grandt
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Madeline Raatz
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Annabelle Signorini
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Shenali Fernando
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Sally Clarke
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
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13
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Roberts E. Management of Children with Swallowing Problems: New Advances in Paediatric Thickeners. EUROPEAN MEDICAL JOURNAL 2022. [DOI: 10.33590/emj/10047359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
A satellite symposium on the evaluation and management of dysphagia in children was held during the 12th Annual Congress of the European Society for Swallowing Disorders (ESSD) in Leuven, Belgium, on 14th September 2022. Dysphagia is the impairment or difficulty in swallowing and may have an oropharyngeal or oesophageal cause. This can result in delayed transit of liquids or solid food from the mouth to the stomach. Food thickening agents can reduce regurgitation and improve swallowing mechanics, particularly in infants and young children. At this symposium, Karen van Hulst, Speech and Language Therapist and Clinical Epidemiologist at Radboud University Medical Center, Amalia’s Children’s Hospital, the Netherlands, introduced the topic of dysphagia and its complications, and the evaluation of dysphagia. She then discussed the use of thickening agents in children with dysphagia. Ben Hanson from the Department of Engineering, University College London, UK, introduced the International Dysphagia Diet Standardization Initiative (IDDSI). The IDDSI has developed a standardised and practical method of measuring the thickness of liquid and food that can be used when preparing foods at home or in the hospital, and may be applied commercially. Analou Sugar, Clinical Lead in Paediatric Speech and Language Therapy at Chelsea and Westminster Hospital Foundation Trust, London, UK, ended the symposium with a presentation of her recent clinical experience using a new thickener (ThickenUp® Junior, Nestlé Health Science, Vevey, Switzerland) in paediatric patients.
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14
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Ledersnaider M, Kreilein N, Triplett R, Peterman NJ. Gastroesophageal Reflux Disease in a One-Week-Old Infant Presenting With Cyanosis and Respiratory Distress. Cureus 2022; 14:e29632. [PMID: 36196293 PMCID: PMC9524716 DOI: 10.7759/cureus.29632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/30/2022] Open
Abstract
Gastroesophageal reflux (GER) is a common occurrence in infancy and early childhood. While GER is considered physiologic, gastroesophageal reflux disease (GERD) can result when extensive GER leads to troublesome symptoms such as choking, gagging, vomiting, refusal to feed, and poor weight gain. In extreme cases, GERD can cause severe respiratory complications such as apnea and aspiration pneumonia. We present the case of a one-week-old Amish female who had no prenatal care and presented with severe hypoxemia, tachypnea, and costal retractions. Further history from the family revealed persistent irregular breathing, sweating during feeds, and episodic perioral cyanosis. The patient required stabilization in the intensive care unit and received an extensive workup to rule out sepsis, cyanotic heart disease, other infectious etiologies, and other common causes of respiratory distress. The patient underwent a modified barium swallow study and was diagnosed with aspiration pneumonitis resulting from GERD and oropharyngeal dysphagia. Infantile cyanosis and respiratory distress can be manifestations of a variety of underlying illnesses. Once common causes of cyanosis have been excluded, GERD or disordered feeding should be considered as a potential etiology.
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15
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McAllister A, Sjöstrand E, Rodby‐Bousquet E. Eating and drinking ability and nutritional status in adults with cerebral palsy. Dev Med Child Neurol 2022; 64:1017-1024. [PMID: 35229295 PMCID: PMC9314006 DOI: 10.1111/dmcn.15196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/09/2022] [Accepted: 02/10/2022] [Indexed: 12/31/2022]
Abstract
AIM To describe eating and drinking ability in adults with cerebral palsy (CP) relative to sex, age, subtype, and severity of gross motor and hand function and nutritional status. METHOD This was a cross-sectional study based on data of 2035 adults with CP, median age 26 years (range 18-78 years). The Eating and Drinking Ability Classification System (EDACS), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification System (MACS) were used in addition to subtype, body weight, height, body mass index (BMI), skin fold thickness, and gastrostomy. Linear regression models were used to estimate associations between body weight and the other variables. RESULTS More than half of the adults (52.5%) eat and drink safely and 32.4% have dysphagia with limitations to eating and drinking safety. Weight, height, and BMI decreased with increasing EDACS levels. In EDACS level V, 86% had a gastrostomy, 23.4% in EDACS levels III to V were underweight, whereas 42.3% in EDACS levels I to II had a BMI over 25, indicating overweight or obesity. Increasing EDACS levels and need of support during meals were associated with lower body weight. INTERPRETATION Adults with CP should be routinely screened and treated for dysphagia to avoid nutritional complications. Being dependent on others during mealtimes is a risk factor for low body weight.
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Affiliation(s)
- Anita McAllister
- Division of Speech and Language PathologyDepartment of Clinical Science, Intervention and Technology—CLINTECKarolinska InstitutetStockholmSweden,Medical Unit Speech and Language PathologyWomen’s Health and Allied Health Professionals ThemeKarolinska University HospitalStockholmSweden
| | | | - Elisabet Rodby‐Bousquet
- Department of Clinical Sciences LundOrthopaedicsLund UniversityLundSweden,Centre for Clinical ResearchUppsala University—Region VästmanlandVästeråsSweden
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16
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Stevens M, O'Rourke S, Casto SC, Benedict J, Lundine JP. Clinical Focus: Findings and Clinical Implications for Thickening Formula With Infant Cereal Using the International Dysphagia Diet Standardisation Initiative Flow Test. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1601-1610. [PMID: 35580232 DOI: 10.1044/2022_ajslp-21-00298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The International Dysphagia Diet Standardisation Initiative (IDDSI) framework was established to provide standardized terminology and objective measures to assess foods and liquids for persons with swallowing difficulties. This clinical focus article reports the findings and clinical implications of the flow testing of infant formulas thickened with infant cereal completed as part of the transition process to IDDSI for one large pediatric quaternary care hospital. METHOD To determine a common recipe that could be used to thicken formulas with infant cereal to the appropriate IDDSI levels, three clinicians completed flow testing on 94 infant formulas. To examine intra- and interclinician variability in the process, they repeated flow testing with three commonly used formulas and infant cereal. RESULTS Clinicians were unable to identify a standard recipe (infant formula + infant cereal combination) that consistently thickened different formula brands to a desired IDDSI thickness level, as there was pronounced variability across and within infant formulas. Reliability testing revealed that, overall, clinician mixers were consistent in replicating similar results to themselves and to each other and that, instead, greater variability lies within the formula (and infant formula + infant cereal combination). CONCLUSIONS Based on findings of pronounced variability within and across infant formulas, our institution determined that the creation of a standard recipe for achieving IDDSI thickness levels of formula mixed with infant cereal was not feasible or clinically appropriate. We offer recommendations for similar institutions for advancing clinical management of infant dysphagia using the IDDSI flow test and directions for future research.
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Affiliation(s)
- Melanie Stevens
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH
| | - Sara O'Rourke
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH
| | | | - Jason Benedict
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus
| | - Jennifer P Lundine
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, OH
- Department of Speech and Hearing Science, The Ohio State University, Columbus
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17
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Stafler P, Akel K, Eshel Y, Shimoni A, Grozovski S, Mei‐Zahav M, Levine H, Gendler Y, Blau H, Prais D. Videofluoroscopy compared with clinical feeding evaluation in children with suspected aspiration. Acta Paediatr 2022; 111:1441-1449. [PMID: 35316543 PMCID: PMC9325498 DOI: 10.1111/apa.16338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/02/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Aim Videofluoroscopy swallow studies (VFSS) are gold standard to diagnose aspiration in children but require resources and radiation compared with clinical feeding evaluation (CFE). We evaluated their added value for diagnosis, feeding management and clinical status. Methods A retrospective single‐centre cross‐sectional study of children aged 0–18 years, with respiratory morbidity, referred for VFSS at a tertiary pediatric hospital. Results A total of 113 children, median age (range) 2.2 years (0.1–17.9), underwent VFSS. Diagnosis included chronic pulmonary aspiration (CPA), 87 (77%); neurological, 73 (64%); gastrointestinal, 73 (64%) and congenital heart disease, 42 (37%), not mutually exclusive. Forty‐six (41%) aspirated, 9 (8%) only overtly and 37 (33%) including silent aspirations. Those with CPA or cerebral palsy were more likely to have VFSS aspiration, OR 3.2 and 9.8 respectively. Feeding recommendations after VFSS differed significantly from those based on prior CFE, p < 0.001: The rate of exclusively orally fed children rose from 65% to 79%, p = 0.006; exclusively enterally fed children from 10% to 14%; p = 0.005. During the year after VFSS, there were significantly less antibiotic courses, total and respiratory admissions. Conclusion In this population with high prevalence of clinically suspected CPA, VFSS altered feeding management compared with CFE and may have contributed to subsequent clinical improvement.
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Affiliation(s)
- Patrick Stafler
- Pulmonary Institute Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Khaled Akel
- Pulmonary Institute Schneider Children's Medical Center of Israel Petah Tikva Israel
| | - Yuliana Eshel
- Occupational Therapy Department Schneider Children's Medical Center of Israel Petach Tikva Israel
| | - Adi Shimoni
- Occupational Therapy Department Schneider Children's Medical Center of Israel Petach Tikva Israel
| | - Sylvia Grozovski
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Radiology Institute Schneider Children's Medical Center of Israel Petach Tikva Israel
| | - Meir Mei‐Zahav
- Pulmonary Institute Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Hagit Levine
- Pulmonary Institute Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yulia Gendler
- The Department of Nursing School of Health Sciences Ariel University Ariel Israel
| | - Hannah Blau
- Pulmonary Institute Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Dario Prais
- Pulmonary Institute Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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18
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Zimmels S, Balfour-Lynn IM, Christodoulou L, Pantazi M, Pavlidou E, Pitt M, Kinali M, Ismayilova N. Isolated bulbar palsy and dysphagia in children with respiratory symptoms. Dev Med Child Neurol 2022; 64:518-522. [PMID: 34601721 DOI: 10.1111/dmcn.15074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
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.
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Affiliation(s)
- Stacey Zimmels
- Department of Speech & Language Therapy, Royal Brompton Hospital, London, UK
| | - Ian M Balfour-Lynn
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | | | - Mantha Pantazi
- Department of Paediatric Neurology, Chelsea & Westminster Hospital, London, UK
| | - Efterpi Pavlidou
- Department of Paediatric Neurology, Chelsea & Westminster Hospital, London, UK
| | - Matthew Pitt
- Department of Neurophysiology, Great Ormond St. Hospital, London, UK
| | - Maria Kinali
- Department of Paediatric Neurology, Chelsea & Westminster Hospital, London, UK.,Department of Paediatric Neurology, The Portland Hospital, HCA Healthcare, London, UK
| | - Naila Ismayilova
- Department of Paediatric Neurology, Chelsea & Westminster Hospital, London, UK
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19
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Propp R, Gill PJ, Marcus S, Ren L, Cohen E, Friedman J, Mahant S. Neuromuscular electrical stimulation for children with dysphagia: a systematic review. BMJ Open 2022; 12:e055124. [PMID: 35338059 PMCID: PMC8961156 DOI: 10.1136/bmjopen-2021-055124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Dysphagia in childhood has important health impacts for the child and their family as well as the healthcare system. This systematic review aims to determine the effectiveness of neuromuscular electrical stimulation (NMES) for treatment of oropharyngeal dysphagia in children. METHODS A search was performed on November 2020 in MEDLINE (from 1946), EMBASE (from 1947), PsycINFO (from 1806), CINAHL (from 1937), CENTRAL (from 1996) and Scopus (from 1970) databases. Studies of children (≤18 years) diagnosed with oropharyngeal dysphagia using NMES in the throat/neck region were included. Screening, data extraction, and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the Cochrane Collaboration's tool for randomised controlled trials (RCTs) and a modified Newcastle-Ottawa assessment for observational studies. A meta-analysis was not conducted due to clinical heterogeneity in studies. RESULTS Ten studies were included (5 RCTs, 4 case series, 1 cohort study; including 393 children, mean or median age below 7 years, including children with neurologic impairments). In all studies, swallowing function improved after NMES treatment. The standardised mean difference (SMD) for improvement of swallowing dysfunction in treatment compared with control groups in the RCTs ranged from 0.18 (95% CI -0.7 to 1.06) to 1.49 (95% CI 0.57 to 2.41). Eight of 10 studies reported on the child's feeding ability, and, with one exception, there was improvement in feeding ability. Few studies reported on health status (N=2), impact on caregiver (N=1), adverse events and harms (N=2), and child's quality of life (N=1). In most studies, outcome follow-up was less than 6 months. The studies demonstrated moderate to high risk of bias. CONCLUSIONS NMES treatment may be beneficial in improving swallowing function for children with dysphagia, however, given the quality of the studies, inadequate outcome reporting, and short follow-up duration, uncertainty remains. Well-designed RCTs are needed to establish its effectiveness before its adoption in clinical practice. PROSPERO REGISTRATION NUMBER CRD42019147353.
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Affiliation(s)
- Roni Propp
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter J Gill
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sherna Marcus
- Rehabilitation, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lily Ren
- Lane Medical Library, Stanford Medicine, Stanford, California, USA
| | - Eyal Cohen
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy Friedman
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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20
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Lanzoni G, Sembenini C, Gastaldo S, Leonardi L, Bentivoglio VP, Faggian G, Bosa L, Gaio P, Cananzi M. Esophageal Dysphagia in Children: State of the Art and Proposal for a Symptom-Based Diagnostic Approach. Front Pediatr 2022; 10:885308. [PMID: 35813384 PMCID: PMC9263077 DOI: 10.3389/fped.2022.885308] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
Pediatric esophageal dysphagia (PED) is an infrequent condition that can be determined by a large number of disorders. The etiologic diagnosis is challenging due to overlapping clinical phenotypes and to the absence of pediatric diagnostic guidelines. This review aims to summarize the most relevant causes of ED during childhood, highlight the clinical scenarios of PED presentation and discuss the indications of available diagnostic tools. Available information supports that PED should always be investigated as it can underlie life-threatening conditions (e.g., foreign body ingestion, mediastinal tumors), represent the complication of benign disorders (e.g., peptic stenosis) or constitute the manifestation of organic diseases (e.g., eosinophilic esophagitis, achalasia). Therefore, the diagnosis of functional PED should be made only after excluding mucosal, structural, or motility esophageal abnormalities. Several clinical features may contribute to the diagnosis of PED. Among the latter, we identified several clinical key elements, relevant complementary-symptoms and predisposing factors, and organized them in a multi-level, hierarchical, circle diagram able to guide the clinician through the diagnostic work-up of PED. The most appropriate investigational method(s) should be chosen based on the diagnostic hypothesis: esophagogastroduodenoscopy has highest diagnostic yield for mucosal disorders, barium swallow has greater sensitivity in detecting achalasia and structural abnormalities, chest CT/MR inform on the mediastinum, manometry is most sensitive in detecting motility disorders, while pH-MII measures gastroesophageal reflux. Further studies are needed to define the epidemiology of PED, determine the prevalence of individual underlying etiologies, and assess the diagnostic value of investigational methods as to develop a reliable diagnostic algorithm.
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Affiliation(s)
- Gloria Lanzoni
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy.,Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Camilla Sembenini
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy
| | - Stefano Gastaldo
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy
| | - Letizia Leonardi
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy
| | | | - Giovanna Faggian
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Luca Bosa
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Paola Gaio
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Mara Cananzi
- School of Specialty in Pediatrics, University Hospital of Padova, Padua, Italy.,Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
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21
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Narawane A, Rappazzo C, Hawney J, Clason H, Roddy DJ, Ongkasuwan J. Vocal Fold Movement and Silent Aspiration After Congenital Heart Surgery. Laryngoscope 2021; 132:701-705. [PMID: 34378798 DOI: 10.1002/lary.29817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/09/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Infants who undergo congenital heart surgery are at risk of developing vocal fold motion impairment (VFMI) and swallowing difficulties. This study aims to describe the dysphagia in this population and explore the associations between surgical complexity and vocal fold mobility with dysphagia and airway protection. STUDY DESIGN Retrospective chart review. METHODS This is a retrospective chart review of infants (age <12 months) who underwent congenital heart surgery between 7/2008 and 1/2018 and received a subsequent videofluoroscopic swallow study (VFSS). Demographic information, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category of each surgery, vocal fold mobility status, and VFSS findings were collected and analyzed. RESULTS Three hundred and seventy-four patients were included in the study. Fifty-four percent of patients were male, 24% were premature, and the average age at the time of VFSS was 59 days. Sixty percent of patients had oral dysphagia and 64% of patients had pharyngeal dysphagia. Fifty-one percent of patients had laryngeal penetration and 45% had tracheal aspiration. Seventy-three percent of these aspirations were silent. There was no association between surgical complexity, as defined by the STAT category, and dysphagia or airway protection findings. Patients with VFMI after surgery were more likely to have silent aspiration (odds ratio = 1.94, P < .01), even when adjusting for other risk factors. CONCLUSION Infants who undergo congenital heart surgery are at high risk for VFMI and aspiration across all five STAT categories. This study demonstrates the high prevalence of silent aspiration in this population and the need for thorough postoperative swallow evaluation. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
| | - Christina Rappazzo
- Speech Language and Learning, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Jean Hawney
- Speech Language and Learning, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Hallie Clason
- Speech Language and Learning, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Dantin J Roddy
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, U.S.A.,Pediatric Critical Care Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Julina Ongkasuwan
- Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, U.S.A
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22
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Raatz M, Ward EC, Marshall J, Burns CL. Evaluating the Use of Telepractice to Deliver Pediatric Feeding Assessments. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1686-1699. [PMID: 34061575 DOI: 10.1044/2021_ajslp-20-00323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This study aimed to investigate the interrater reliability of pediatric feeding assessments conducted via synchronous (real-time) telepractice. Secondary aims were to investigate parent and clinician satisfaction. Method The eating and/or cup drinking skills of 40 children (aged 4 months to 7 years) were simultaneously assessed by one speech-language pathologist (SLP) leading the appointment via telepractice and a second SLP present in the family home. A purpose-designed assessment form was used to assess (a) positioning, (b) development, (c) oral sensorimotor function, (d) prefeeding respiratory status, (e) observation of eating and drinking, (f) parent-child interaction, (g) overall feeding skills, and (h) feeding recommendations. The telepractice SLP completed a postappointment satisfaction questionnaire, and parents completed five questionnaires specifically investigating perceptions of and satisfaction with the telepractice feeding appointment. Results Agreement for all assessment components except intraoral examination (palate integrity and tonsils) was > 85%. All appointments were able to be conducted via telepractice, and for 90% of these (n = 36), clinicians agreed that telepractice was an effective service delivery method. Parents reported high levels of satisfaction with telepractice, with 76% reporting that the telepractice appointment was similar to a traditional in-person appointment. Conclusion Study results demonstrated that synchronous pediatric feeding assessments conducted in family homes via telepractice were feasible, reliable, and acceptable to both clinicians and parents. Supplemental Material https://doi.org/10.23641/asha.14700228.
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Affiliation(s)
- Madeline Raatz
- Speech Pathology Department, Queensland Children's Hospital, South Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jeanne Marshall
- Speech Pathology Department, Queensland Children's Hospital, South Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Clare L Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology and Audiology Department, Royal Brisbane and Women's Hospital, Queensland, Australia
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23
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Luu K, Belsky MA, Dharmarajan H, Kaffenberger T, McCoy JL, Cangilla K, Tobey ABJ, Simons JP, Maguire R, Padia R. Dysphagia in Pediatric Patients with Tracheostomy. Ann Otol Rhinol Laryngol 2021; 131:457-462. [PMID: 34142561 DOI: 10.1177/00034894211025179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Post-tracheotomy swallowing function has not been well described in the pediatric population. This study aims to (1) determine differences in swallowing functioning pre- and post-tracheotomy and (2) examine the association between postoperative dysphagia and indication for tracheotomy, age at the time of tracheotomy, and time between tracheotomy and modified barium swallow (MBS). METHODS A retrospective chart review was performed on 752 patients who underwent a tracheotomy from 2003 to 2018 and had adequate documentation for review. Patients were included if they received a post-operative MBS. Descriptive statistics, logistic regression, and Fisher's exact test were used to analyze the data. RESULTS The cohort included 233 patients. The mean age at the time of tracheotomy was 25 months (±50.5). The indications for the tracheotomy were upper airway obstruction (110/233, 47.2%), chronic respiratory failure (104/233, 44.6%), and neurologic disease (19/233, 8.2%). The mean time from tracheotomy to post-operative MBS was 224 days (±297.7). Of the patients who had documented pre- and post-tracheotomy diets, nearly half of patients had improvement in their swallowing function after tracheotomy placement (82/195; 42.1%). Post-tracheotomy MBS recommended thickened liquids in 30.9% of the patients (72/233) and 42.5% (99/233) were recommended thin liquids. The remainder (62/233, 26.6%) remained nothing by mouth (NPO). Patients with neurological disease as the indication for the tracheotomy were more likely to remain NPO (P = .039). CONCLUSION A tracheotomy can functionally and anatomically affect swallowing in pediatric patients. The majority of our studied cohort was able to resume some form of an oral diet postoperatively based on MBS. This study highlights the need for objective measurements of swallowing in the postoperative tracheotomy patient to allow for safe and timely commencement of an oral diet. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Kimberly Luu
- Department of Otolaryngology, University of California-San Francisco, San Francisco, CA, USA
| | - Michael A Belsky
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Harish Dharmarajan
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas Kaffenberger
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer L McCoy
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Kristin Cangilla
- Department of Audiology and Speech Language Pathology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Allison B J Tobey
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey P Simons
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Raymond Maguire
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Reema Padia
- Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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24
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Aguirregomezcorta FR, Osona B, Peña-Zarza JA, Gil JA, Vetter-Laracy S, Frontera G, Figuerola J, Bover-Bauza C. Diagnosis and management of aspiration using fiberoptic endoscopic evaluation of swallowing in a Pediatric Pulmonology Unit. Pediatr Pulmonol 2021; 56:1651-1658. [PMID: 33620151 DOI: 10.1002/ppul.25328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Swallowing disorders lead to chronic lung aspiration. Early detection and treatment of aspiration in children with dysphagia are important to prevent lung damage. Diagnosis of aspiration, which may be silent, requires an instrumental study such as fiberoptic endoscopic evaluation of swallowing (FEES). Despite its usefulness, it is rarely practiced by pediatric pulmonologists. This study aimed to evaluate the feasibility and utility of FEES performed in the pediatric respiratory unit of a tertiary hospital, analyze the clinical characteristics, endoscopic findings and proposed treatments, and identify the factors associated with penetration or aspiration. METHODS Medical records of 373 children with suspected aspiration who were referred to the pediatric respiratory unit for FEES were reviewed retrospectively. Clinical characteristics, FEES findings, and the proposed treatments were analyzed. RESULTS Laryngeal penetration/aspiration was seen in 47.9% of the patients. The most common associated conditions were neurological disease and prematurity. The most frequently observed endoscopic finding was altered laryngeal sensitivity (36.5%). Intervention was recommended in 54.2% of the patients. Complications were not seen during any of the procedures. The multivariate logistic regression model revealed an independent association between aspiration and alterations in laryngeal sensitivity (odds ratio [OR], 5.68), pharyngeal pooling (OR, 11.47), and post-swallowing food residues (OR, 8.08). CONCLUSIONS The FEES procedure performed by pediatric pulmonologists is a reliable method for diagnosing aspiration in children. It can be safely executed by trained pulmonologists, and significant endoscopic signs other than aspiration can guide in the diagnosis and management recommendations.
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Affiliation(s)
- Fernando R Aguirregomezcorta
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain.,Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Borja Osona
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain.,Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Jose A Peña-Zarza
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain.,Research Group in Sleep Apnea and Hypopnea Syndrome, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Jose A Gil
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain.,Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Susanne Vetter-Laracy
- Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain.,Division of Neonatology, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Guiem Frontera
- Balearic Islands Health Research Institute (IdISBa), University Hospital Son Espases, Palma de Mallorca, Spain
| | - Joan Figuerola
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain.,Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Catalina Bover-Bauza
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain.,Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
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25
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Abstract
Children with a tracheostomy often present with swallowing disorders. Assessing the impact the presence of the tracheostomy tube has on swallowing function next to the underlying pathology can be very challenging. This article gives an overview of normal swallowing physiology and development, swallowing difficulties as encountered in various airway pathologies and addresses the mechanism by which the tracheostomy tube impacts swallowing. We discuss methods of investigating swallowing disorders and offer tools for management in everyday practice.
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Affiliation(s)
- Bas Pullens
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Marloes Streppel
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
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26
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Brooks L, Liao J, Ford J, Harmon S, Breedveld V. Thickened Liquids Using Pureed Foods for Children with Dysphagia: IDDSI and Rheology Measurements. Dysphagia 2021; 37:578-590. [PMID: 33954811 DOI: 10.1007/s00455-021-10308-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
Children with dysphagia, or swallowing disorder, are at an increased risk for developing respiratory compromise, failure to thrive, and aversion. Thickened liquids can be recommended for children with dysphagia, if shown to be effective on instrumental examination and if strategies/interventions with thin liquids are not successful. Thickened liquids have many benefits, including creating a more cohesive bolus, slowing oropharyngeal transit time, and reducing aspiration. However, preparing thickened liquids with commercially available thickeners can result in poor compliance due to concerns regarding taste, texture, accessibility, cost, thickness variability, and potential negative impact of these substances on a child's immature digestive tract. The purpose of this study was to determine if liquids could be successfully thickened with widely available, commercial pureed foods, and to assess how these mixtures compare to starch and gum based thickening agents. The International Dysphagia Diet Standardisation Initiative (IDDSI) flow test was performed for each sample of puree thickened liquids, gum based thickened water, and cornstarch based thickened water. In addition, rheology testing was performed on each category of the samples to measure viscosity at various shear rates and temperatures, and to assess the presence of yield stress. Results revealed that liquids thickened with smooth textured purees were comparable to commercial starch and gum based thickeners, and may be offered as a viable alternative.
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Affiliation(s)
- Laura Brooks
- Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Jianshan Liao
- School of Chemical & Biomolecular Engineering and Renewable Bioproducts Institute, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Jaclyn Ford
- Department of Psychology and Neuroscience, Boston College, Boston, MA, USA
| | - Sarah Harmon
- Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Victor Breedveld
- School of Chemical & Biomolecular Engineering and Renewable Bioproducts Institute, Georgia Institute of Technology, Atlanta, GA, 30332, USA
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27
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Shao F, Zhao X, Toyama H, Ichihara T, Zhuang H, Zhao R, Kung BT, Ng KS, Zhang Z, Wu H. Semi-quantitative assessment optimized the grading of pulmonary aspiration on salivagram in children. Ann Nucl Med 2021; 35:321-327. [PMID: 33555558 DOI: 10.1007/s12149-020-01564-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/04/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Salivagram is one of the imaging modalities to detect pulmonary aspiration in children. This study aims to optimize the classification of pulmonary aspiration detected by salivagram with a semi-quantitative analytical method. METHODS This is a retrospective study involving 737 patients (471 males, 266 females; aged 1 month to 8 years; mean age 5.3 months, median age 3.0 months old) with suspected pulmonary aspiration, who had salivagram done between January 2018 and June 2019. Positive cases were divided into 10 groups (Grade 1, R2, L2, R2L2, R3, L3, R3L2, R2L3, R3L3, and 4) according to the scintigraphic findings. Aspiration index was determined as the ratio of the count in the respiratory tract to the total count in the image field of view and compared among different groups using the receiver operating characteristics (ROC) curve analysis. RESULTS A total of 180 cases had positive scintigraphic findings of various grades of aspiration (24.4%, 180/737). There is a high consistency among the two independent nuclear medicine physicians involved in the study, in determining both the disease gradings (κ = 0.919;95% CI: 0.915-0.923) and aspiration index (ICC = 0.994;95% CI: 0.993-0.996). There is no significant difference (p > 0.05) in aspiration index among the gradings in "mild" group (grade 1, R2, L2, L2R2), and "moderate" group (grade R3, R3L2, R3L3). After dividing the different grades into "mild", "moderate" and "severe" groups, the aspiration index of "mild" group is 4.40 ± 2.01, that of "moderate" group is 16.43 ± 8.20, and that of "severe" group is 46.94 ± 14.81. Difference in groups was statistically significant (p < 0.0001). In ROC curve analysis, AUC of "mild" and "moderate" groups is 0.970 and that of "moderate" and "severe" groups is 0.943; the cut-off value with highest diagnostic efficiency is 6.75 between "mild" and "moderate" groups and 38.00 between "moderate" and "severe" groups. CONCLUSIONS We introduced a semi-quantitative analytical method in pulmonary aspiration on salivagram, to optimize and supplement to the current classification of pulmonary aspiration.
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Affiliation(s)
- Fuqiang Shao
- Department of Nuclear Medicine, Zigong First People's Hospital, Zigong, Sichuan, 643000, People's Republic of China
| | - Xiaofei Zhao
- Department of Nuclear Medicine, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai, 201102, People's Republic of China.,Department of Radiology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Takashi Ichihara
- Department of Radiology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hongming Zhuang
- Department of Nuclear Medicine, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai, 201102, People's Republic of China.,Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruifang Zhao
- Department of Nuclear Medicine, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai, 201102, People's Republic of China
| | - Boom Ting Kung
- Nuclear Medicine Unit and Clinical PET Centre, Queen Elizabeth Hospital, Kowloon, Hong Kong, People's Republic of China
| | - Kwok Sing Ng
- Nuclear Medicine Unit and Clinical PET Centre, Queen Elizabeth Hospital, Kowloon, Hong Kong, People's Republic of China
| | - Ziwei Zhang
- Department of Nuclear Medicine, Zigong First People's Hospital, Zigong, Sichuan, 643000, People's Republic of China
| | - Ha Wu
- Department of Nuclear Medicine, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai, 201102, People's Republic of China.
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Gatcliffe C, Rao A, Brigger M, Dimmock D, Hansen C, Montgomery J, Schlaberg R, Coufal NG, Farnaes L. Metagenomic sequencing and evaluation of the host response in the pediatric aerodigestive population. Pediatr Pulmonol 2021; 56:516-524. [PMID: 33270378 DOI: 10.1002/ppul.25198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/30/2020] [Accepted: 11/19/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To assess the diagnostic utility of metagenomic sequencing in pediatric aerodigestive clinic patients being evaluated for chronic aspiration. We hypothesize that using a metagenomics platform will aid in the identification of microbes not found on standard culture. STUDY DESIGN AND METHODS Twenty-four children referred to an aerodigestive clinic were enrolled in a prospective, single-site, cross-sectional cohort study. At the time of clinical evaluation under anesthesia, two samples were obtained: an upper airway sample and a sample from bronchoalveolar lavage (BAL). Samples were sent for routine culture and analyzed using Explify® Respiratory, a CLIA Laboratory Developed Test which identifies respiratory commensals and pathogens through RNA and DNA sequencing. Since RNA was sequenced in the course of the metagenomic analysis to identify organisms (RNA viruses and bacteria), the sequencing approach also captured host derived messenger RNA during sample analysis. This incidentally obtained host transcriptomic data were analyzed to evaluate the host immune response. The results of these studies were correlated with the clinical presentation of the research subjects. RESULTS In 10 patients, organisms primarily associated with oral flora were identified in the BAL. Standard culture was negative in three patients where clinical metagenomics led to a result with potential clinical significance. Transcriptomic data correlated with the presence or absence of dysphagia as identified on prior videofluoroscopic evaluation of swallowing. CONCLUSIONS Clinical metagenomics allows for simultaneous analysis of the microbiota and the host immune response from BAL samples. As the technologies in this field continue to advance, such testing may improve the diagnostic evaluation of patients with suspected chronic aspiration.
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Affiliation(s)
- Chelsea Gatcliffe
- Department of Pediatrics, Division of Pediatric Respiratory Medicine, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California, USA.,Department of Surgery, Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California, USA
| | - Aparna Rao
- Department of Pediatrics, Division of Pediatric Respiratory Medicine, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California, USA
| | - Matthew Brigger
- Rady Children's Institute for Genomic Medicine, Rady Children's Hospital San Diego, San Diego, California, USA
| | - David Dimmock
- Department of Surgery, Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California, USA
| | - Christian Hansen
- Department of Surgery, Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California, USA
| | | | | | - Nicole G Coufal
- Department of Surgery, Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California, USA.,Department of Pediatrics, Pediatric Critical Care, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California, USA
| | - Lauge Farnaes
- Department of Surgery, Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California, USA.,Department of Pediatrics, Division of Pediatric Infectious Diseases, Rady Children's Hospital San Diego, University of California San Diego, San Diego, California, USA
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29
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Disorders Affecting Feeding and Swallowing in Infants and Children. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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30
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Basso CSD, Arroyo MADS, Fucuta PDS, Maia AB. Feeding of children with tracheostomy at hospital discharge. REVISTA CEFAC 2021. [DOI: 10.1590/1982-0216/20212353321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
ABSTRACT Purpose: to describe the work of speech-language-hearing therapists and verify which was the most prevalent feeding method in the sample studied. Methods: a descriptive observational study based on data surveyed from medical records. The following variables were used: age, medical diagnosis, hospital ward, feeding method before and after the tracheostomy, time of speech-language-hearing care, and speech-language-hearing discharge. The data were submitted to descriptive statistical analysis with the appropriate tests to compare the categorical variables. All infants and children with tracheostomy performed either before or during hospital stay between July 2017 and July 2018, who received speech-language-hearing care upon request of the physician, were included. Results: a total of 51 children took part in the study, most of whom were males (56.9%), with a median age of 12 months, ranging from 1 month to 12 years old at the time of the speech-language-hearing assessment. The feeding methods at hospital discharge were described as follows: full oral feeding (37%), partial oral feeding (25.5%), nasogastric/nasoenteral tube (19.6%), and gastrostomy (17.6%). Conclusion: the full oral diet of tracheostomized children was the most prevalent feeding method at hospital speech-language-hearing discharge.
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31
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Etges CL, Barbosa LDR, Cardoso MCDAF. Development of the Pediatric Dysphagia Risk Screening Instrument (PDRSI). Codas 2020; 32:e20190061. [PMID: 33053082 DOI: 10.1590/2317-1782/20202019061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/28/2019] [Indexed: 01/30/2023] Open
Abstract
OBJETIVO Desenvolver um instrumento de rastreio para a identificação de crianças com risco para disfagia, em ambiente hospitalar. MÉTODO O Instrumento de Rastreio para o Risco de Disfagia Pediátrica (IRRD-Ped), constituído por 23 questões, foi desenvolvido por fonoaudiólogos, após revisão da literatura. Ele foi proposto para ser aplicado aos responsáveis por crianças em internação hospitalar. O IRRD-Ped foi enviado a juízes para análise, tendo sido também realizado um estudo piloto. Para verificar a validade de critério, aplicou-se o IRRD-Ped aos responsáveis por crianças internadas e, posteriormente, realizou-se, com estas crianças, avaliação clínica da deglutição, através do Protocolo de Avaliação da Disfagia Pediátrica (PAD-PED). Os responsáveis assinaram o Termo de Consentimento Livre e Esclarecido. Os sujeitos foram separados em dois grupos (com disfagia e com deglutição normal), sendo verificada a associação entre as questões do IRRD-Ped e o resultado do PAD-PED, através do teste qui-quadrado de Person ou exato de Fisher. Definiu-se o ponto de corte para presença de risco para disfagia através da Curva ROC. A confiabilidade do IRRD-Ped foi verificada pelo coeficiente α de Cronbach. RESULTADOS A amostra foi constituída por 40 crianças com mediana de idade de 3,7 meses. Verificou-se associação estatisticamente significativa em oito itens do instrumento. A consistência interna do IRRD-Ped foi de 0,828. O ponto de corte para o risco de disfagia foi de cinco pontos (sensibilidade = 100% e especificidade = 80%). CONCLUSÃO Devido aos satisfatórios resultados encontrados, deve-se dar prosseguimento ao processo de validação do IRRD-Ped.
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Affiliation(s)
- Camila Lucia Etges
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brasil
| | - Lisiane De Rosa Barbosa
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brasil
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32
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The Ethics of Feeding the Aspirating Child in an Age of Increasing Patient Complexity. J Pediatr Gastroenterol Nutr 2020; 71:586-588. [PMID: 33093363 DOI: 10.1097/mpg.0000000000002919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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33
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Infants without apparent risk factors with aspiration as a cause of respiratory symptoms - a retrospective study. Ir J Med Sci 2020; 190:217-223. [PMID: 32583311 DOI: 10.1007/s11845-020-02282-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Dysphagia is common in children born prematurely or those with neuromuscular conditions or airway malformations. Few studies have reported on children with isolated dysphagia and there is significant variation in the literature regarding clinical outcomes. AIMS The aim of this study was to characterise the clinical presentation of children with isolated dysphagia as well as the diagnostic evaluation, treatment strategies and clinical outcomes. METHODS A retrospective chart review was conducted of children with isolated dysphagia presenting to a tertiary paediatric centre over a 10-year period. RESULTS We describe these patients' presentation, clinical feeding assessment findings, radiological findings, treatment strategies and outcomes. Seventeen children were identified. Recurrent respiratory tract infections were the most common presentation (82%). Oral feeds were continued in 9 (53%) with the remaining being NG fed. Gastrostomy tubes were required for long-term nutrition in 6/8 (75%) of these cases. At follow-up, 11/17 (65%) had resolution of symptoms and are on full oral feeds. The mean age at resolution is 3.45 years. Of those who required gastrostomy 50% have had them removed. CONCLUSION Isolated dysphagia should be considered in children presenting with recurrent, otherwise unexplained respiratory symptoms. Resolution can take a number of years.
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Narawane A, Eng J, Rappazzo C, Sfeir J, King K, Musso MF, Ongkasuwan J. Airway protection & patterns of dysphagia in infants with down syndrome: Videofluoroscopic swallow study findings & correlations. Int J Pediatr Otorhinolaryngol 2020; 132:109908. [PMID: 32018163 DOI: 10.1016/j.ijporl.2020.109908] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/23/2020] [Accepted: 01/26/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Down syndrome is a genetic condition that affects 1:737 births. Along with cardiac, otolaryngologic, and developmental anomalies, infants with Down syndrome can have swallowing difficulties resulting in respiratory infections. This study aims to characterize the airway protection and dysphagia seen in infants with Down syndrome. METHODS This is a retrospective chart review of infants with Down syndrome who underwent videofluoroscopic swallow studies (VFSS) from 2008 to 2018 at a tertiary children's hospital. Demographic data and VFSS findings were collected. RESULTS 89.8% (114/127) of infants presented with at least one element of oral dysphagia, while 72.4% (92/127) had at least one element of pharyngeal dysphagia. Sucking skills were classified as abnormal in 63.7% of the patients and bolus formation-control was determined to be deficient (abnormal) in 62.2% of the patients. Oral residuals were present in 37.8% of the patients. With regard to pharyngeal phase, the swallow initiation was considered abnormal in 53.5% of the patients. Pharyngeal residue was present in 17.3% and pharyngo-nasal reflux was present in 27.5% of the patients. CONCLUSIONS Swallowing assessments in infants with Down syndrome suspected of dysphagia should be considered, especially in those with any alterations in pulmonary health.
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Affiliation(s)
| | - James Eng
- Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, USA
| | | | - Jeanan Sfeir
- Speech Language and Learning, Texas Children's Hospital, USA
| | - Kimberly King
- Speech Language and Learning, Texas Children's Hospital, USA
| | - Mary Frances Musso
- Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, USA; Pediatric Otolaryngology, Texas Children's Hospital, USA
| | - Julina Ongkasuwan
- Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, USA; Pediatric Otolaryngology, Texas Children's Hospital, USA.
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35
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Affiliation(s)
- James D Tutor
- Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center, LeBonheur Children's Hospital, and St. Jude Children's Research Hospital, Memphis, TN
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36
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Manikam L, Schilder AGM, Lakhanpaul M, Littlejohns P, Alexander EC, Hayward A. Respiratory tract infection-related healthcare utilisation in children with Down's syndrome. Infection 2020; 48:403-410. [PMID: 32172511 PMCID: PMC7095390 DOI: 10.1007/s15010-020-01408-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/02/2020] [Indexed: 02/02/2023]
Abstract
Purpose Children with Down’s syndrome (DS) are prone to respiratory tract infections (RTIs) due to anatomical variation, immune system immaturity and comorbidities. However, evidence on RTI-related healthcare utilisation, especially in primary care, is incomplete. In this retrospective cohort study, we use routinely collected primary and secondary care data to quantify RTI-related healthcare utilisation in children with DS and matched controls without DS. Methods Retrospective cohort study of 992 children with DS and 4874 matched controls attending English general practices and hospitals as identified in Clinical disease research using LInked Bespoke studies and Electronic health Records (CALIBER) from 1997 to 2010. Poisson regression was used to calculate consultation, hospitalisation and prescription rates, and rate ratios. Wald test was used to compare risk of admission following consultation. The Wilcoxon rank–sum test was used to compare length of stay by RTI type and time-to-hospitalisation. Results RTI-related healthcare utilisation is significantly higher in children with DS than in controls in terms of GP consultations (adjusted RR 1.73; 95% CI 1.62–1.84), hospitalisations (adjusted RR 5.70; 95% CI 4.82–6.73), and antibiotic prescribing (adjusted RR 2.34; 95% CI 2.19–2.49). Two percent of children with DS presenting for an RTI-related GP consultation were subsequently admitted for an RTI-related hospitalisation, compared to 0.7% in controls. Conclusions Children with DS have higher rates of GP consultations, hospitalisations and antibiotic prescribing compared to controls. This poses a significant burden on families. Further research is recommended to characterise healthcare behaviours and clinical decision-making, to optimise care for this at risk group. Electronic supplementary material The online version of this article (10.1007/s15010-020-01408-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Logan Manikam
- UCL Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK. .,UCL Institute of Health Informatics Research, University College London, 222 Euston Road, London, NW1 2DA, UK.
| | - Anne G M Schilder
- National Institute of Health Research University College London Hospitals Biomedical Research Centre, 149 Tottenham Court Road, London, W1T 7DN, UK.,evidENT, UCL Ear Institute, University College London, 332 Grays Inn Road, London, WC1X 8DA, UK
| | - Monica Lakhanpaul
- Population, Policy & Practice, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.,Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Peter Littlejohns
- Centre for Implementation Science, Institute of Psychiatry, Psychology and Neurosciences, King's College London, 6 De Crespigny Park, Camberwell, London, SE5 8AB, UK
| | - Emma C Alexander
- Paediatric Liver, GI and Nutrition Centre and Mowatlabs, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Andrew Hayward
- UCL Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.,UCL Institute of Health Informatics Research, University College London, 222 Euston Road, London, NW1 2DA, UK
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Bowman OJ, Hagan JL, Toruno RM, Wiggin MM. Identifying Aspiration Among Infants in Neonatal Intensive Care Units Through Occupational Therapy Feeding Evaluations. Am J Occup Ther 2020; 74:7401205080p1-7401205080p9. [PMID: 32078519 PMCID: PMC7018452 DOI: 10.5014/ajot.2020.022137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE When a neonate's sucking, swallowing, and breathing are disorganized, oropharyngeal aspiration often occurs and results in illness, developmental problems, and even death. Occupational therapists who work in the neonatal intensive care unit (NICU) need to identify neonates who are at risk for aspirating so they can provide appropriate treatment. OBJECTIVE To ascertain whether client factors and performance skills of infants ages 0-6 mo during occupational therapy feeding evaluations are related to results of videofluoroscopic swallowing studies (VFSSs). DESIGN Retrospective chart reviews. SETTING 187-bed NICU in a nonprofit teaching hospital. PARTICIPANTS A purposive sample of 334 infants ages 0-6 mo, ≥33 wk gestational age at birth, admitted to a Level II, III, or IV NICU as defined by the American Academy of Pediatrics. OUTCOMES AND MEASURES Neonates were administered a feeding evaluation by an occupational therapist and a VFSS by a speech-language pathologist, which yielded information about client factors and performance skills. RESULTS Signs and symptoms of aspiration on the evaluations were significantly associated with VFSS results. Of 310 patients, 79 had silent aspiration. Of 55 infants who demonstrated no aspiration symptoms during the feeding evaluation, 45% demonstrated aspiration symptoms on the VFSS, and 55% aspirated on the VFSS but demonstrated no symptoms of aspiration. CONCLUSIONS AND RELEVANCE Aspiration among infants occurs inconsistently and depends on client factors, contexts, and environments. Occupational therapists are encouraged to assess an infant's feeding over several sessions to obtain a more accurate picture of the infant's feeding status. WHAT THIS ARTICLE ADDS This study provides information that helps occupational therapists identify infants at risk for aspiration and make optimal recommendations regarding safe feeding practices and appropriate referrals for a VFSS. Making appropriate referrals for VFSS is also important in preventing unnecessary exposure to radiation for preterm infants.
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Affiliation(s)
- O Jayne Bowman
- O. Jayne Bowman, OT, PhD, is Associate Professor, School of Occupational Therapy, Texas Woman's University, Houston;
| | - Joseph L Hagan
- Joseph L. Hagan, PhD, is Research Statistician, Center for Research and Evidence-Based Practice, Texas Children's Hospital, Houston
| | - Rose Marie Toruno
- Rose Marie Toruno, OTR, MOT, NDT/C, is Advanced Clinical Specialist, Texas Children's Hospital, Houston
| | - Mitzi M Wiggin
- Mitzi M. Wiggin, PT, MS, is Manager, Research and Clinical Education, Texas Children's Hospital, Houston
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McSweeney ME, Meleedy-Rey P, Kerr J, Chan Yuen J, Fournier G, Norris K, Larson K, Rosen R. A Quality Improvement Initiative to Reduce Gastrostomy Tube Placement in Aspirating Patients. Pediatrics 2020; 145:peds.2019-0325. [PMID: 31996405 PMCID: PMC6993527 DOI: 10.1542/peds.2019-0325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Oropharyngeal dysphagia and aspiration may occur in infants and children. Currently, there is wide practice variation regarding when to feed children orally or place more permanent gastrostomy tube placement. Through implementation of an evidence-based guideline (EBG), we aimed to standardize the approach to these patients and reduce the rates of gastrostomy tube placement. METHODS Between January 2014 and December 2018, we designed and implemented a quality improvement intervention creating an EBG to be used by gastroenterologists evaluating patients ≤2 years of age with respiratory symptoms who were found to aspirate on videofluoroscopic swallow study (VFSS). Our primary aim was to encourage oral feeding and decrease the use of gastrostomy tube placement by 10% within 1 year of EBG initiation; balancing measures included total hospital readmissions or emergency department (ED) visits within 6 months of the abnormal VFSS. RESULTS A total of 1668 patients (27.2%) were found to have aspiration or penetration noted on an initial VFSS during our initiative. Mean gastrostomy tube placement in these patients was 10.9% at the start of our EBG implementation and fell to 5.2% approximately 1 year after EBG initiation; this improvement was sustained throughout the next 3 years. Our balancing measures of ED visits and hospital readmissions also did not change during this time period. CONCLUSIONS Through implementation of this EBG, we reduced gastrostomy tube placement by 50% in patients presenting with oropharyngeal dysphagia and aspiration, without increasing subsequent hospital admissions or ED visits.
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Affiliation(s)
- Maireade E. McSweeney
- Aerodigestive Center and Motility and Functional Gastrointestinal Disorders Center, Division of Gastroenterology, Hepatology and Nutrition
| | | | | | | | - Gregory Fournier
- Aerodigestive Center and Motility and Functional Gastrointestinal Disorders Center, Division of Gastroenterology, Hepatology and Nutrition
| | - Kerri Norris
- Finance, Boston Children’s Hospital, Boston, Massachusetts
| | - Kara Larson
- Aerodigestive Center and Motility and Functional Gastrointestinal Disorders Center, Division of Gastroenterology, Hepatology and Nutrition
| | - Rachel Rosen
- Aerodigestive Center and Motility and Functional Gastrointestinal Disorders Center, Division of Gastroenterology, Hepatology and Nutrition
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Twenty years of quantitative instrumental measures of swallowing in children: a systematic review. Eur J Pediatr 2020; 179:203-223. [PMID: 31900589 DOI: 10.1007/s00431-019-03546-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 01/21/2023]
Abstract
Early identification and intervention has shown better health outcomes for children with dysphagia. Instrumental swallowing assessments are vital and have been a focus of dysphagia research in the last two decades. This systematic review explores published quantitative instrumental measures of swallowing in children. Five subject-related databases were searched to identify original scientific articles published in English, using instrumental quantitative measures of swallowing to study swallowing/feeding mechanism in children since 1998. Two thousand two hundred and two articles were found from the initial database search and 36 were included in the final qualitative synthesis following PRISMA guidelines. Selected studies showed great diversity in target population, phase/s of swallowing studied, instrumentation used (n = 10) and quantitative measures reported (n = 144). Videofluoroscopy and manometry have been studied most repeatedly. With less frequency, a variety of other instruments has been used to describe suck-swallow patterns and swallowing-related respiration. High-resolution manometry shows the greatest increase in publications with validated, reliable quantitative measures of pharyngeal and oesophageal pressures and timing. More recently, quantification of videofluoroscopy analysis has been a focus.Conclusion: A diverse range of quantitative measures of swallowing is available for children in the literature. However, further reliability and validity testing is needed. Opportunities for clinical application of these quantitative manometric and videofluoroscopic measures are restricted by limited normative comparisons and vast variability in published measures.What is known?• Instrumental swallowing assessments are reliable and accurate in diagnosing swallowing difficulties in children.• However, subjective interpretation of observational findings often questions the optimal use of instrumentation.What is new?• High-resolution manometry has shown promising progress with the development of quantitative objective swallow measures for children. While attempts to quantify video-fluoroscopic measures have been increased in the recent past.• A vast variety of instruments has been used to obtain quantitative and/or objective swallow measures of children, yet clinical application is still in progress.
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Abstract
OBJECTIVE The aim of this study was to analyse the potential effect of indwelling nasogastric tubes (NGTs) on the positive rate of pulmonary aspiration in the salivagram of paediatric patients. METHODS This retrospective study evaluated 290 children suffering from respiratory tract infection with clinical suspicion of pulmonary aspiration (104 cases with NGT and 186 cases without NGT). Among them, 216 had good past health, while 74 had history of oropharyngeal diseases or brain injuries. Tc-DTPA salivagrams were performed to determine whether the risk of pulmonary aspiration was different between patients with and without NGT. RESULTS The positive rates of aspiration in salivagram were 32.3% (60/186) and 29.8% (31/104) in the patients without and with NGT, respectively. The positive rates of the two groups had not statistically significant difference [risk ratio (RR) = 0.924; 95% confidence interval (CI): 0.644-1.326; P = 0.666]. Subgroup analyses showed that the patients with good past health had the positive rates of 24.4% (19/78) with NGT and 25.4 % (35/138) without NGT. The two groups had no statistically significant difference (RR = 0.960; 95% CI: 0.592-1.559; P = 0.870). For the patients with underlying diseases, the positive rates were 46.2% (12/26) with NGT and 52.1% (25/48) without NGT. These two groups also demonstrated no statistically significant difference (RR = 0.886; 95% CI: 0.540-1.455; P = 0.626). CONCLUSION The positive rate of pulmonary aspiration was relatively high in patients with respiratory tract infection who have underlying diseases but NGT feeding did not affect salivagram accuracy.
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Jackson A, Maybee J, Wolter-Warmerdam K, DeBoer E, Hickey F. Associations between age, respiratory comorbidities, and dysphagia in infants with down syndrome. Pediatr Pulmonol 2019; 54:1853-1859. [PMID: 31402588 DOI: 10.1002/ppul.24458] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 06/26/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Children with Down syndrome (DS) have a high risk of dysphagia and the pediatric pulmonologist may be involved in diagnosis and management. The objective of this study is to evaluate the associations between age, dysphagia, and medical comorbidities in young children with DS. We hypothesized that swallow study findings are more likely to change in younger infants and that medical comorbidities may be associated with dysphagia. STUDY DESIGN Results of videofluoroscopic swallow studies (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) from 2010 to 2016 were collected retrospectively in children with DS with initial swallow study at less than 12 months of age. Results were analyzed for findings and change based on age at initial study, reason for referral, and medical comorbidities. RESULTS One hundred eleven infants with 247 VFSS and 14 FEES were included. Deep laryngeal penetration and/or aspiration were found in 31.9% of infants less than 6 months and 51.3% of infants 6 to 12 months. Children with initial swallow study performed at greater than or equal to 6 months of age were more likely (80.0%) to have unchanged findings on follow-up study compared to children imaged at less than 6 months (35.3%). Laryngomalacia, pulmonary hypertension, pneumonia, and congenital cardiac disease were associated with dysphagia. CONCLUSION We confirmed that dysphagia is common in infants with DS and comorbidities and provided preliminary evidence that swallow study findings may be more likely to change in children tested under 6 months of age. Providers should consider that results for instrumental swallow studies may change, particularly if the test was completed on a young infant.
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Affiliation(s)
- Arwen Jackson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Children's Hospital Colorado, Aurora, Colorado
| | - Jennifer Maybee
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Children's Hospital Colorado, Aurora, Colorado
| | | | - Emily DeBoer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Children's Hospital Colorado, Aurora, Colorado
| | - Francis Hickey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Children's Hospital Colorado, Aurora, Colorado
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Wong NS, Feng Z, Rappazzo C, Turk C, Randall C, Ongkasuwan J. Patterns of Dysphagia and Airway Protection in Infants with 22q11.2‐Deletion Syndrome. Laryngoscope 2019; 130:2532-2536. [DOI: 10.1002/lary.28317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 08/13/2019] [Accepted: 09/04/2019] [Indexed: 12/30/2022]
Affiliation(s)
| | - Zipei Feng
- Department of Otolaryngology Head and Neck Surgery Baylor College of Medicine Houston Texas U.S.A
| | - Christina Rappazzo
- Department of Speech Language and Learning Texas Children's Hospital Houston Texas U.S.A
| | - Catherine Turk
- Department of Speech Language and Learning Texas Children's Hospital Houston Texas U.S.A
| | - Chelsea Randall
- Department of Speech Language and Learning Texas Children's Hospital Houston Texas U.S.A
| | - Julina Ongkasuwan
- Department of Otolaryngology Head and Neck Surgery Baylor College of Medicine Houston Texas U.S.A
- Pediatric Otolaryngology Texas Children's Hospital Houston Texas U.S.A
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Shay EO, Meleca JB, Anne S, Hopkins B. Natural history of silent aspiration on modified barium swallow studies in the pediatric population. Int J Pediatr Otorhinolaryngol 2019; 125:116-121. [PMID: 31295702 DOI: 10.1016/j.ijporl.2019.06.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/16/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To investigate the natural history of silent aspiration in the pediatric population. METHODS Retrospective chart review of patients (age < 3 years) who underwent modified barium swallow studies (MBSS), between January 1, 2007, to December 31, 2017, were studied to compare comorbidities and determine course of resolution in those with silent aspiration. RESULTS A total of 148 charts were reviewed. Patients that underwent surgical intervention for laryngeal anomalies causing silent aspiration and those with overt aspiration or oral aversion were excluded. Of the 56 patients in the study, 25 had silent aspiration and 31 demonstrated no silent aspiration on MBSS. There was a higher rate of overall comorbidities amongst silent aspirators (96.0% vs. 48.4%, p=0.003) in comparison to patients with no silent aspiration on MBSS. Silent aspirators had higher rates of cerebral palsy (16.0% vs. 0%, p=0.034), and seizures (36.0% vs. 3.2%, p=0.003). Of the 20 patients with silent aspiration with an MBSS completed beyond the initial one, 13 (65.0%) experienced resolution, 5 (20.0%) did not experience resolution by age 5, and 2 (10.0%) had unknown resolution due to being lost to follow up or not yet reaching age 5. No statistically significant associations were found between comorbidities, gender, presence of a gastrostomy tube and resolution. CONCLUSIONS Silent aspiration in children is associated with neurological comorbidities, particularly cerebral palsy and seizures. More than half of the patients with silent aspiration spontaneously resolve over time. Expectant management, close surveillance, and clinical assessments can be considered in these patients on an individual basis.
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Affiliation(s)
- Elizabeth O Shay
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Joseph B Meleca
- Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA.
| | - Samantha Anne
- Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA
| | - Brandon Hopkins
- Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA
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Consideration of Cough Reflex Development When Ordering Modified Barium Swallow Studies in Infants. Dysphagia 2019; 35:533-541. [DOI: 10.1007/s00455-019-10062-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/27/2019] [Indexed: 11/26/2022]
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Streppel M, Veder LL, Pullens B, Joosten KFM. Swallowing problems in children with a tracheostomy tube. Int J Pediatr Otorhinolaryngol 2019; 124:30-33. [PMID: 31154120 DOI: 10.1016/j.ijporl.2019.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Swallowing problems in children with a tracheostomy tube seem to be a common problem, although exact prevalence is not known. The aim of this study is to identify the prevalence and type of swallowing problems in children with a tracheostomy tube. METHODS We retrospectively included 44 children having a tracheostomy tube at Erasmus MC-Sophia Children's hospital. Assessment by a specialized speech and language therapist, the Modified Evans Blue Dye test, Video Fluoroscopic Swallowing Study and a Fiber-optic Endoscopic Evaluation of Swallowing were reviewed with regard to the different phases of swallowing, in particular signs of aspiration. RESULTS In our cohort, 31 (70%) children with a tracheostomy tube presented with problems in the oral and/or the pharyngeal phase of swallowing. Overall 19 (43%) children aspirated. CONCLUSIONS The majority of children with a tracheostomy tube have swallowing problems in the different swallowing phases with a high risk for aspiration.
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Affiliation(s)
- Marloes Streppel
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Laura L Veder
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Bas Pullens
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Koen F M Joosten
- Department of Pediatrics, Pediatric Intensive Care Unit, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
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Canning A, Fairhurst R, Chauhan M, Weir KA. Oral Feeding for Infants and Children Receiving Nasal Continuous Positive Airway Pressure and High-Flow Nasal Cannula Respiratory Supports: A Survey of Practice. Dysphagia 2019; 35:443-454. [DOI: 10.1007/s00455-019-10047-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/09/2019] [Accepted: 08/05/2019] [Indexed: 12/19/2022]
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Hoffmeister J, Zaborek N, Thibeault SL. Postextubation Dysphagia in Pediatric Populations: Incidence, Risk Factors, and Outcomes. J Pediatr 2019; 211:126-133.e1. [PMID: 30954246 DOI: 10.1016/j.jpeds.2019.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/22/2019] [Accepted: 02/13/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess incidence, risk factors for, and impact on outcomes of postextubation dysphagia. We hypothesized that the incidence of postextubation dysphagia in pediatric patients would approximate or exceed that in adults, that age and duration of intubation would increase odds for postextubation dysphagia, and that the presence of postextubation dysphagia would negatively impact patient outcomes. STUDY DESIGN We performed a retrospective, observational cohort study of patients aged 0-16 years admitted between 2011 and 2017. Patients were included if they were extubated in the intensive care unit and fed orally within 72 hours. Records were reviewed to determine dysphagia status and assess the impact of patient factors on odds of postextubation dysphagia. The impact of postextubation dysphagia on patient outcomes was then assessed. RESULTS Following application of inclusion and exclusion criteria, the sample size was 372 patients. Postextubation dysphagia was observed in 29% of patients. For every hour of intubation, odds of postextubation dysphagia increased by 1.7% (P < .0001). Age of <25 months increased odds of postextubation dysphagia more than 2-fold (P < .05). When we controlled for age, diagnosis, number of complex chronic conditions, and dysphagia status, patients with dysphagia had an increase in total length of stay of 10.95 days (P < .0001). Postextubation dysphagia increased odds of gastrostomy or nasogastric tube at time of discharge (aOR 22.22, P < .0001). CONCLUSIONS This study found that postextubation dysphagia is associated with increased time between extubation and discharge and with odds of gastrostomy or nasogastric tube at time of discharge.
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Affiliation(s)
- Jesse Hoffmeister
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery; Department of Communication Sciences and Disorders
| | - Nicholas Zaborek
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Susan L Thibeault
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery; Department of Communication Sciences and Disorders.
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Use of Static Imaging as a Substitute for Conventional Dynamic Imaging for Salivagrams in Children. Clin Nucl Med 2019; 44:532-534. [DOI: 10.1097/rlu.0000000000002595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Goday PS, Huh SY, Silverman A, Lukens CT, Dodrill P, Cohen SS, Delaney AL, Feuling MB, Noel RJ, Gisel E, Kenzer A, Kessler DB, Kraus de Camargo O, Browne J, Phalen JA. Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework. J Pediatr Gastroenterol Nutr 2019; 68:124-129. [PMID: 30358739 PMCID: PMC6314510 DOI: 10.1097/mpg.0000000000002188] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/27/2018] [Indexed: 12/10/2022]
Abstract
Pediatric feeding disorders (PFDs) lack a universally accepted definition. Feeding disorders require comprehensive assessment and treatment of 4 closely related, complementary domains (medical, psychosocial, and feeding skill-based systems and associated nutritional complications). Previous diagnostic paradigms have, however, typically defined feeding disorders using the lens of a single professional discipline and fail to characterize associated functional limitations that are critical to plan appropriate interventions and improve quality of life. Using the framework of the World Health Organization International Classification of Functioning, Disability, and Health, a unifying diagnostic term is proposed: "Pediatric Feeding Disorder" (PFD), defined as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. By incorporating associated functional limitations, the proposed diagnostic criteria for PFD should enable practitioners and researchers to better characterize the needs of heterogeneous patient populations, facilitate inclusion of all relevant disciplines in treatment planning, and promote the use of common, precise, terminology necessary to advance clinical practice, research, and health-care policy.
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Affiliation(s)
- Praveen S. Goday
- Feeding, Swallowing and Nutrition Center, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Susanna Y. Huh
- Growth and Nutrition Program, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Alan Silverman
- Feeding, Swallowing and Nutrition Center, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Colleen T. Lukens
- Pediatric Feeding and Swallowing Center, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Pamela Dodrill
- Feeding and Developmental Therapy Team, Brigham & Women's Hospital NICU, Boston, MA
| | - Sherri S. Cohen
- Pediatric Feeding and Swallowing Center, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Amy L. Delaney
- Feeding, Swallowing and Nutrition Center, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Mary B. Feuling
- Feeding, Swallowing and Nutrition Center, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Richard J. Noel
- Pediatric Gastroenterology, Hepatology, and Nutrition, Duke University Medical Center, Durham, NC
| | - Erika Gisel
- Department of Pediatrics and CanChild Centre for Childhood Disability Research McGill University, School of Physical & Occupational Therapy, Montreal, Quebec, Canada
| | - Amy Kenzer
- Southwest Autism Research & Resource Center, Phoenix, AZ
| | - Daniel B. Kessler
- Developmental and Behavioral Pediatrics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | | | - Joy Browne
- University of Colorado School of Medicine, Anschutz Medical Campus, Fielding Graduate University, Aurora, CO
| | - James A. Phalen
- Developmental-Behavioral Pediatrics University Health System, Uniformed Services University, San Antonio, TX
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Yi YG, Oh BM, Yang S, Shin HI. Oral Feeding Challenges in Children With Tracheostomy Can Improve Feeding Outcomes, Even With the Finding of Aspiration. Front Pediatr 2019; 7:362. [PMID: 31555626 PMCID: PMC6737036 DOI: 10.3389/fped.2019.00362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/20/2019] [Indexed: 11/13/2022] Open
Abstract
It has been suggested that oral feeding trial has therapeutic implications for improving oral-motor and swallowing function in infants and young children fed via an enteral tube or gastrostomy. This study aimed to investigate whether oral feeding challenges in children with tracheostomy could improve feeding outcomes, even with the finding of aspiration compared to those who did not receive oral feeding at all. Children (age <7 years) with tracheostomy who had thin fluid aspiration on videofluoroscopic swallowing study (VFSS) were included in this retrospective study. Enrolled children were then divided into two feeding method groups according to the physician's decision at the time of VFSS: oral feeding (OF) group and non-oral feeding (NOF) group. Data were obtained from 47 children (median age: 49.75 months, interquartile range [IQR]: 24.08-79.42). The incidence of pneumonia within 1 year after the VFSS was not different between NOF (n = 17) and OF (n = 30) groups. In OF group, 11 subjects achieved full oral feeding and 16 subjects were in partial oral feeding status 1 year after the VFSS. On the contrary, only one subject achieved full oral feeding and 5 subjects were in partial oral feeding status in NOF group (p < 0.001). Initial and follow-up penetration-aspiration scale on VFSS were different only in the OF group (p = 0.003). These results suggest that oral feeding challenges might be attempted even with the findings of aspiration in infants or young children with tracheostomy.
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Affiliation(s)
- You Gyoung Yi
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Women's University Seoul Hospital, Ewha Women's University School of Medicine, Seoul, South Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
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