1
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Boesch RP. Instrumental swallowing studies for the prevention of pulmonary morbidity in children and the importance of multi-disciplinary teams. J Pediatr (Rio J) 2024:S0021-7557(24)00070-6. [PMID: 38821487 DOI: 10.1016/j.jped.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024] Open
Affiliation(s)
- R Paul Boesch
- Mayo Clinic, Division of Pediatric Pulmonology, Rochester, MN, USA.
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2
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Pazinatto DB, Brandão MAB, Costa FLP, Favaro MMA, Maunsell R. Role of fiberoptic endoscopic evaluation of swallowing (FEES) in children with suspected dysphagia. J Pediatr (Rio J) 2024:S0021-7557(24)00041-X. [PMID: 38679061 DOI: 10.1016/j.jped.2024.03.008] [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: 11/29/2023] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE To assess FEES findings in defining oral feeding safety in children with suspected dysphagia, comparing them with clinical feeding evaluation results. METHODS This study comprised a case series involving children with suspected dysphagia, referred for evaluation by otolaryngologists and speech-language pathologists (SLPs) at a Brazilian quaternary public university hospital. These children underwent both clinical evaluations and fiberoptic endoscopic evaluation of swallowing (FEES), with a comprehensive collection of demographic and clinical data. Subsequently, the authors performed a comparative analysis of findings from both assessments. RESULTS Most patients successfully completed the FEES procedure (93.7%), resulting in a final number of 60 cases included in the study. The prevalence of dysphagia was confirmed in a significant 88% of these cases. Suspected aspiration on clinical SLP evaluation was present in 34 patients. Of these, FEES confirmed aspiration or penetration in 28 patients. Among the 35 patients with aspiration or penetration on FEES, 7 (20%) had no suspicion on SLP clinical assessment. All seven patients in whom clinical SLP evaluation failed to predict penetration/aspiration had neurological disorders. The median age of the children was 2.8 years, and 49 (81.6%) had neurological disorders, while 35 (58.3%) had chronic pulmonary disease. The most prevalent complaints were choking (41.6%) and sialorrhea (23.3%). CONCLUSION FEES can diagnose structural anomalies of the upper aerodigestive tract and significantly contribute to the detection of aspiration and penetration in this group of patients with suspected dysphagia, identifying moderate and severe dysphagia even in cases where clinical assessment had no suspicion.
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Affiliation(s)
| | | | | | | | - Rebecca Maunsell
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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3
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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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4
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Lefton-Greif MA, Arvedson JC, Farneti D, Levy DS, Jadcherla SR. Global State of the Art and Science of Childhood Dysphagia: Similarities and Disparities in Burden. Dysphagia 2024:10.1007/s00455-024-10683-5. [PMID: 38503935 DOI: 10.1007/s00455-024-10683-5] [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: 11/01/2023] [Accepted: 02/02/2024] [Indexed: 03/21/2024]
Abstract
Feeding/swallowing and airway protection are complex functions, essential for survival, and continue to evolve throughout the lifetime. Medical and surgical advances across the globe have improved the long-term survival of medically complex children at the cost of increasing comorbidities, including dysfunctional swallowing (dysphagia). Dysphagia is prominent in children with histories of preterm birth, neurologic and neuromuscular diagnoses, developmental delays, and aerodigestive disorders; and is associated with medical, health, and neurodevelopmental problems; and long-term socioeconomic, caregiver, health system, and social burdens. Despite these survival and population trends, data on global prevalence of childhood dysphagia and associated burdens are limited, and practice variations are common. This article reviews current global population and resource-dependent influences on current trends for children with dysphagia, disparities in the availability and access to specialized multidisciplinary care, and potential impacts on burdens. A patient example will illustrate some questions to be considered and decision-making options in relation to age and development, availability and accessibility to resources, as well as diverse cultures and family values. Precise recognition of feeding/swallowing disorders and follow-up intervention are enhanced by awareness and knowledge of global disparities in resources. Initiatives are needed, which address geographic and economic barriers to providing optimal care to children with dysphagia.
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Affiliation(s)
- Maureen A Lefton-Greif
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD, USA.
- Departments of Pediatrics, Otolaryngology-Head and Neck Surgery, and Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA.
| | - Joan C Arvedson
- Department of Speech-Language Pathology, Children's Wisconsin, Milwaukee, WI, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Daniele Farneti
- Audiologic Phoniatric Service, ENT Department AUSL Romagna, Infermi Hospital, Rimini, Italy
| | - Deborah S Levy
- Department of Health and Human Communication, Universidade Federal, do Rio Grande do Sul, Brazil
- Department of Speech Pathology and Audiology, Hospital de Clínicas, de Porto Alegre, Brazil
- Multi-Professional Residency Program, Hospital de Clínicas, de Porto Alegre, Brazil
| | - Sudarshan R Jadcherla
- Divisions of Neonatology, Pediatric Gastroenterology and Nutrition, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
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5
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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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Smith JB, Kamarunas E, O'Donoghue C. The Influence of Side-Lying Position on Oropharyngeal Swallow Function in At-Risk Infants: An Exploratory Study. Clin Pediatr (Phila) 2023; 62:1087-1100. [PMID: 36919839 DOI: 10.1177/00099228231159158] [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] [Indexed: 03/16/2023]
Abstract
This investigation assessed the effect of side-lying position on infant oropharyngeal swallow physiology. Infant modified barium swallow studies (MBS) recordings were retrospectively examined in matched-pairs comparing at-risk infants swallowing in both an upright/cradled position and a side-lying position. Swallow parameters were measured independently and through a consensus coding approach. Infants fed in side-lying position showed a decrease in airway invasion severity as compared with when those same infants were fed in an upright/cradled position (P = .009). Bolus location at the time of swallow initiation was higher when infants were fed in side-lying position as compared with cradle position (P = .024), representing decreased risk of airway invasion. Infants fed in side-lying position demonstrated fewer swallows per breaths (P = .032). This pilot study validates the need for additional research to further define the mechanisms related to this improvement, and to determine how diagnosis and medical stability moderate these findings.
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Affiliation(s)
- Julian B Smith
- Department of Communication Disorders, College of Health and Human Services, Southern Connecticut State University, New Haven, CT, USA
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
- Speech-Language Pathology, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Erin Kamarunas
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
| | - Cynthia O'Donoghue
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA, USA
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7
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Imdad A, Wang AG, Adlakha V, Crespo NM, Merrow J, Smith A, Tsistinas O, Tanner-Smith E, Rosen R. Laryngeal Penetration and Risk of Aspiration Pneumonia in Children with Dysphagia-A Systematic Review. J Clin Med 2023; 12:4087. [PMID: 37373780 DOI: 10.3390/jcm12124087] [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: 05/19/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
This study was a systematic review and meta-analysis that assessed the risk of aspiration pneumonia in children with laryngeal penetration or tracheal aspiration via a video-fluoroscopic study (VFSS) and compared the results to those for children with neither condition. Systematic searches were conducted using databases, including PubMed, Cochrane Library, and Web of Science. Meta-analysis was used to obtain summary odds ratios (OR) and 95% confidence intervals (CI). The overall quality of evidence was assessed using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. In total, 13 studies were conducted with 3159 participants. Combined results from six studies showed that laryngeal penetration on VFSS may be associated with aspiration pneumonia compared to no laryngeal penetration; however, the summary estimate was imprecise and included the possibility of no association (OR 1.44, 95% CI 0.94, 2.19, evidence certainty: low). Data from seven studies showed that tracheal aspiration might be associated with aspiration pneumonia compared to no tracheal aspiration (OR 2.72, 95% CI 1.86, 3.98, evidence certainty: moderate). The association between aspiration pneumonia and laryngeal penetration through VFSS seems to be weaker than that for tracheal aspiration. Prospective cohort studies with clear definitions of laryngeal penetration and that measure clinical and patient reported outcomes are needed to further define the association between laryngeal penetration and aspiration pneumonia.
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Affiliation(s)
- Aamer Imdad
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Alice G Wang
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Vaishali Adlakha
- Division of Pediatric Gastroenterology, Department of Pediatrics, McGovern Medical School, UTHealth Houston, Houston, TX 77030, USA
| | - Natalie M Crespo
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Jill Merrow
- Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Abigail Smith
- Health Science Library, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Olivia Tsistinas
- Health Science Library, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | | | - Rachel Rosen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Boston Children Hospital, Boston, MA 02115, USA
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8
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Evaluation and Management of Pediatric Feeding Disorder. GASTROINTESTINAL DISORDERS 2023. [DOI: 10.3390/gidisord5010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Feeding disorders are increasingly common in children, especially as medical advancements improve the life expectancy of children born with prematurity and complex medical conditions. The most common symptoms include malnutrition, refusal to eat and drink, food pocketing, disruptive feeding behavior, slow feeding, food selectivity or rigid food preferences, limited appetite, and delayed feeding milestones. A unifying diagnostic definition of pediatric feeding disorder has been proposed by a panel of experts to improve the quality of health care and advance research. Referral to specialized care should be considered when feeding problems are complex or difficult to resolve. In this review, we provide an overview of the evaluation and management of pediatric feeding disorders and information that may be useful when considering whether referral to specialized care may be beneficial.
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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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10
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Malandraki GA, Arkenberg RH. Advances in Swallowing Neurophysiology across Pediatric Development: Current Evidence and Insights. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021; 9:267-276. [PMID: 34956736 DOI: 10.1007/s40141-021-00334-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review This review article analyzes current evidence on the neurophysiology of swallowing during development and offers expert opinion on clinical implications and future research directions. Recent Findings In the past five years, basic and clinical research has offered advances in our understanding of pediatric swallowing neurophysiology. Animal models have elucidated the role of brainstem circuits and the peripheral and central nervous system in neonatal swallowing. Recent human studies have further showcased that fetal and infant swallowing require cerebral inputs in order to develop functionally. Finally, neurophysiological and neuroimaging studies are starting to better define these cerebral inputs, as well as neuroplastic adaptations that may be needed for optimal feeding development. Summary The neural development of swallowing is a complex and dynamic process. Continued research is needed to better understand influences on swallowing neural development, which can be essential for improving prevention, diagnosis, and interventions for pediatric dysphagia.
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Affiliation(s)
- Georgia A Malandraki
- Purdue University, Speech, Language, & Hearing Sciences, West Lafayette, Indiana, United States of America
- Purdue University, Weldon School of Biomedical Engineering, West Lafayette, Indiana, United States of America
| | - Rachel Hahn Arkenberg
- Purdue University, Speech, Language, & Hearing Sciences, West Lafayette, Indiana, United States of America
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11
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Baqays A, Zenke J, Campbell S, Johannsen W, Rashid M, Seikaly H, El-Hakim H. Systematic review of validated parent-reported questionnaires assessing swallowing dysfunction in otherwise healthy infants and toddlers. J Otolaryngol Head Neck Surg 2021; 50:68. [PMID: 34863293 PMCID: PMC8642864 DOI: 10.1186/s40463-021-00549-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES There has been increasing interest in the management of oropharyngeal swallowing dysfunction (SwD). Its prevalence, particularly in otherwise healthy infants and toddlers (OHITs), is underappreciated. As the standard diagnostic tests are either invasive or scarce, valid parent-reported outcome (PRO) questionnaires could play a pivotal role in the understanding and managing SwD in this group. This article reviewed the literature on PRO questionnaires pertaining to SwD in OHITs. DATA SOURCE A librarian searched Prospero, Cochrane Library, Embase, Medline, PsycINFO, HaPI, CINAHL, and SCOPUS until February 2021 using the MeSH terms for deglutition and screening methods. REVIEW METHOD Questionnaires that examined disease-specific or eating and feeding concerns or difficulties were excluded. Two reviewers independently identified PRO questionnaires for SwD that were used in OHITs and extracted the author names, publication year, questionnaire name, the studied population, and the reported psychometric assessments. A quality assessment was performed based on consensus-based standards for the selection of health measurement instruments (COSMIN) and updated criteria for good measurement properties. RESULTS Of the 3488 screened articles, we identified only two questionnaires, the pediatric version of the Eating Assessment Tool (PEDI-EAT-10) and the PRO questionnaire for Swallowing Dysfunction in OHITs. The PEDI-EAT-10 authors assessed the validity and reliability on children with cerebral palsy. However, concerns were identified regarding the developmental process and the internal structure validity. The PRO questionnaire for SwD in OHITs meets criteria but has not yet been validated in the population of interest nor its psychometric properties assessed. CONCLUSION Two instruments were identified. The PED-EAT-10 exhibits methodological flaws, while Edmonton PRO questionnaire for SwD in OHITs awaits construct validation and could fill the current knowledge gap.
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Affiliation(s)
- Abdulsalam Baqays
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3. 57 Walter MacKenzie Center, Edmonton, AB, T6H0R3, Canada
- Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Julianna Zenke
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3. 57 Walter MacKenzie Center, Edmonton, AB, T6H0R3, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Wendy Johannsen
- Department of Pediatric Speech Language Pathology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Marghalara Rashid
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3. 57 Walter MacKenzie Center, Edmonton, AB, T6H0R3, Canada
| | - Hamdy El-Hakim
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3. 57 Walter MacKenzie Center, Edmonton, AB, T6H0R3, Canada.
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Jančíková J, Bezděková D, Urbanová P, Dohnalová L, Jabandžiev P, Tedla M, Frajková Ž, Jarkovský J, Urík M. Association between Swallowing-Related Questionnaire Responses and Pathological Signs on Videofluoroscopy in Children. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121109. [PMID: 34943305 PMCID: PMC8700346 DOI: 10.3390/children8121109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 12/30/2022]
Abstract
The aim of this study was to identify relationships in children between responses to specific questions of interest in a clinical questionnaire concerning swallowing-related difficulties and pathological signs on a videofluoroscopic swallowing study (VFSS). A prospective data analysis was made of children evaluated with swallowing disorder between January 2018 and April 2021 at a tertiary care centre. Each child enrolled in the study underwent a subjective evaluation (targeted questions) and instrumental examination (VFSS). In total, 51 children suffering from swallowing problems (32 with a neurological disorder and 19 without neurological disorder) were included into the study. Our results showed there was a correlation between the occurrence of specific symptoms (wet voice, wet breathing, recurrent respiratory infections, chronic mucus) and other pathological signs on a VFSS (laryngeal penetration, residua, nasal regurgitation). The evaluation of these specific questions is a reliable and useful method for the management of dysphagia in neonates and infants. It can help us in selecting those patients for which it is appropriate to perform a VFSS.
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Affiliation(s)
- Jana Jančíková
- Department of Pediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, 61300 Brno, Czech Republic; (J.J.); (D.B.)
| | - Denisa Bezděková
- Department of Pediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, 61300 Brno, Czech Republic; (J.J.); (D.B.)
| | - Petra Urbanová
- Department of Pediatric Radiology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, 61300 Brno, Czech Republic; (P.U.); (L.D.)
| | - Lucie Dohnalová
- Department of Pediatric Radiology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, 61300 Brno, Czech Republic; (P.U.); (L.D.)
| | - Petr Jabandžiev
- Department of Pediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, 61300 Brno, Czech Republic;
| | - Miroslav Tedla
- Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, 85107 Bratislava, Slovakia; (M.T.); (Ž.F.)
| | - Žofia Frajková
- Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, 85107 Bratislava, Slovakia; (M.T.); (Ž.F.)
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University Brno, 62500 Brno, Czech Republic;
| | - Milan Urík
- Department of Pediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, 61300 Brno, Czech Republic; (J.J.); (D.B.)
- Correspondence: ; Tel.: +421-532-234-440
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13
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Chandran R, Alagesan J. Oro-Motor Intervention Protocol to Improve Sucking Behavior among Neonates with Immature Sucking: An Experimental Protocol. Int J Surg Protoc 2021; 25:129-134. [PMID: 34327289 PMCID: PMC8300586 DOI: 10.29337/ijsp.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Oro-motor intervention methods were previously adopted to improve the sucking pattern but there is still a lag in the structured protocol for improving sucking behavior in infants with immature sucking. Thus, this study is aimed to develop a structured protocol for the Oro-motor intervention to improve sucking behavior. Method: Using the prospective observational study design, neonates with poor suck (producing less than 10 sucks per minute), under NG tube feeding, and maintaining oxygen saturation at room air were included. A total of 6 subjects were enrolled in this study and they were treated with Oro-motor intervention protocol. The Sucking rate and LATCH score were taken as the outcome measures and measured at beginning of intervention and after 2 weeks of intervention. Result: The mean pre-test and post-test values for sucking rate were is (8.66), (32.5) and LATCH were (4.66), (8.16) respectively. The data collected showed that the protocol framed for Oro-motor intervention was significantly effective in improving quality of feeding among infants with immature sucking behavior. Conclusion: The structured Oro-motor intervention protocol improves the feeding performance in infants with poor sucking behavior and improves the LATCH score. All the infants included in this study where under nasogastric tube feeding, thus the structured protocol can be considered to be helpful in weaning from NG tube feeding.
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Affiliation(s)
- Ramya Chandran
- Saveetha College of physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India
| | - Jagatheesan Alagesan
- Saveetha College of physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India
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14
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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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15
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Baqays A, Rashid M, Johannsen W, Seikaly H, El-Hakim H. What are parents' perceptions related to barriers in diagnosing swallowing dysfunction in children? A grounded theory approach. BMJ Open 2021; 11:e041591. [PMID: 33737420 PMCID: PMC7978080 DOI: 10.1136/bmjopen-2020-041591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Swallowing dysfunction (SwD) is under-reported in otherwise healthy infants and toddlers (OHITs). The identification of parental perceptions of factors that may hinder the diagnosis could help clinicians manage these children in a more expeditious manner. This study investigated the barriers to diagnosing SwD, as reported by the families. DESIGN Grounded theory study. SETTING This study was performed in a tertiary care paediatric centre in Canada. PARTICIPANTS Parents of OHITs were recruited using purposeful sampling. INTERVENTION We used detailed, semistructured, in-person interviews and the audiotapes and transcriptions were thematically analysed. From the parental insights, we built a framework composed of three themes of barriers. RESULT Ten parents of OHITs with SwD were interviewed. The children presented with recurrent coughing, choking, cold-like symptoms, recurring/consistent illnesses and feeding difficulties. They were managed with multiple rounds of antibiotics and diagnosed with allergies, asthma or recurrent viral infections before considering SwD. The three emerging themes are false beliefs about SwD among parents and some physicians, parent-related barriers and physician-related barriers. These barriers had severely impacted the parents, impairing work productivity and leading to work-related reprimands and changes in the family dynamics. CONCLUSION This study suggests that there are several barriers that face the parents of OHITs when seeking a diagnosis of SwD and initiating appropriate management. These barriers likely interact with one another and amplify their effects on the family and the child. A common denominator is a lack of education regarding SwD, its clinical manifestations and the available expertise to manage this condition.
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Affiliation(s)
- Abdulsalam Baqays
- Otolaryngology, Head & Neck Surgery, King Saud University College of Medicine, Riyadh, Saudi Arabia
- Otolaryngology, Head & Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | | | - Wendy Johannsen
- Speech-Language pathology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Hadi Seikaly
- Otolaryngology, Head & Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Otolaryngology, Head & Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
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16
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Stevens M, Mayerl C, Bond L, German RZ, Barkmeier-Kraemer JM. Pathophysiology of aspiration in a unilateral SLN lesion model using quantitative analysis of VFSS. Int J Pediatr Otorhinolaryngol 2021; 140:110518. [PMID: 33310447 PMCID: PMC7770015 DOI: 10.1016/j.ijporl.2020.110518] [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: 06/29/2020] [Revised: 10/23/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to elucidate the pathophysiology of aspiration in previously studied female infant piglets after a unilateral superior laryngeal nerve (uSLN) lesion. METHODS Videofluoroscopic swallow studies (VFSS) were acquired from 15 female piglets ages 2-3 weeks (9 with uSLN lesion and 6 controls). VFSS were analyzed at 30 frames/second sampling rate. Quantitative measures were conducted and compared between groups using published methodologies for VFSS assessment in adult and infant humans. Measures included the: 1) number of lingual-palatal contacts (LPC) (i.e. pre-swallow), 2) total pharyngeal transit time (TPT), 3) offset of swallow (offP), as well as onset of: 4) pharyngeal stage (onP), 5) pharyngoesophageal segment opening (oPES), 6) maximum PES opening (maxPES), 7) airway closure onset (oAC), and 8) maximum airway closure (maxAC). Measures 5-7 were determined relative to onP. Bolus residue was rated by severity (0 (none) to 3 (severe)). A gamma regression was used to compare continuous measures between lesioned and control groups. RESULTS The number of LPC (p = .006), TPT (p = .023) and timing of maxAC (p = .041) were significantly greater in the uSLN lesion than the control group. CONCLUSIONS Outcomes of this study replicated prior published findings and elucidated that piglets with right uSLN lesions exhibited delayed maxAC. Noteworthy was the use of clinically relevant quantitative videofluoroscopic measures in piglets for comparison to future studies in human pediatric populations.
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Affiliation(s)
- Maya Stevens
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA; Department of Surgery, Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
| | - Christopher Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH
| | - Laura Bond
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, USA.
| | - Rebecca Z. German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH
| | - Julie M Barkmeier-Kraemer
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA; Department of Surgery, Division of Otolaryngology, University of Utah, Salt Lake City, UT, USA.
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17
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Baqays A, Johannsen W, Rashid M, Jaffal H, Hicks A, Jeffery C, Seikaly H, El-Hakim H. Parent-Reported Outcome Questionnaire for Swallowing Dysfunction in Healthy Infants and Toddlers: Construction and Content Validation. Otolaryngol Head Neck Surg 2020; 165:197-205. [PMID: 33287657 DOI: 10.1177/0194599820970950] [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: 11/15/2022]
Abstract
OBJECTIVES There is limited epidemiological information on swallowing dysfunction (SwD) in otherwise healthy infants and toddlers (OHITs). Cost, invasiveness, expertise, and resources constrain the repeatability and utility of instrumental diagnostic tests. A parent-reported outcomes (PRO) tool has the potential to mitigate these disadvantages. Hence, we set out to develop and validate a novel PRO tool to assess SwD in OHITs. STUDY DESIGN A mixed-method study. SETTING Tertiary pediatric center. METHODS We recruited parents of OHITs with SwD and excluded those with a confounding diagnosis (syndromes or neurological impairment). Interviews were conducted and thematically analyzed to extract the relevant domains and items. A similar analytical method was performed on the reports from a systematic review and literature search. Four verification sessions of parents and experts were conducted to maintain rigor. A panel of experts assessed and established the content validity of the items using a modified Delphi technique. RESULTS We achieved information saturation after interviewing 10 parents and generated 7 domains with 72 items. Over the course of 3 rounds of modified Delphi content validation, the domains were reduced to 3 (swallowing, breathing, and illness) containing 21 items; a content validity index of 82.1% was achieved. CONCLUSION We validated the content of a new PRO instrument to assess SwD in OHITs. The instrument is composed of 3 primary domains representing 21 items. This tool has the potential to screen for swallowing dysfunction and can assess management outcomes specifically for this population at a community level.
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Affiliation(s)
- Abdulsalam Baqays
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada.,Division of Otolaryngology, King Saud University, Riyadh, Saudi Arabia
| | - Wendy Johannsen
- Department of Pediatric Speech Language Pathology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Marghalara Rashid
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hussein Jaffal
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
| | - Anne Hicks
- Department of Pediatrics, Division of Pediatric Respiratory Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Caroline Jeffery
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
| | - Hadi Seikaly
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
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18
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Jaffal H, Isaac A, Johannsen W, Campbell S, El-Hakim HG. The prevalence of swallowing dysfunction in children with laryngomalacia: a systematic review. Int J Pediatr Otorhinolaryngol 2020; 139:110464. [PMID: 33120104 DOI: 10.1016/j.ijporl.2020.110464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/16/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Laryngomalacia (LM) is commonly diagnosed in infants and children with upper aerodigestive symptoms. In the literature, the focus has been on the respiratory impairment, with fewer studies addressing swallowing dysfunction (SwD). The objective of this study is to systematically review the literature for evidence on the prevalence of SwD in children diagnosed with LM. METHODS A search was conducted on the following databases: OVID Medline, Ovid EMBASE, EBSCO CINAHL, PROSPERO, and Cochrane Library. We included all the studies that reported on children with LM and documented objective swallowing assessment using fiberoptic endoscopic evaluation of swallowing (FEES) or videofluoroscopic swallowing study (VFSS). Two authors independently screened all the studies, assessed the level of evidence in the included studies, and extracted data. Risk of bias assessment and pooled data analysis were performed. RESULTS The search yielded 512 abstracts. Four studies met the selection criteria representing 425 children. Three studies were retrospective uncontrolled case series and one was a prospective cohort study. In all studies but one, an instrumental assessment of swallowing was selectively performed in patients with clinical indicators of SwD. The pooled estimate (range) of prevalence of SwD was 49% (13.9-90.6%). CONCLUSION The literature suggests a high prevalence of SwD in children with LM, however the level of evidence is low and generalizability is poor. The wide range of prevalence figures suggests a significant variability in the threshold and indications to assess swallowing in children with LM.
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Affiliation(s)
- Hussein Jaffal
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta and the Stollery Children's Hospital, Edmonton, Alberta, Canada.
| | - Andre Isaac
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta and the Stollery Children's Hospital, Edmonton, Alberta, Canada; Division of Pediatric Surgery, Department of Pediatrics, University of Alberta and the Stollery Children's Hospital, Edmonton, Alberta, Canada.
| | - Wendy Johannsen
- Outpatient Feeding & Swallowing Service, Departments of Surgery & Pediatrics, University of Alberta and the Stollery Children's Hospital, Edmonton, Alberta, Canada.
| | - Sandra Campbell
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Hamdy G El-Hakim
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta and the Stollery Children's Hospital, Edmonton, Alberta, Canada; Division of Pediatric Surgery, Department of Pediatrics, University of Alberta and the Stollery Children's Hospital, Edmonton, Alberta, Canada.
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19
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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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20
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Suiter DM, Daniels SK, Barkmeier-Kraemer JM, Silverman AH. Swallowing Screening: Purposefully Different From an Assessment Sensitivity and Specificity Related to Clinical Yield, Interprofessional Roles, and Patient Selection. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:979-991. [PMID: 32650661 DOI: 10.1044/2020_ajslp-19-00140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this clinical focus article is to summarize the goal and process by which identification of individuals at risk for having feeding problems or dysphagia is clinically screened across the life span by speech-language pathologists (SLPs). The topic of this clinical focus article was presented at the Charleston Swallowing Conference in Chicago, Illinois, in July 2018. The contents of this clinical focus article offer an expanded summary of information discussed at this meeting with focus on critical considerations to guide clinical decisions by SLPs regarding the optimal feeding and dysphagia screening approach and process. Conclusion Screening is a critical first step in the identification of individuals at risk for feeding problems and dysphagia across the life span. Understanding the difference between screening and assessment objectives as well as having the knowledge, skills, and clinical competency to implement psychometrically sound screening approaches is a recommended clinical practice standard for SLPs working with these clinical populations. This clinical focus article summarizes critical considerations for identifying individuals at risk for feeding problems and dysphagia across the life span to guide clinicians working with dysphagia populations.
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Affiliation(s)
- Debra M Suiter
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Stephanie K Daniels
- Department of Communication Sciences and Disorders, University of Houston, TX
| | | | - Alan H Silverman
- Section of Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee
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21
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Garand KLF, McCullough G, Crary M, Arvedson JC, Dodrill P. Assessment Across the Life Span: The Clinical Swallow Evaluation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:919-933. [PMID: 32650662 DOI: 10.1044/2020_ajslp-19-00063] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose This clinical focus article considers the roles of the clinical swallow examination (CSE) as a clinically meaningful assessment method used in both adult and pediatric populations. Method This clinical focus article explores the utility of the CSE across the life span. Specifically, components, reliability, standardized assessments, and limitations of the CSE within the adult and pediatric populations are highlighted. Conclusions The CSE remains a crucial assessment tool for the speech-language pathologist. The experienced clinician can make important judgments regarding patient safety and function. If the CSE is conducted mindfully and methodically, findings can help chart the course of care for individuals needing additional assessment and possibly intervention.
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Affiliation(s)
| | - Gary McCullough
- Department of Communication Sciences and Disorders, Appalachian State University, Boone, NC
| | - Michael Crary
- School of Communication Sciences and Disorders, University of Central Florida, Orlando
| | - Joan C Arvedson
- Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin-Milwaukee
| | - Pamela Dodrill
- Department of Otolaryngology, Boston Children's Hospital Boston, MA
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22
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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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23
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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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24
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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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25
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The effects of oral feeding while on nasal continuous positive airway pressure (NCPAP) in preterm infants. J Perinatol 2020; 40:909-915. [PMID: 32086439 PMCID: PMC7224016 DOI: 10.1038/s41372-020-0632-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/30/2020] [Accepted: 02/11/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine whether delaying oral feeding until coming off NCPAP will alter feeding and respiratory-related morbidities in preterm infants. DESIGN In this retrospective pre-post analysis, outcomes were compared in two preterm infant groups (≤32 weeks gestation). Infants in Group 1 were orally fed while on NCPAP, while infants in Group 2 were only allowed oral feedings after ceasing NCPAP. RESULTS Although infants in Group 2 started feeds at a later postmenstrual age (PMA), they reached full oral feeding at a similar PMA compared with Group 1. Interestingly, there was a positive correlation between the duration of oral feeding while on NCPAP and the time spent on respiratory support in Group 1. CONCLUSIONS Delayed oral feeding until ceasing NCPAP did not contribute to feeding-related morbidities. We recommend caution when initiating oral feedings in preterm infants on NCPAP without evaluating the safety of the infants and their readiness for oral feedings.
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Ozsin Ozler C, Öztürk Ş, Uzamıs Tekcıcek M. Dysphagia and Oral Health. ANKARA MEDICAL JOURNAL 2019. [DOI: 10.17098/amj.652021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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27
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Duncan DR, Mitchell PD, Larson K, McSweeney ME, Rosen RL. Association of Proton Pump Inhibitors With Hospitalization Risk in Children With Oropharyngeal Dysphagia. JAMA Otolaryngol Head Neck Surg 2019; 144:1116-1124. [PMID: 30325987 DOI: 10.1001/jamaoto.2018.1919] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Proton pump inhibitors (PPI) are commonly prescribed to children with oropharyngeal dysphagia and resultant aspiration based on the assumption that these patients are at greater risk for reflux-related lung disease. There is little data to support this approach and the potential risk for increased infections in children treated with PPI may outweigh any potential benefit. Objective The aim of this study was to determine if there is an association between hospitalization risk in pediatric patients with oropharyngeal dysphagia and treatment with PPI. Design, Setting, and Participants We performed a retrospective cohort study to compare the frequency and length of hospitalizations for children who had abnormal results on videofluoroscopic swallow studies that were performed between January 1, 2015, and December 31, 2015, and who were or were not treated with PPI, with follow-up through December 31, 2016. Records were reviewed for children who presented for care at Boston Children's Hospital, a tertiary referral center. Participants included 293 children 2 years and younger with evidence of aspiration or penetration on videofluoroscopic swallow study. Exposures Groups were compared based on their exposure to PPI treatment. Main Outcomes and Measures The primary outcomes were hospital admission rate and hospital admission nights and these were measured as incident rates. Multivariable analyses were performed to determine predictors of hospitalization risk after adjusting for comorbidities. Kaplan-Meier curves were created to determine the association of PPI prescribing with time until first hospitalization. Results A total of 293 patients with a mean (SD) age of 8.8 (0.4) months and a mean (SD) follow-up time of 18.15 (0.20) months were included in the analysis. Patients treated with PPI had higher admission rates (Incidence rate ratio [IRR], 1.77; 95% CI, 1.16-2.68) and admission nights (IRR, 2.51; 95% CI, 1.36-4.62) even after adjustment for comorbidities. Patients with enteral tubes who were prescribed PPIs were at the highest risk for admission (hazard ratio [HR], 2.31; 95% CI, 1.24-4.31). Conclusions and Relevance Children with aspiration who are treated with PPI have increased risk of hospitalization compared with untreated patients. These results support growing concern about the risks of PPI use in children.
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Affiliation(s)
- Daniel R Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - Paul D Mitchell
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts
| | - Kara Larson
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - Maireade E McSweeney
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - Rachel L Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
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Sherman V, Greco E, Moharir M, Beal D, Thorpe K, Martino R. Feeding and swallowing impairment in children with stroke and unilateral cerebral palsy: a systematic review. Dev Med Child Neurol 2019; 61:761-769. [PMID: 30411334 DOI: 10.1111/dmcn.14094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2018] [Indexed: 01/12/2023]
Abstract
AIM This systematic review targeted frequency estimates of dysphagia (feeding and swallowing problems), related health outcomes, and caregiver burden in children with stroke or unilateral cerebral palsy (CP). METHOD Six electronic databases were searched from their inception to November 2017 along with a manual search of eight relevant journals. Two blinded raters assessed abstracts and full articles for eligibility. Discrepancies were resolved by consensus. Accepted articles were evaluated for quality. Data were extracted and analysed descriptively. RESULTS Of 1660 abstracts, five met inclusion criteria, of which three focused on stroke and two unilateral CP. Across studies, operational definitions of feeding and swallowing varied. Insufficient details were provided on assessment methods and timing. Reported frequencies of dysphagia ranged from 24.2% to 88.6%. One study reported dysphagia-related health outcomes and none reported caregiver burden. INTERPRETATION These results suggest that dysphagia is common in children with stroke and unilateral CP; however, its frequency is yet unknown as is its impact on health and caregiver burden. Availability of a standardized tool to identify dysphagia in these children accurately is a recommended first step to address this evidence gap. WHAT THIS PAPER ADDS There is limited data on the incidence of dysphagia after childhood stroke and unilateral cerebral palsy. Available evidence shows reported dysphagia frequencies from 24.2% to 88.6%. Only one study reported on dysphagia-related health outcomes. No study reported on caregiver burden.
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Affiliation(s)
- Victoria Sherman
- Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada
| | - Elissa Greco
- Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada
| | - Mahendranath Moharir
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deryk Beal
- Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rosemary Martino
- Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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Feeding Interventions Are Associated With Improved Outcomes in Children With Laryngeal Penetration. J Pediatr Gastroenterol Nutr 2019; 68:218-224. [PMID: 30320668 PMCID: PMC6501833 DOI: 10.1097/mpg.0000000000002167] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To determine if children with laryngeal penetration on videofluoroscopic swallow study (VFSS) who received feeding interventions (thickened liquids, change in liquid flow rate, and/or method of liquid delivery) had improved symptoms and decreased hospitalizations compared with those without intervention. METHODS We performed a retrospective cohort study of children under 2 years with laryngeal penetration on VFSS at our institution in 2015 to determine initial and follow-up VFSS findings, symptom improvement at follow-up, and hospitalization risk before and after VFSS. Proportions were compared with Fisher exact test and hospitalizations with paired t tests. RESULTS We evaluated 137 subjects with age 8.93 ± 0.59 months who had laryngeal penetration without aspiration on VFSS. Fifty-five percent had change in management, with 40% receiving thickening and 15% a change in flow rate. There was significant improvement in symptoms for children that had feeding intervention and this improvement was the greatest with thickening (OR 41.8, 95% CI 12.34-141.69, P < 0.001). On repeat VFSS, 26% had evidence of aspiration that was not captured on initial VFSS. Subjects had decreased total and pulmonary hospitalizations with feeding intervention and decreased pulmonary nights with thickening (P < 0.05). CONCLUSIONS Laryngeal penetration appears to be clinically significant in children with oropharyngeal dysphagia and interventions to decrease its occurrence are associated with improved outcomes including decreased symptoms of concern and hospitalization nights. Thickening or other feeding intervention should be considered for all symptomatic children with laryngeal penetration on swallow study.
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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: 206] [Impact Index Per Article: 41.2] [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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Pavithran J, Puthiyottil IV, Narayan M, Vidhyadharan S, Menon JR, Iyer S. Observations from a pediatric dysphagia clinic: Characteristics of children at risk of aspiration pneumonia. Laryngoscope 2018; 129:2614-2618. [DOI: 10.1002/lary.27654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 10/10/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Jayanthy Pavithran
- Dysphagia Services, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Center Kochi Kerala India
| | - Indu Vadakke Puthiyottil
- Dysphagia Services, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Center Kochi Kerala India
| | - Mythili Narayan
- Dysphagia Services, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Center Kochi Kerala India
| | - Sivakumar Vidhyadharan
- Dysphagia Services, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Center Kochi Kerala India
| | - Jayakumar R. Menon
- Dysphagia Services, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Center Kochi Kerala India
| | - Subramania Iyer
- Dysphagia Services, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences and Research Center Kochi Kerala India
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Duncan DR, Mitchell PD, Larson K, Rosen RL. Presenting Signs and Symptoms do not Predict Aspiration Risk in Children. J Pediatr 2018; 201:141-146. [PMID: 29960768 PMCID: PMC6412137 DOI: 10.1016/j.jpeds.2018.05.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/02/2018] [Accepted: 05/16/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine if any presenting symptoms are associated with aspiration risk, and to evaluate the reliability of clinical feeding evaluation (CFE) in diagnosing aspiration compared with videofluoroscopic swallow study (VFSS). STUDY DESIGN We retrospectively reviewed records of children under 2 years of age who had evaluation for oropharyngeal dysphagia by CFE and VFSS at Boston Children's Hospital and compared presenting symptoms, symptom timing, and CFE and VFSS results. We investigated the relationship between symptom presence and aspiration using the Fisher exact test and stepwise logistic regression with adjustment for comorbidities. CFE and VFSS results were compared using the McNemar test. Intervals from CFE to VFSS were compared using the Student t test. RESULTS A total of 412 subjects with mean (±SD) age 8.9 ± 6.9 months were evaluated. No symptom, including timing relative to meals, predicted aspiration on VFSS. This lack of association between symptoms and VFSS results persisted even in the adjusted multivariate model. The sensitivity of CFE for predicting aspiration by VFSS was 44%. Patients with a reassuring CFE waited 28.2 ± 8.5 days longer for confirmatory VFSS compared with those with a concerning CFE (P < .05). CONCLUSIONS Presenting symptoms are varied in patients with aspiration and cannot be relied upon to determine which patients have aspiration on VFSS. The CFE does not have the sensitivity to consistently diagnose aspiration so a VFSS should be performed in persistently symptomatic patients.
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Affiliation(s)
- Daniel R. Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Paul D. Mitchell
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA
| | - Kara Larson
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Rachel L. Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
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Sassi FC, Bühler KCB, Juste FS, Almeida FCF, Befi-Lopes DM, de Andrade CRF. Dysphagia and associated clinical markers in neurologically intact children with respiratory disease. Pediatr Pulmonol 2018; 53:517-525. [PMID: 29393599 DOI: 10.1002/ppul.23955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 01/08/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The identification of oropharyngeal aspiration is paramount since it can have negative consequences on a compromised respiratory status. Our hypothesis was that dysphagia in neurologically intact children with respiratory disease is associated to specific clinical markers. STUDY DESIGN Using the medical files we conducted a retrospective, observational cohort study on children admitted to the pediatric hospital unit due to respiratory disease. We collected data on specific parameters of a clinical swallowing assessment and dysphagia was classified according to the Dysphagia Management Staging Scale. We also included the following clinical markers: age, days of hospitalization, need for orotracheal intubation (OTI), duration of orotracheal intubation (in hours), number of previous hospital admissions due to respiratory disease, number of previous hospital admissions due to other causes, and previous orotracheal intubations. RESULTS The final study sample consisted of 102 patients (mean age of 5.88 months). For the purposes of statistical analysis, the patients were grouped according to the classification of dysphagia (ie, no dysphagia, mild dysphagia, and moderate-severe dysphagia). Data analysis indicated that the clinical markers of orotracheal intubation (P = 0.042), duration of orotracheal intubation (P = 0.025), and days of hospitalization (P = 0.037) were significant in children with moderate-severe dysphagia. CONCLUSIONS Our data indicate that neurologically intact children with respiratory disease who were submitted to prolonged OTI (ie, over 48 h) should be prioritized for receiving a detailed swallowing assessment.
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Affiliation(s)
- Fernanda C Sassi
- Department of Physiotherapy, Speech-Language and Hearing Science and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Karina C B Bühler
- Division of Speech-Language and Hearing Science, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Fabiola S Juste
- Department of Physiotherapy, Speech-Language and Hearing Science and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Fabiola C F Almeida
- Division of Speech-Language and Hearing Science, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Debora M Befi-Lopes
- Department of Physiotherapy, Speech-Language and Hearing Science and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Claudia R F de Andrade
- Department of Physiotherapy, Speech-Language and Hearing Science and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
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Krummrich P, Kline B, Krival K, Rubin M. Parent perception of the impact of using thickened fluids in children with dysphagia. Pediatr Pulmonol 2017; 52:1486-1494. [PMID: 28436603 DOI: 10.1002/ppul.23700] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 03/03/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia occurs in children without known neurological disorders, increasing their risk for respiratory problems and inadequate intake. Clinicians may recommend thickening nutritive fluids; however, there is little research regarding the impact of thickening nutritive fluids on clinical outcomes in children. METHODS We used a parental reporting tool to determine whether parents identified changes in signs of dysphagia or volume of intake when thickened fluids were incorporated into an individualized feeding program for dysphagic children without known neurological problems. Fifty-five children diagnosed with dysphagia, for whom thickened fluids had been recommended per radiographic and clinical exam, qualified for the study. Parents of 44 children (24 females, 20 males) aged 2 weeks to 14 months completed baseline and post-thickening (within 90 days) rating scales. RESULTS Compared to baseline, parents reported significant decreases in the frequency of apnea (W = -219, P < 0.0001, r = 0.399), congestion (W = -450, P < 0.0001, r = 0.579), coughing/choking with drinking (W = -485, P < 0.0001, r = 0.603), resistance to feeding (W = -344.5, P < 0.0001, r = 0.476), vomiting during feeding (W = -409, P < 0.0001, r = 0.565), and wheezing (W = -337, P < 0.001, r = 0.449). For those children whose parents initially reported inadequate levels of intake, there was a significant (Z = 3.15, P = 0.0029, r = 0.47) increase (+49.63 mm) in the rated adequacy of liquid intake, as well as a significant increase (+1.41 oz.) in the estimated volume per feeding (Z = 224, P = 0.29, r = 0.33). CONCLUSION These results provide information for clinicians and physicians to incorporate when considering the use of thickened fluids in the dysphagia management of children without a known neurological diagnosis.
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Affiliation(s)
| | - Barbara Kline
- Department of Speech Pathology, Akron Children's Hospital, Akron, Ohio
| | - Kate Krival
- Edinboro University of Pennsylvania, Edinboro, Pennsylvania
| | - Michael Rubin
- Department of Radiology, Akron Children's Hospital, Akron, Ohio
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First Steps Towards Development of an Instrument for the Reproducible Quantification of Oropharyngeal Swallow Physiology in Bottle-Fed Children. Dysphagia 2017; 33:76-82. [PMID: 28894942 DOI: 10.1007/s00455-017-9834-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 08/04/2017] [Indexed: 10/18/2022]
Abstract
The incidence of feeding/swallowing impairments (deglutition disorders) in young children is rising and poses serious acute and long-term health consequences. Accurate detection and prompt intervention can lessen the impact of dysphagia-induced sequelae. Videofluoroscopic Swallow Studies (VFSSs) are used to make critical decisions for medically fragile children despite procedural variability and the lack of agreed upon measures for interpreting and reporting results. This investigation represents the first steps in the development of a novel tool for the quantification of oropharyngeal swallow physiology from full-length VFSS examinations in bottle-fed children. The Modified Barium Swallow Impairment Profile MBSImP™© served as the conceptual assessment model for development of components and operational score variants to characterize distinguishable VFSS observations. Twenty-four components of swallowing physiology were validated via expert consensus. Training materials included a library of 94 digitized video images comprised of distinct score variants for each component. Materials were disseminated to seven speech-language pathologists (SLPs) who participated in didactic and self-training sessions, and rated components. All SLPs achieved ≥80% reliability criterion after completing two or three training sessions. Agreement for 17 (71%) components was achieved after two sessions. Nutritive sucking/oral and airway-related components were most difficult to distinguish. Three sessions were required for 2 (33%) of the sucking/oral components and 4 (57%) of the airway-related components. These findings support the feasibility to standardize training and reliably score swallowing physiology using precise definitions and unambiguous visual images, and represent preliminary steps towards content validity and reliability of a standardized VFSS tool for bottle-fed children.
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Svystun O, Johannsen W, Persad R, Turner JM, Majaesic C, El-Hakim H. Dysphagia in healthy children: Characteristics and management of a consecutive cohort at a tertiary centre. Int J Pediatr Otorhinolaryngol 2017; 99:54-59. [PMID: 28688566 DOI: 10.1016/j.ijporl.2017.05.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/27/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Whereas the literature is replete with reports on complex children with dysphagia (DP), the parameters characterizing non-neurologically impaired (NNI) children have been underreported, leaving a substantial knowledge gap. We set to characterize a consecutive cohort of NNI children, their management, and outcomes. METHODS We undertook a retrospective case series. Children (<18 years old) attending a tertiary multidisciplinary swallowing clinic were eligible. Patients with neuro-developmental, neuromuscular, or syndromic abnormalities were excluded. Primary outcomes included demographics, co-morbidities, presentations, McGill score, swallowing and airway abnormalities (and their predictors). Secondary outcomes were interventions and management response. RESULTS From 171 consecutive patients (37-month period), 128 were included (69 males, median age 6.6 months (0.5-124.2)). Significant clinical presentations included recurrent pneumonias (20), cyanotic spells (14) and life-threatening events (10). Swallowing assessments revealed laryngeal penetration (67), aspiration (25). Other investigations included overnight oximetry (77), airway (70), and gastrointestinal endoscopy (24); revealing laryngomalacia (29), laryngeal mobility disorder (8), and subglottic stenosis (8). Non-surgical interventions involved oral diet modifications (85) and enteral nutrition (15). Surgical interventions included supraglottoplasties (18), endoscopic laryngeal cleft repair (14), and injection (19). 119 patients received intervention and at last follow-up (median 5.2 months (0.3-88.8)) 94 had improved. Of those treated 116 were on an unmodified oral diet, and 24 on a modified diet. ALTE and snoring predicted airway abnormalities, recurrent pneumonia predicted swallowing abnormalities, and age and airway lesions predicted the McGill score. CONCLUSION a significant proportion of NNI children with DP harbor airway and swallowing abnormalities warranting endoscopic and instrumental assessment.
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Affiliation(s)
- Orysya Svystun
- Pediatric Otolaryngology, Divisions of Otolaryngology - Head & Neck Surgery, Departments of Surgery & Pediatrics, The Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Wendy Johannsen
- Outpatient Feeding & Swallowing Service, Departments of Surgery & Pediatrics, The Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Rabin Persad
- Pediatric Gastroenterology, Departments of Surgery & Pediatrics, The Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Justine M Turner
- Pediatric Gastroenterology, Departments of Surgery & Pediatrics, The Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Carina Majaesic
- Pediatric Pulmonology, Departments of Surgery & Pediatrics, The Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Pediatric Otolaryngology, Divisions of Otolaryngology - Head & Neck Surgery, Departments of Surgery & Pediatrics, The Stollery Children's Hospital, Edmonton, Alberta, Canada.
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Gasparin M, Schweiger C, Manica D, Maciel AC, Kuhl G, Levy DS, Marostica PJC. Accuracy of clinical swallowing evaluation for diagnosis of dysphagia in children with laryngomalacia or glossoptosis. Pediatr Pulmonol 2017; 52:41-47. [PMID: 27228428 DOI: 10.1002/ppul.23484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/03/2016] [Accepted: 05/06/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the accuracy of clinical evaluation of swallowing in a sample of children with laryngomalacia or glossoptosis and describe the prevalence of dysphagia in each of these diseases, as well as characterize the swallow response to speech and language therapy interventions. STUDY DESIGN Children aged 1 month to 11 years receiving care at the Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Brazil, were evaluated in a cross-sectional design. Evaluation of swallowing was performed at two time points by two blinded speech-language pathologists, one responsible for clinical evaluation and the other for videofluoroscopic study. The protocols employed were based on the instruments proposed by DeMatteo et al. (DeMatteo C, Matovich D, Hjartarson A. Comparison of clinical and videofluoroscopic evaluation of children with feeding and swallowing difficulties. Dev Med Child Neurol 2005;47:149-157.). RESULTS The study sample consisted of 29 patients: 10 patients with laryngomalacia and 19 patients with glossoptosis. The sensitivity of clinical evaluation did not exceed 50% in any of the evaluations, but specificity reached 100% in some cases, using thickened liquids. The prevalence of dysphagia was 100%, and the use of thickened liquids significantly reduced tracheal aspiration. CONCLUSIONS Dysphagia was highly prevalent in this sample. The sensitivity of clinical evaluation to detect laryngeal penetration and tracheal aspiration was low, as the majority of aspiration events were silent. The videofluoroscopic study is important in order to determine a safest method to feed the patient. Pediatr Pulmonol. 2017;52:41-47. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Marisa Gasparin
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcellos, 2400, Porto Alegre 90035-003, RS, Brazil
| | - Cláudia Schweiger
- Laryngology Unit, Department of Otolaryngology, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, School of Medicine, UFRGS, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Denise Manica
- Laryngology Unit, Department of Otolaryngology, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, School of Medicine, UFRGS, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Antônio Carlos Maciel
- Department of Radiology, HCPA, Universidade Federal do Rio de Janeiro (UFRJ), Porto Alegre, RS, Brazil
| | - Gabriel Kuhl
- Department of Otolaryngology, HCPA, Porto Alegre, RS, Brazil
| | - Deborah Salle Levy
- School of Speech-Language Pathology and Audiology, UFRGS, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Paulo José Cauduro Marostica
- Pediatric Pulmonology Unit, Department of Pediatrics, HCPA, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, School of Medicine, UFRGS, Porto Alegre, RS, Brazil
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Fuller JC, Sinha S, Caruso PA, Hersh CJ, Butler WE, Krishnamoorthy KS, Hartnick CJ. Chiari malformations: An important cause of pediatric aspiration. Int J Pediatr Otorhinolaryngol 2016; 88:124-8. [PMID: 27497399 DOI: 10.1016/j.ijporl.2016.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/02/2016] [Accepted: 06/04/2016] [Indexed: 11/16/2022]
Abstract
Chronic aspiration poses a major health risk to the pediatric population. We describe four cases in which work up for chronic aspiration with a brain MRI revealed a Chiari I malformation, a poorly described etiology of pediatric aspiration. All patients had at least one non-specific neurologic symptom but had swallow studies more characteristic of an anatomic than a neurologic etiology. Patients were referred to neurosurgery and underwent posterior fossa decompression with symptom improvement. A high index of suspicion for Chiari malformation should be maintained when the standard work up for aspiration is non-diagnostic, particularly when non-specific neurologic symptoms are present.
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Affiliation(s)
- Jennifer C Fuller
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114, USA.
| | - Sumi Sinha
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114, USA
| | - Paul A Caruso
- Department of Radiology, Massachuesetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114, USA
| | - Cheryl J Hersh
- Pediatric Airway, Voice and Swallowing Center, Massachusetts Eye and Ear Infirmary - Massachusetts General Hospital for Children, 243 Charles St., Boston, MA 02114, USA
| | - William E Butler
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | | | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114, USA
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Recognizing the Importance of Dysphagia: Stumbling Blocks and Stepping Stones in the Twenty-First Century. Dysphagia 2016; 32:78-82. [PMID: 27571768 PMCID: PMC5306342 DOI: 10.1007/s00455-016-9746-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 08/16/2016] [Indexed: 12/02/2022]
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Jackson A, Maybee J, Moran MK, Wolter-Warmerdam K, Hickey F. Clinical Characteristics of Dysphagia in Children with Down Syndrome. Dysphagia 2016; 31:663-71. [DOI: 10.1007/s00455-016-9725-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 07/02/2016] [Indexed: 11/28/2022]
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Calvo I, Conway A, Henriques F, Walshe M. Diagnostic accuracy of the clinical feeding evaluation in detecting aspiration in children: a systematic review. Dev Med Child Neurol 2016; 58:541-53. [PMID: 26862075 DOI: 10.1111/dmcn.13058] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/28/2022]
Abstract
The aim of this systematic review is to determine the diagnostic accuracy of clinical feeding evaluation (CFE) compared to instrumental assessments in detecting oropharyngeal aspiration (OPA) in children. This is important to support clinical decision-making and to provide safe, cost-effective, higher quality care. All published and unpublished studies in all languages assessing the diagnostic accuracy of CFE compared to videofluoroscopic swallowing study (VFSS) and/or fibre-optic endoscopic examination of swallowing (FEES) in detecting OPA in paediatric populations were sought. Databases were searched from inception to April 2015. Grey literature, citations, and references were also searched. Two independent reviewers extracted and analysed data. Accuracy estimates were calculated. Research reports were translated into English as required. Six studies examining the diagnostic accuracy of CFE using VFSS and/or FEES were eligible for inclusion. Sample sizes, populations studied, and CFE characteristics varied widely. The overall methodological quality of the studies, assessed with QUADAS-2, was considered 'low'. Results suggested that CFEs trialling liquid consistencies might provide better accuracy estimates than CFEs trialling solids exclusively. This systematic review highlights the critical lack of evidence on the accuracy of CFE in detecting OPA in children. Larger well-designed primary diagnostic test accuracy studies in this area are needed to inform dysphagia assessment in paediatrics.
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Affiliation(s)
- Irene Calvo
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland.,Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milano, Italy
| | - Aifric Conway
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Filipa Henriques
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
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Skinner ML, Lee SK, Collaco JM, Lefton-Greif MA, Hoch J, Au Yeung KJ. Financial and Health Impacts of Multidisciplinary Aerodigestive Care. Otolaryngol Head Neck Surg 2016; 154:1064-7. [PMID: 26980920 DOI: 10.1177/0194599816637830] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 02/17/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) Analyze upstream and downstream activity before and after enrollment with the Multidisciplinary Pediatric Aerodigestive Care Team (MPACT). (2) Identify potential demand for MPACT services with ICD-9 data. STUDY DESIGN Retrospective review of financial claims data. SETTING Tertiary care children's center. SUBJECTS Pediatric patients (0-18 years old) enrolled with MPACT (pediatric otolaryngology, gastroenterology, pulmonary, speech-language pathology). METHODS Case mix data from fiscal years (FYs) 2010-2013 were analyzed for primary, secondary, and tertiary ICD-9 codes in 4 aerodigestive diagnostic categories (ADCs): dysphagia, chronic cough, gastroesophageal disease, and chronic pulmonary disease/asthma. Inclusion criteria included patients <18 years old, seen by MPACT, with FY2010-FY2013 case mix data and ≥2 ADCs. Unique outpatient and inpatient encounters and associated charges were evaluated to determine upstream and downstream activity trends. RESULTS Of the 126 patients meeting inclusion criteria, 55 (44%) had ≥3 ADCs, and 11 (9%) had 4. These 126 patients received outpatient care during 3068 unique encounters. Outpatient total charges were $282,102 before and $744,542 after MPACT intervention. Eighty-six (68%) patients received inpatient care during 423 unique encounters. Inpatient charges were $4,257,137 before and $2,872,849 after MPACT enrollment. Overall, a net reduction of $921,848 in total charges, $7316 per MPACT patient, was noted. FY2010-FY2014 data identified an additional 1728 pediatric patients with ≥2 ADCs not enrolled in MPACT. CONCLUSION A cohort of children with aerodigestive disease experienced a shift from inpatient to outpatient care with an overall 20% reduction in patient charges when the years before and after MPACT enrollment were compared. Available ICD-9 data suggest potential demand for MPACT services.
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Affiliation(s)
- Margaret L Skinner
- Department of Otolaryngology-Head & Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Seohee K Lee
- Cornell University, Ithaca, New York, USA Financial Analysis Unit, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Joseph M Collaco
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maureen A Lefton-Greif
- Department of Otolaryngology-Head & Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Physical and Rehabilitative Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeannine Hoch
- Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Karla J Au Yeung
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kemps G, Sewitch M, Birnbaum R, Daniel SJ. Contrast pooling in videofluoroscopic swallowing study as a risk factor for pneumonia in children with dysphagia. Int J Pediatr Otorhinolaryngol 2015; 79:1306-9. [PMID: 26092551 DOI: 10.1016/j.ijporl.2015.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/28/2015] [Accepted: 05/31/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine if laryngeal contrast pooling on a videofluoroscopic swallowing study increases the risk for pneumonia in the following 6 months in children with dysphagia. Secondarily, to determine in the same population, if laryngeal abnormalities or syndromic disorders increase the risk for pneumonia in the same timeframe. STUDY DESIGN Retrospective cohort study. METHODS A chart review of pediatric patients that presented to the swallowing and dysphagia clinic at the Montreal Children's Hospital for a videofluoroscopic swallowing study in the last three years was conducted. Videofluoroscopic findings, patient characteristics, demographic data, and pneumonias occurring within 6 months after the study were recorded for all patients. Patients with unsuccessful swallowing studies, incomplete charts, extra-laryngeal etiologies for recurrent pneumonia, or who were lost to follow up were excluded. RESULTS Of the 287 children who presented to the clinic, 239 patients remained after exclusion, of which 40 (16.7%) exhibited pooling and 199 (83.3%) did not. Children with pooling on videofluoroscopic swallowing study did not have significantly more pneumonias than patients without pooling (22.5% vs 17.1%, P=0.42). Secondary analyses revealed that laryngeal abnormalities were a significant independent risk factor (P=0.02) for pneumonia at 6 months, while being diagnosed with a syndrome was not (P=0.18). CONCLUSION In this study of contrast pooling in videofluoroscopic swallowing study, there was no significant difference in pneumonia occurrence in patients with and without pooling at 6 months post study. Future prospective studies should be conducted to confirm these findings. The present review showed that feeding changes should not be made based on pooling alone.
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Affiliation(s)
- Glen Kemps
- Radboud University Nijmegen, Nijmegen, Netherlands; Department of Otolaryngology Head & Neck Surgery, The Montreal Children's Hospital, Montréal, QC, Canada
| | - Maida Sewitch
- Division of Clinical Epidemiology, McGill University Health Centre, Montréal, QC, Canada
| | - Rena Birnbaum
- Department of Occupational Therapy, The Montreal Children's Hospital, Montréal, QC, Canada
| | - Sam J Daniel
- Department of Otolaryngology-Head and Neck Surgery, McGill University, The Montreal Children's Hospital, Montréal, QC, Canada.
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Dodrill P, Gosa MM. Pediatric Dysphagia: Physiology, Assessment, and Management. ANNALS OF NUTRITION AND METABOLISM 2015; 66 Suppl 5:24-31. [DOI: 10.1159/000381372] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Infancy and childhood represent a time of unparalleled physical growth and cognitive development. In order for infants and children to reach their linear and neurological growth potential, they must be able to reliably and safely consume sufficient energy and nutrients. Swallowing difficulties (dysphagia) in pediatric populations can have a detrimental effect on dietary intake and, thus, growth and development. As a result, it is imperative to accurately identify and appropriately manage dysphagia in pediatric populations. This article provides an overview of dysphagia in children, as well as common causes of childhood swallowing difficulties, populations at risk for pediatric dysphagia, techniques used to assess swallowing in pediatric patients, and the current treatment options available for infants and children with dysphagia.
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Delaney AL. Special Considerations for the Pediatric Population Relating to a Swallow Screen Versus Clinical Swallow or Instrumental Evaluation. ACTA ACUST UNITED AC 2015. [DOI: 10.1044/sasd24.1.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Careful consideration should be taken to determine how a swallow screen could be implemented in the pediatric population. A variety of factors to be considered include: age, developmental level, feeding experience of the child, diagnosis, the status of the child's dysphagia, and the setting where the patient is treated. A swallow screen might be feasible in specific situations in the pediatric population to identify aspiration risk in those with a change in normal swallow status. Yet, more research is needed to improve the accurate identification for the pediatric population of aspiration risk and other signs of dysphagia that warrant an instrumental assessment. While risk for aspiration is a concern in this population, it is not the only concern due to the dynamic changes in feeding and swallowing performance that occur throughout childhood. These dynamic changes require a thorough clinical observation that neither a swallow screening nor instrumental assessment can provide the clinician. Thus, the clinical swallow evaluation (CSE) remains the most comprehensive tool available to assess oral feeding skill development and function, as well as, to identify risk factors for not only aspiration, but for other aspects of dysphagia, which may warrant an instrumental assessment.
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Affiliation(s)
- Amy L. Delaney
- Masters Family Speech and Hearing Center, Children's Hospital of WisconsinMilwaukee, WI
- Clinical & Translational Science Institute & Otolaryngology, Medical College of WisconsinMilwaukee, WI
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Abstract
PURPOSE To evaluate swallowing function using a videofluoroscopic swallow study (VFSS), and to identify factors related to long-term swallowing function in children with swallowing dysfunction. METHODS Ninety children, aged 1-120 months (mean 27.5 months) were randomly selected from among children referred for the evaluation of swallowing dysfunction. We retrospectively reviewed the charts, and long-term outcomes were tracked up to 5 years. RESULTS Baseline American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale was 3.4 ± 2.5. Supraglottic penetration and subglottic aspiration comfirmed by VFSS were detected in 30 children. After follow-up, oral feeding was possible in 74 patients, and the ASHA NOMS swallowing scale improved significantly, from 3.4 ± 2.5 to 5.8 ± 2.0. Baseline VFSS severity, serum albumin concentration, baseline weight percentile and neurologic conditions were significantly correlated with long-term swallowing function. CONCLUSIONS The long-term outcomes in children with swallowing dysfunction were favorable, and baseline videofluoroscopic severity was significantly correlated with long-term swallowing function.
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Affiliation(s)
- Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Jeju National University Hospital, Jeju National University School of Medicine , Jeju , South Korea
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Lefton-Greif MA, Okelo SO, Wright JM, Collaco JM, McGrath-Morrow SA, Eakin MN. Impact of children's feeding/swallowing problems: validation of a new caregiver instrument. Dysphagia 2014; 29:671-7. [PMID: 25159316 DOI: 10.1007/s00455-014-9560-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 07/11/2014] [Indexed: 11/27/2022]
Abstract
The impact of caring for children with deglutition disorders is poorly understood and tools to measure the unique concerns of these caregivers are lacking. The aims of this investigation were to develop and validate The Feeding/Swallowing Impact Survey (FS-IS) as an instrument designed to measure and improve understanding of caregiver issues. Demographic, economic, and dysphagic data were provided by the primary caregivers of 164 children (median age: 14 months, male: 78, female: 86) presenting for initial outpatient feeding/swallowing evaluations. Caregivers completed the PEDS-QL™ Family Impact Module (PEDS-QL™ FIM) and the FS-IS. A principal component analysis was conducted on the FS-IS to identify appropriate subscales. Concurrent validity was assessed by examining correlations between the FS-IS and PEDS-QL™ FIM. Caring for children with feeding/swallowing problems adversely impacted the Health-Related Quality of Life (HRQoL) of their caregivers. The FS-IS had a strong 3-factor solution to indicate 3 subscales: Daily Activities, Worry, and Feeding Difficulties. All three subscales and total score of the FS-IS correlated with PEDS-QL™ FIM. The FS-IS was validated as an instrument that may help clinicians detect specific factors that influence caregiver HRQoL, identify caregivers who might benefit from additional support, and ultimately improve the care of their children with feeding/swallowing disorders.
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Affiliation(s)
- Maureen A Lefton-Greif
- Department of Pediatrics, Johns Hopkins University School of Medicine, David M. Rubenstein Building, Suite 3017, 200 North Wolfe Street, Baltimore, MD, 21287, USA,
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Horn DL, DeMarre K, Parikh SR. Interarytenoid Sodium Carboxymethylcellulose Gel Injection for Management of Pediatric Aspiration. Ann Otol Rhinol Laryngol 2014; 123:852-8. [DOI: 10.1177/0003489414539129] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study aimed to investigate the role of interarytenoid injection laryngoplasty (IL) for the management of pediatric aspiration. Methods: Medical records of 30 patients, 9 female, with radiographically confirmed chronic aspiration who underwent intraoperative IL were retrospectively reviewed. Clinical improvement was defined as successful advancement of feeds to thinner consistencies. Results: Clinical improvement was observed in 57% of patients. Six children with type 1 posterior laryngeal cleft (PLC-1) were not significantly more likely to show improvement compared to the children without PLC-1. Type 1 posterior laryngeal cleft was associated with older age and higher prevalence of neurodevelopmental risk factors relative to absence of PLC-1. Patients with PLC-1 were more likely than noncleft patients to show recurrence of symptoms after initial improvement with IL. Five patients underwent endoscopic repair. Repair was successful in 3 patients who improved after IL but not in 2 patients who did not improve after IL. Conclusion: Chronic aspiration can improve after IL even in patients with normal anatomy. Injection laryngoplasty can be performed to improve selection of PLC-1 patients for definitive endoscopic repair. Further prospective research, with a randomized control group, is needed to understand whether interarytenoid incompetence plays a role in some patients with chronic aspiration, who do not have a PLC-1.
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Affiliation(s)
- David L. Horn
- Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine; Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Kim DeMarre
- Department of Speech and Language, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Sanjay R. Parikh
- Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine; Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, Washington, USA
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Abstract
Feeding and swallowing disorders in the pediatric population are becoming more common, particularly in infants born prematurely and in children with chronic medical conditions. The normal swallowing mechanism is divided into 4 stages: the preparatory, the oral, the pharyngeal, and the esophageal phases. Feeding disorders have multiple causes: medical, nutritional, behavioral, psychological, and environmental factors can all contribute. Pathologic conditions involving any of the anatomic sites associated with the phases of swallowing can negatively impact the coordination of these phases and lead to symptoms of dysphagia and feeding intolerance.
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Affiliation(s)
- Kedar Kakodkar
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611-2605, USA
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