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Raynor EM, Kern J. Assessing Dysphagia in the Child. Otolaryngol Clin North Am 2024; 57:511-521. [PMID: 38485540 DOI: 10.1016/j.otc.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Swallowing problems in children can occur for a variety of reasons, and assessment varies based on the age of the child, underlying medical problems, and results of the clinical swallow evaluation. The need for interdisciplinary management with speech language pathologists skilled in the management of children with dysphagia is imperative to identify the components of swallowing that are impaired and provide specific recommendations for safe and adequate nutrition supporting growth, development, and oral feeding if possible. This study focuses on the types of assessment tools available and how and when they are utilized for children of different ages and abilities.
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Affiliation(s)
- Eileen M Raynor
- Duke Department of Head and Neck Surgery & Communication Sciences, DUMC Box 3805, Durham, NC 27710, USA.
| | - Jennifer Kern
- Duke Department of Speech Pathology & Audiology, DUMC Box 3887, Durham, NC 27710, USA
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Pados BF, Hill RR. Gastrointestinal and Gastroesophageal Reflux Scale Reference Values. MCN Am J Matern Child Nurs 2024:00005721-990000000-00059. [PMID: 38976777 DOI: 10.1097/nmc.0000000000001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
PURPOSE The purpose of this study was to determine age-based reference values for the Gastrointestinal and Gastroesophageal Reflux (GIGER) Scale for Infants and Toddlers. STUDY DESIGN AND METHODS GIGER data from healthy, full-term born children under 2 years of age were used to determine reference values. For each age group, median, interquartile range, 90th, and 95th percentile scores were calculated for each subscale and the total score. 90th percentile scores were also calculated for each of the 36 items based on the full sample. RESULTS Data from 625 children were used to determine reference values for children 0-2, 2-4, 4-6, 6-8, 8-10, 10-12, and 12-24 months. In healthy, full-term infants, gastrointestinal and gastroesophageal reflux symptoms improved over the first 24 months of life, with the most improvement occurring over the first 2 months. CLINICAL IMPLICATIONS The GIGER is a 36-item measure of gastrointestinal and gastroesophageal reflux symptoms for children under 2 years old that has evidence of adequate psychometrics for clinical practice and research. The age-based reference values established in this study can be used to guide score interpretation and determine when a child's symptoms warrant further investigation. This may help identify infants and toddlers with significant symptoms earlier so that they can obtain the care they need.
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Cordray H, Raol N, Mahendran GN, Tey CS, Nemeth J, Sutcliffe A, Ingram J, Sharp WG. Quantitative impact of frenotomy on breastfeeding: a systematic review and meta-analysis. Pediatr Res 2024; 95:34-42. [PMID: 37608056 DOI: 10.1038/s41390-023-02784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Symptoms related to infant ankyloglossia/tongue-tie may deter mothers from breastfeeding, yet frenotomy is controversial. METHODS Databases included PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar from 1961-2023. Controlled trials and cohort studies with validated measures of surgical efficacy for breastfeeding outcomes were eligible. Meta-analyses synthesized data with inverse-variance weighting to determine standardized mean differences (SMD) between pre-/postoperative scores. RESULTS Twenty-one of 1568 screened studies were included. Breastfeeding self-efficacy improved significantly post-frenotomy: medium effect after 5-10 days (SMD 0.60 [95% CI: 0.48, 0.71; P < 0.001]), large effect after 1 month (SMD 0.91 [CI: 0.79, 1.04; P < 0.001]). Nipple pain decreased significantly post-frenotomy: large effect after 5-15 days (SMD -1.10 [CI: -1.49, -0.70; P < 0.001]) and 1 month (SMD -1.23 [CI: -1.79, -0.67; P = 0.002]). Frenotomy had a medium effect on infant gastroesophageal reflux severity at 1-week follow-up (SMD -0.63 [CI: -0.95, -0.31; P = 0.008]), with continued improvement at 1 month (SMD -0.41 [CI: -0.78, -0.05; P = 0.04]). From LATCH scores, breastfeeding quality improved after 5-7 days by a large SMD of 1.28 (CI: 0.56, 2.00; P = 0.01). CONCLUSIONS Providers should offer frenotomy to improve outcomes in dyads with ankyloglossia-associated breastfeeding difficulties. PROTOCOL REGISTRATION PROSPERO identifier CRD42022303838 . IMPACT This systematic review and meta-analysis showed that breastfeeding self-efficacy, maternal pain, infant latch, and infant gastroesophageal reflux significantly improve after frenotomy in mother-infant dyads with breastfeeding difficulties and ankyloglossia. Providers should offer frenotomy to improve breastfeeding outcomes in symptomatic mother-infant dyads who face challenges associated with ankyloglossia.
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Affiliation(s)
- Holly Cordray
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nikhila Raol
- Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Geethanjeli N Mahendran
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
| | - Ching Siong Tey
- Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - John Nemeth
- Emory University Woodruff Health Sciences Center Library, Atlanta, GA, USA
| | - Alastair Sutcliffe
- Population, Policy, and Practice Department, Institute of Child Health, University College London, London, UK
| | | | - William G Sharp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Atlanta, GA, USA
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