Comprehensive Manometric Evaluation of Dysphagia in Patients with Down Syndrome

Dysphagia is a common symptom in children with Down syndrome and is conventionally evaluated with imaging and endoscopy; high-resolution manometry is not routinely utilized. The aim of this study was to describe and correlate pharyngeal and esophageal manometry findings with contrast studies and endoscopy in patients with Down syndrome and dysphagia. Electronic medical records of patients with Down syndrome with dysphagia seen at our center between January 2008 and January 2022 were reviewed. Data collected included demographics, co-morbidities, symptoms, imaging, endoscopy, and manometry. Twenty-four patients with Down syndrome [median age of 14.9 years (IQR 7.6, 20.5), 20.8% female] met inclusion criteria. Common presenting symptoms of dysphagia included vomiting or regurgitation in 15 (62.5%) patients, and choking, gagging, or retching in 10 (41.7%) patients. Esophageal manometry was abnormal in 18/22 (81.2%) patients. The most common findings were ineffective esophageal motility in 9 (40.9%) followed by esophageal aperistalsis in 8 (36.4%) patients. Rumination pattern was noted in 5 (22.8%) patients. All 6 (25%) patients who previously had fundoplication had esophageal dysmotility. Strong agreement was noted between upper gastrointestinal studies and high-resolution esophageal manometry (p = 1.0) but no agreement was found between pharyngeal manometry and video fluoroscopic swallow studies (p = 0.041). High-resolution pharyngeal and esophageal manometry provide complementary objective data that may be critical in tailoring therapeutic strategies for managing patients with Down syndrome with dysphagia.

Breathing and Oxygen Carrying Capacity in Ts65Dn and Down Syndrome

Individuals with Down syndrome (Ds) are at increased risk of respiratory infection, aspiration pneumonia, and apnea. The Ts65Dn mouse is a commonly used model of Ds, but there have been no formal investigations of awake breathing and respiratory muscle function in these mice. We hypothesized that breathing would be impaired in Ts65Dn vs. wild-type (WT), and would be mediated by both neural and muscular inputs. Baseline minute ventilation was not different at 3, 6, or 12 mo of age. However, VT/Ti, a marker of the neural drive to breathe, was lower in Ts65Dn vs. WT and central apneas were more prevalent. The response to breathing hypoxia was not different, but the response to hypercapnia was attenuated, revealing a difference in carbon dioxide sensing, and/or motor output in Ts65Dn. Oxygen desaturations were present in room air, demonstrating that ventilation may not be sufficient to maintain adequate oxygen saturation in Ts65Dn. We observed no differences in arterial PO2 or PCO2, but Ts65Dn had lower hemoglobin and hematocrit. A retrospective medical record review of 52,346 Ds and 52,346 controls confirmed an elevated relative risk of anemia in Ds. We also performed eupneic in-vivo electromyography and in-vitro muscle function and histological fiber typing of the diaphragm, and found no difference between strains. Overall, conscious respiration is impaired in Ts65Dn, is mediated by neural mechanisms, and results in reduced hemoglobin saturation. Oxygen carrying capacity is reduced in Ts65Dn vs. WT, and we demonstrate that individuals with Ds are also at increased risk of anemia.

Morbidity and mortality in neonates with Down Syndrome based on gestational age

BACKGROUND

Greater than 50% of neonates with Down Syndrome (DS) have perinatal complications that require admission to the neonatal intensive care unit (NICU) at birth. Previous studies have shown increased morbidity and mortality rates in neonates without DS delivered prior to 39 weeks of completed gestation.

OBJECTIVE

To determine if an association exists between gestational age at delivery and adverse outcomes in neonates with DS.

STUDY DESIGN

Neonates with DS admitted to a large, tertiary care center NICU from 2010 to 2020 were evaluated. Gestational age (GA) was stratified into 4 groups: <34 (preterm), 34-36 (late-preterm), 37-38 (early-term) and ≥39 (term + post-term) completed weeks. Fisher's exact tests were used to evaluate morbidity and mortality rates between groups.

RESULT

Of the 314 neonates with DS, 10% (N = 31) were <34 weeks, 22% (N = 68) 34-36 weeks, 40% (N = 127) 37-38 weeks, and 28% (N = 88) ≥39 completed weeks at birth. Baseline characteristics were similar between groups. GA at birth <34 weeks was associated with a higher in-hospital mortality rate when compared to those born 37-38 (19% vs. 0%, P < 0.001) and ≥39 (19% vs. 3%, P = 0.01). Neonates with DS born <34 weeks had a higher likelihood of oxygen requirement at time of discharge compared to 34-36, 37-38, and ≥39 groups (P = 0.01; P < 0.001; P < 0.001 respectively). Neonates with DS < 34 weeks were more likely to develop necrotizing enterocolitis (P = 0.02) and require nitric oxide (P = 0.014) compared to neonates with DS ≥ 39. We observed no differences in the need for surgical interventions between groups aside from the rate of gastrostomy/jejunostomy tube placement between 34-36 weeks and 37-38 weeks GA.

CONCLUSION

Neonates with DS born preterm (<34 weeks) represent a highly vulnerable subgroup. Multidisciplinary strategies are needed to address their higher rates of morbidity and mortality.

Eating behaviors in children with down syndrome: Results of a home-use test

Children with Down syndrome (DS) display a disproportionate number of health challenges, including feeding and swallowing difficulties and food texture sensitivities. To start addressing food texture challenges early in life, the aim of this research was to understand mealtime behaviors and identify preferred food textures of children with DS. Children (aged 11 to 58 months) with DS (n = 111) and without (typically developing, TD; n = 107) participated in a home use test evaluating snack products of varying textures. Parents recorded their children's reactions to each food product; a panel of trained coders coded videos for mealtime behaviors. Children were also identified as food texture sensitive (TS) or non-texture sensitive (NTS). Results showed that age, TS, the presence of a DS diagnosis and the TS*DS interaction influenced the child's behaviors to the food products. Children with DS were more likely to increase distance from the food, mouth/suck on the food, and less likely to chew/much on the food compared to children TD. Children with DS also ate significantly less than typically developing children. Similar mealtime behaviors were observed between the children with TD/<30 months of age and children with DS regardless of age (p < .05). While children with DS/TS had a higher disposition for the dissolvable texture, along with products that were salty and cheesy, children with DS/NTS had a greater tolerance for more textures in general, including crunchy and grainy. Overall, this research identified mealtime behaviors in children with DS, determined overall disposition of children with DS to foods of differences sensory properties, and demonstrated the influence of TS on a child's disposition to a food. This research will be extended to develop acceptable and innovative food products for children with DS/TS.

Intensive Voice Treatment (Lee Silverman Voice Treatment [LSVT LOUD]) for Children With Down Syndrome: Phase I Outcomes

PURPOSE

This study examined the effects of an intensive voice treatment Lee Silverman Voice Treatment (LSVT LOUD) on children with Down syndrome (DS) and motor speech disorders.

METHOD

A Phase I, multiple baseline, single-subject design with replication across nine participants with DS was used. Single-word intelligibility, acoustic measures of vocal functioning, and parent perceptions of pre- and posttreatment communication function were used as treatment outcome measures.

RESULTS

All participants completed the full dose of LSVT LOUD and showed gains on one or more of the outcome measures. Patterns of posttreatment improvements were not consistent across participants but were more frequently observed on trained maximum performance tasks compared to tasks reflecting generalization of the treatment skillset. Some participants exhibited a stronger response to treatment, whereas others showed a mixed or weaker response. Parents liked the treatment protocol, perceived benefits from intensive intervention, and indicated they would strongly recommend LSVT LOUD to other parents who have children with DS and motor speech disorders.

CONCLUSIONS

These preliminary results show that children with DS tolerated intensive voice treatment without adverse effects and made select meaningful therapeutic gains. The treatment evidence from this study warrants Phase II treatment studies using LSVT LOUD with a larger group of children with DS.

Down syndrome and breastfeeding: A systematic review

Several conditions related to serious difficulty in initiating and maintaining breastfeeding in neonates with Down syndrome are described in the literature. This study aimed to investigate the frequency of breastfeeding in neonates with Down syndrome, as well as the reasons for not breastfeeding, through a systematic literature review by searching MEDLINE via PubMed, Cochrane Library, Scopus, Embase via Elsevier, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Sixteen studies were included with a total sample size of 2022 children with Down syndrome. The frequency of exclusive breastfeeding was 31.6-55.4%, with five studies reporting breastfeeding for longer than 6 months. Breastfeeding from birth was present for 48-92.5% of the children with Down syndrome in six studies. Two studies reported that around 50% and 23.3% of the children with Down syndrome were never breastfed, and rates of breastfeeding in infants with Down syndrome were lower than those in controls in three studies. The reasons for not breastfeeding or cessation of breastfeeding were associated with Down syndrome-specific challenges, maternal reasons, and healthcare aspects.

Airway obstruction and inflammation on combined bronchoscopy in children with Down syndrome

OBJECTIVE

To characterize the upper and lower airway findings in children with Down syndrome and chronic respiratory symptoms, based on evaluation by flexible bronchoscopy (FB) with bronchoalveolar lavage and microlaryngoscopy with bronchoscopy (MLB).

STUDY DESIGN

A retrospective review was conducted of children with Down syndrome aged 1 month to 17 years, who underwent both FB and MLB within a 1-year timeframe between 2010 and 2019 at Children's Hospital Colorado. Anatomic airway findings are reported as frequencies within the cohort. Bronchoalveolar lavage fluid (BALF) culture results, cell differential, and cytopathology are reported as frequencies or mean ± standard deviation. BALF results were compared between children with and without dysphagia documented on a recent swallow evaluation.

RESULTS

Overall, 168 children with Down syndrome were included, with median age of 2.1 years (interquartile range: 0.9-5.1 years). At least one abnormal airway finding was recorded in 96% of patients and 46% had at least three abnormal findings. The most common findings included tracheomalacia (39% FB; 37% MLB), subglottic stenosis (35% MLB), pharyngomalacia (32% FB), and laryngomalacia (16% FB; 30% MLB). Comparison of BALF based on dysphagia status showed that children with dysphagia had more frequent cultures positive for mixed upper respiratory flora (76% vs. 47%, p = 0.004) and a higher percentage of neutrophils (20% vs. 7%, p = 0.006).

CONCLUSION

Abnormal findings for FB and MLB are common in children with Down syndrome and chronic respiratory symptoms, and performing the procedures together may increase the diagnostic yield.

Validation of the Childhood Dysphagia Management Scale (CDMS): An Impact Scale for determining medical home for dysphagia

BACKGROUND

The results and recommendations from instrumental assessments of swallowing do not, by themselves, provide guidance regarding the type of medical management that might be needed for the pediatric patient with dysphagia. The aim of this study is to evaluate the reliability and validity of the Childhood Dysphagia Management Scale (CDMS), a clinical scale developed to estimate the impact of dysphagia and determine the need for a multidisciplinary medical home to manage dysphagia.

METHODS

This was a prospective observational study implemented in three phases to evaluate validity and reliability of the CDMS. Analyses for internal consistency, inter-rater and intra-rater reliability, repeated measure, content, structural, criterion and external validity and hypothesis testing were conducted.

RESULTS

This study established content, structural, internal, external, and criterion validity of the CDMS. The CDMS was found to have robust inter-rater (κ = 0.776) and intra-rater reliability (κ = 0.853), and consistency across repeated measures (κ = 0.853). Providers who used the CDMS had a high level of agreement with the recommended medical management plan. CDMS scores correlated (F(5,118) = 22.105, p < 0.001) with Functional Oral Intake Scale (FOIS) scores confirming that patients with significant diet restrictions were more likely to be referred for multidisciplinary care. To establish external validity, the CDMS was administered to a higher risk group, patients with Down syndrome, who were more likely to be referred for multidisciplinary care based on CDMS results versus the general swallowing disorders clinic population (F(1,281) = 24.357, p < 0.001).

CONCLUSION

The CDMS is a reliable and valid scale for guiding decision-making regarding the medical home for pediatric dysphagia management.

Altered sucking dynamics in a breastfed infant with Down syndrome: a case report

BACKGROUND

The health and developmental advantages of human milk and breastfeeding are particularly important for infants with Down syndrome. However, they typically have shorter breastfeeding duration due to sucking issues that are not well understood. This case report describes serial measures of milk transfer volumes, sucking dynamics and tongue movement in a breastfeeding infant with Down syndrome. Management of maternal milk production enabled feeding of only breast milk until maturation of breastfeeding skills and the achievement of full breastfeeding by 6 months.

CASE PRESENTATION

The mother of a term infant with Down syndrome and no associated health complications presented with concerns regarding adequacy of milk removal at the breast and low milk supply. We monitored sucking dynamics during breastfeeding by measuring intraoral vacuum strength, nutritive and non-nutritive suck rates and burst durations, and tongue movement using submental ultrasound. Breastfeeds were monitored at 4, 10, 14, 19 and 24 weeks, and maternal 24 h milk production was measured at 4, 10 and 24 weeks postpartum. We observed a weaker suck strength and shorter nutritive suck duration, and atypical tongue movement up to 19 weeks, with low milk transfer volumes. Regular breast expression was effective in increasing maternal milk production, providing expressed milk for all complementary feeds. Full breastfeeding was achieved by 6 months when reference sucking values were observed.

CONCLUSIONS

This case report illustrates that infants with Down syndrome may have low intraoral vacuum and limited nutritive sucking that persists for several months, likely due to delayed oro-motor development. In the absence of effective sucking human milk feeding can continue when milk production is stimulated with frequent and adequate breast expression. It is possible for infants with Down syndrome and no associated health complications to eventually establish full breastfeeding. Mothers that wish to breastfeed their infant with Down syndrome require anticipatory guidance and continuing lactation and family support.

Airway protection & patterns of dysphagia in infants with down syndrome: Videofluoroscopic swallow study findings & correlations

INTRODUCTION

Down syndrome is a genetic condition that affects 1:737 births. Along with cardiac, otolaryngologic, and developmental anomalies, infants with Down syndrome can have swallowing difficulties resulting in respiratory infections. This study aims to characterize the airway protection and dysphagia seen in infants with Down syndrome.

METHODS

This is a retrospective chart review of infants with Down syndrome who underwent videofluoroscopic swallow studies (VFSS) from 2008 to 2018 at a tertiary children's hospital. Demographic data and VFSS findings were collected.

RESULTS

89.8% (114/127) of infants presented with at least one element of oral dysphagia, while 72.4% (92/127) had at least one element of pharyngeal dysphagia. Sucking skills were classified as abnormal in 63.7% of the patients and bolus formation-control was determined to be deficient (abnormal) in 62.2% of the patients. Oral residuals were present in 37.8% of the patients. With regard to pharyngeal phase, the swallow initiation was considered abnormal in 53.5% of the patients. Pharyngeal residue was present in 17.3% and pharyngo-nasal reflux was present in 27.5% of the patients.

CONCLUSIONS

Swallowing assessments in infants with Down syndrome suspected of dysphagia should be considered, especially in those with any alterations in pulmonary health.

Co-occurring medical conditions in adults with Down syndrome: A systematic review toward the development of health care guidelines. Part II

Adults with Down syndrome (DS) represent a unique population who are in need of clinical guidelines to address their medical care. Many of these conditions are of public health importance with the potential to develop screening recommendations to improve clinical care for this population. Our workgroup previously identified and prioritized co-occurring medical conditions in adults with DS. In this study, we again performed detailed literature searches on an additional six medical conditions of clinical importance. A series of key questions (KQ) were formulated a priori to guide the literature search strategy. Our KQs focused on disease prevalence, severity, risk-factors, methodologies for screening/evaluation, impact on morbidity, and potential costs/benefits. The available evidence was extracted, evaluated and graded on quality. The number of participants and the design of clinical studies varied by condition and were often inadequate for answering most of the KQ. Based upon our review, we provide a summary of the findings on hip dysplasia, menopause, acquired cardiac valve disease, type 2 diabetes mellitus, hematologic disorders, and dysphagia. Minimal evidence demonstrates significant gaps in our clinical knowledge that compromises clinical decision-making and management of these medically complex individuals. The creation of evidence-based clinical guidance for this population will not be possible until these gaps are addressed.

Identifying Aspiration Among Infants in Neonatal Intensive Care Units Through Occupational Therapy Feeding Evaluations

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.

Associations between age, respiratory comorbidities, and dysphagia in infants with down syndrome

OBJECTIVES

Children with Down syndrome (DS) have a high risk of dysphagia and the pediatric pulmonologist may be involved in diagnosis and management. The objective of this study is to evaluate the associations between age, dysphagia, and medical comorbidities in young children with DS. We hypothesized that swallow study findings are more likely to change in younger infants and that medical comorbidities may be associated with dysphagia.

STUDY DESIGN

Results of videofluoroscopic swallow studies (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) from 2010 to 2016 were collected retrospectively in children with DS with initial swallow study at less than 12 months of age. Results were analyzed for findings and change based on age at initial study, reason for referral, and medical comorbidities.

RESULTS

One hundred eleven infants with 247 VFSS and 14 FEES were included. Deep laryngeal penetration and/or aspiration were found in 31.9% of infants less than 6 months and 51.3% of infants 6 to 12 months. Children with initial swallow study performed at greater than or equal to 6 months of age were more likely (80.0%) to have unchanged findings on follow-up study compared to children imaged at less than 6 months (35.3%). Laryngomalacia, pulmonary hypertension, pneumonia, and congenital cardiac disease were associated with dysphagia.

CONCLUSION

We confirmed that dysphagia is common in infants with DS and comorbidities and provided preliminary evidence that swallow study findings may be more likely to change in children tested under 6 months of age. Providers should consider that results for instrumental swallow studies may change, particularly if the test was completed on a young infant.

The Adult Ts65Dn Mouse Model of Down Syndrome Shows Altered Swallow Function

There are increased risks for deglutition disorders in people with Down syndrome (DS). Although mouse models have been used to study the biological underpinnings of DS in other areas, relatively little is known about swallowing phenotypes in these models. We hypothesized that swallowing performance would be affected in adult mouse models of DS, relative to typical control mice. Videofluoroscopic swallow studies (VFSS) were conducted on adults of two mouse models of DS: Ts65Dn and Dp(16)1Yey, and evaluated in comparison with age-matched controls. Relative to other groups, adult Ts65Dn showed significantly slower swallow rates, longer inter-swallow intervals (ISI), and greater numbers of jaw excursion cycles preceding each swallow. In contrast, adult Dp(16)1Yey mice showed swallowing performance similar to control mice. Exploratory quantitative analyses of the intrinsic tongue (transverse muscle), and extrinsic tongue muscles [genioglossus (GG), styloglossus (SG), and hyoglossus (HG)] showed no significant differences between genotype groups in myosin heavy chain isoform profiles. Collectively, these findings suggest that while swallowing is typical in adult Dp(16)1Yey, swallowing in adult Ts65Dn is atypical due to unknown causes. The finding that adult Ts65Dn may have utility as a model of dysphagia provides new opportunities to elucidate biological underpinnings of dysphagia associated with DS.

Clinical identification of feeding and swallowing disorders in 0-6 month old infants with Down syndrome

Feeding and swallowing disorders have been described in children with a variety of neurodevelopmental disabilities, including Down syndrome (DS). Abnormal feeding and swallowing can be associated with serious sequelae such as failure to thrive and respiratory complications, including aspiration pneumonia. Incidence of dysphagia in young infants with DS has not previously been reported. To assess the identification and incidence of feeding and swallowing problems in young infants with DS, a retrospective chart review of 174 infants, ages 0-6 months was conducted at a single specialty clinic. Fifty-seven percent (100/174) of infants had clinical concerns for feeding and swallowing disorders that warranted referral for Videofluroscopic Swallow Study (VFSS); 96/174 (55%) had some degree of oral and/or pharyngeal phase dysphagia and 69/174 (39%) had dysphagia severe enough to warrant recommendation for alteration of breast milk/formula consistency or nonoral feeds. Infants with certain comorbidities had significant risk for significant dysphagia, including those with functional airway/respiratory abnormalities (OR = 7.2). Infants with desaturation with feeds were at dramatically increased risk (OR = 15.8). All young infants with DS should be screened clinically for feeding and swallowing concerns. If concerns are identified, consideration should be given to further evaluation with VFSS for identification of dysphagia and additional feeding modifications.

Early impacts of modified food consistency on oromotor outcomes in mouse models of Down syndrome

Down syndrome (DS) in humans is associated with differences of the central nervous system and oromotor development. DS also increases risks for pediatric feeding challenges, which sometimes involve the use of altered food consistencies. Therefore, experimental food consistency paradigms are of interest to oromotor investigations in mouse models of Down syndrome (DS). The present work reports impacts of an altered food consistency paradigm on the Ts65Dn and Dp(16)1Yey mouse models of DS, and sibling control mice. At weaning, Ts65Dn, Dp(16)1Yey and respective controls were assigned to receive either a hard food or a soft food (eight experimental groups, n = 8-10 per group). Two weeks later, mice were assessed for mastication speeds and then euthanized for muscle analysis. Soft food conditions were associated with significantly smaller weight gain (p = .003), significantly less volitional water intake through licking (p = .0001), and significant reductions in size of anterior digastric myofibers positive for myosin heavy chain isoform (MyHC) 2b (p = .049). Genotype was associated with significant differences in weight gain (p = .004), significant differences in mastication rate (p = .001), significant differences in a measure of anterior digastric muscle size (p = .03), and significant reductions in size of anterior digastric myofibers positive for MyHC 2a (p = .04). In multiple measures, the Ts65Dn model of DS was more affected than other genotype groups. Findings indicate a soft food consistency condition in mice is associated with significant reductions in weight gain and oromotor activity, and may impact digastric muscle. This suggests extended periods of food consistency modifications may have impacts that extend beyond their immediate roles in facilitating deglutition.

Measuring feeding difficulties in toddlers with Down syndrome

Early feeding problems occur frequently across the population, but have a higher incidence in children with Down syndrome (DS). Early identification can possibly be improved with the help of a valid screening instrument based on caregiver reports. In a previous study, we investigated the concurrent validity of the Dutch version of the Montreal Children's Hospital Feeding Scale (MCH-FS, SEP in Dutch) in a sample of typically developing toddlers, and we found a correlation between the score on the instrument and observed behavior during a regular meal. The current pilot study was a replication in a sample of children with DS (aged 1; 0-3; 0) and their primary caregivers (n = 32). The results showed that children in the sample did not score higher on the SEP than children in their respective norm groups. In addition, when caregivers reported more symptoms of feeding problems on the SEP, children showed more food refusal and negative affect during the observed meal. This suggests that the screening instrument is particularly associated with negative mealtime interactions. This is in contrast with earlier results, which mainly indicated a relation with eating skills.

Prevalence of Dysphagia in People With Intellectual Disability: A Systematic Review

Dysphagia (feeding and swallowing disorder) is associated with serious health complications and psychosocial sequelae. This review summarizes international research relating to the prevalence of dysphagia in people with intellectual disability. Studies published from 1990 to July 2016 were identified using Medline, Cinahl, PsycINFO, Web of Science, email requests, and cross-citations. Twenty studies were identified. Dysphagia in people with intellectual disability appears to be associated with more severe levels of intellectual disability, comorbid cerebral palsy, and motor impairments. However, further research with representative samples of people with intellectual disability using adequate methods of assessment are required in order to provide more precise prevalence estimates and clarify factors that may be associated with dysphagia in this population.

Qualitative and quantitative analysis of oropharyngeal swallowing in Down syndrome

PURPOSE

To describe the qualitative and quantitative temporal analysis of oropharyngeal swallowing in children diagnosed with Down syndrome (DS) through a case series study of six individuals aged 4 to 17 months (mean age = 11.16 months; median = 12 months).

METHODS

Qualitative and quantitative temporal analysis of swallowing using videofluoroscopy and specific software. The following parameters were assessed: presence or absence of oral incoordination, labial sphincter sealing incompetence, oral residue, posterior oral spillage, laryngotracheal penetration and aspiration, pharyngeal and total oral transit time (TOTT).

RESULTS

Qualitative analysis identified individuals with disorders in at least four of the swallowing parameters investigated. Only one individual presented total oral transit time (TOTT) different from the others. No difference was observed between the cases regarding pharyngeal transit time.

CONCLUSION

Qualitative swallowing disorders are observed in children with DS, with difference in TOTT only in the case report of the youngest infant.

Management of swallowing and communication difficulties in Down syndrome: A survey of speech-language pathologists

PURPOSE

To explore speech pathology services for people with Down syndrome across the lifespan.

METHOD

Speech-language pathologists (SLPs) working in Australia were invited to complete an online survey, which enquired about the speech pathology services they had provided to client/s with Down syndrome in the past 12 months. The data were analysed using descriptive statistics.

RESULT

A total of 390 SLPs completed the survey; 62% reported seeing a client with Down syndrome in the past 12 months. Most commonly, SLPs provided assessment and individual intervention for communication with varying levels of family involvement. The areas of dysphagia and/or communication addressed by SLPs, or in need of more services differed according to the age of the person with Down syndrome. SLPs reported a number of reasons why services were restricted.

CONCLUSION

There is a need to re-assess the way that SLPs currently provide services to people with Down syndrome. More research is needed to develop and evaluate treatment approaches that can be used to better address the needs of this population.

Current demand of paediatric otolaryngology input for children with Down's syndrome in a tertiary referral centre

Objective:

This study aimed to evaluate the activity of paediatric otolaryngology services required for children with Down's syndrome in a tertiary referral centre.

Methods:

A review of the paediatric otolaryngology input for children with Down's syndrome was performed; data were obtained from the coding department for a two-year period and compared with other surgical specialties.

Results:

Between June 2011 and May 2013, 106 otolaryngology procedures were performed on children with Down's syndrome. This compared to 87 cardiac and 81 general paediatrics cases. The most common pathologies in children with Down's syndrome were obstructive sleep apnoea, otitis media, hearing loss and cardiac disease. The most common otolaryngology procedures performed were adenoidectomy, tonsillectomy, grommet insertion and bone-anchored hearing aid implant surgery.

Conclusion:

ENT manifestations of Down's syndrome are common. Greater provisions need to be made to streamline the otolaryngology services for children and improve transition of care to adult services.

Digastric Muscle Phenotypes of the Ts65Dn Mouse Model of Down Syndrome

Down syndrome is frequently associated with complex difficulties in oromotor development, feeding, and swallowing. However, the muscle phenotypes underlying these deficits are unclear. We tested the hypotheses that the Ts65Dn mouse model of DS has significantly altered myosin heavy chain (MyHC) isoform profiles of the muscles involved in feeding and swallowing, as well as reductions in the speed of these movements during behavioral assays. SDS-PAGE, immunofluorescence, and qRT-PCR were used to assess MyHC isoform expression in pertinent muscles, and functional feeding and swallowing performance were quantified through videofluoroscopy and mastication assays. We found that both the anterior digastric (ADG) and posterior digastric (PDG) muscles in 11-day old and 5–6 week old Ts65Dn groups showed significantly lower MyHC 2b protein levels than in age-matched euploid control groups. In videofluoroscopic and videotape assays used to quantify swallowing and mastication performance, 5–6 week old Ts65Dn and euploid controls showed similar swallow rates, inter-swallow intervals, and mastication rates. In analysis of adults, 10–11 week old Ts65Dn mice revealed significantly less MyHC 2b mRNA expression in the posterior digastric, but not the anterior digastric muscle as compared with euploid controls. Analysis of MyHC 2b protein levels across an adult age range (10–53 weeks of age) revealed lower levels of MyHC 2b protein in the PDG of Ts65Dn than in euploids, but similar levels of MyHC 2b in the ADG. Cumulatively, these results indicate biochemical differences in some, but not all, muscles involved in swallowing and jaw movement in Ts65Dn mice that manifest early in post-natal development, and persist into adulthood. These findings suggest potential utility of this model for future investigations of the mechanisms of oromotor difficulties associated with Down syndrome.