Document Detail

Investigation and management of dysphagia.
MedLine Citation:
PMID:  14992457     Owner:  NLM     Status:  MEDLINE    
Dysphagia is a common finding in infants and children with neuromuscular disabilities. Dysphagia may be developmental, as in the preterm infant, transient, chronic, or progressive. The evaluation of dysphagia must take into account the age of the patient and typical development of feeding and swallowing for that age. The typical abilities seen in neonatal, early infancy, later infancy and early childhood periods vary in sensorimotor skills and feeding efficiency. In addition to knowing the substrate of expected skills by age, knowledge of the neurophysiology of feeding and swallowing is essential to diagnosis. Each physiologic phase of deglutition: oral, pharyngeal, and esophageal can present with symptoms of dysphagia that can guide investigation. Common symptoms of dysphagia include generalized feeding difficulty such as poor efficiency, food refusal and failure to thrive. Specific symptoms include tongue thrust, choking, cough, and oxygen desaturation. The possibility of dysphagia can be identified through a thorough feeding history. Examination initially includes the infant's muscle tone and posture in the head, neck and body. Anomalies of structures of the head and neck must be identified and examined for their effect on function. Next, examination of oral structures for reflexes, tongue movements, and symmetry will identify neurologic abnormalities. Observation of feeding is essential and will reveal signs of dysphagia. Aspiration in the infant can present without specific signs. Respiratory abnormalities or Gastroesophageal reflux can be identified during history or examination. Investigation of dysphagia most commonly includes videofluoroscopy, endoscopy, and ultrasonography. The management of dysphagia requires an individualized approach and will include neurologic, respiratory, nutritional and possibly gastrointestinal management. Six broad areas are identified that must be considered in the management of dysphagia in infants and children. They include: normalization of posture and positioning, adaptation of foods and feeding equipment, oromotor therapy, feeding therapy, nutritional support and management of associated disorders. A team of professionals will assist the parent and child in achieving pleasant feedings to foster appropriate growth and development.
Anna Dusick
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Seminars in pediatric neurology     Volume:  10     ISSN:  1071-9091     ISO Abbreviation:  Semin Pediatr Neurol     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2004-03-02     Completed Date:  2004-04-05     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9441351     Medline TA:  Semin Pediatr Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  255-64     Citation Subset:  IM    
Section of Developmental Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
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MeSH Terms
Deglutition / physiology
Deglutition Disorders* / diagnosis,  therapy
Disease Management*
Feeding Behavior / physiology
Physical Examination

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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