pediatric dysphagia

What is dysphagia?

Difficulty or discomfort in swallowing.

What is the role of the caregiver in the oral preparatory stage?

Assess how, where, and what the infant eats.

What are some challenges in the oral preparatory stage?

Respiratory problems, tongue tie, small oral cavity/large tongue, immature buccinators, and importance of nasal breathing.

What is nutritive sucking (NS)?

Feeding with a slower rhythm, organized suck-swallow-breath pattern.

What is non-nutritive sucking (NNS)?

Sucking on a pacifier or finger with a faster rhythm.

What is the suck-swallow-breathe ratio for nutritive sucking?

Starts at 1:1:1 and later becomes 2:1:1.

What is the suck-swallow-breathe ratio for non-nutritive sucking?

6-8:1:1.

What is the oral phase in feeding?

Involves repeated tongue/jaw pumping from the nipple with critical rhythmicity.

What sensory inputs are involved in the oral phase?

Mechanoreceptors, proprioceptors, taste, smell, and temperature.

What occurs during the pharyngeal phase in infants?

Laryngeal elevation is minimal, and the tongue base contacts the pharyngeal wall.

What is a normal gag reflex in infants?

Triggered by CNS perception of a noxious stimulus, indicating a motor response to expel foreign bodies.

What are key milestones in pediatric feeding development?

Breastfeeding in the first 4 minutes, transitional feeds at 4-6 months, and teeth eruption at 6-24 months.

What is assessed during a clinical feeding and swallowing assessment?

Physiologic function including heart rate, respiratory rate, and oxygen saturation.

What imaging techniques are used in the assessment of pediatric dysphagia?

VFSS (Videofluoroscopic Swallowing Study) and FEES (Fiberoptic Endoscopic Evaluation of Swallowing).

What are some etiologies of pediatric dysphagia?

Gastrointestinal disorders, respiratory disorders, CNS/PNS disorders, cardiac disorders, prematurity, structural abnormalities, and traumatic birth.

What are abnormal findings in the oral stage of dysphagia?

4-6 tongue pumps before swallow, reduced lip closure/latching, and reduced tongue strength/coordination.

What are some intervention strategies for pediatric dysphagia?

Compensatory strategies like establishing optimal infant state and facilitative strategies like oral-motor therapy.

What factors contribute to the success of feeding interventions?

Group interaction, strong leadership, creative problem solving, and time & dedication.

What is the significance of rhythmicity in suck-swallow-breathe patterns?

Rhythmicity is more important than the specific ratio in feeding.

What happens to respiratory rate during feeding in infants?

Decreased respiratory rate and tidal volume during feeding.

What is the typical swallow frequency for infants when awake?

6 swallows per minute.

What is the role of teeth eruption in feeding development?

Provides sensory input and reduces tongue thrust.

What is the impact of neurologically impaired children on feeding?

They may retain respiratory changes during feeding that typically disappear in normal development.

What is the importance of assessing family and feeding history?

To understand the context and potential influences on the child's feeding and swallowing development.