Dysphagia in Infants and Children

Normal Feeding Development

  • Newborns have smaller oral cavities and larger tongues for easier latching.

  • Newborn larynx positioned higher for feeding; the brainstem controls swallowing reflexes.

Infant Swallowing Anatomy

  • Key structures: Eustachian tube, hard palate, soft palate, tongue, epiglottis, trachea, esophagus.

Feeding Reflexes

  • Neonates: all swallowing phases involuntary.

  • Adaptive reflexes: Rooting and suckling.

  • Protective reflexes: Tongue protrusion, gag, cough; diminish by 6 months.

  • Suck-swallow-breathe coordination develops by third trimester.

Feeding Milestones

  • Newborn to 4 years: progressive development of oral skills and reflexes.

  • Key milestones include spoon response, food transfer, and ability to chew and bite.

Feeding and Swallowing Disorders

  • Feeding disorders: Issues with suckling, chewing, or drinking.

  • Swallowing disorders: Abnormalities in oral, pharyngeal, or esophageal phases.

  • Lactation issues: Problems in breastmilk supply/delivery.

Signs and Symptoms of Dysphagia

  • Oral Phase: Weak suck, latching problems.

  • Pharyngeal Phase: Poor suck-swallow coordination, aspiration risk.

  • Esophageal Phase: Reflux, impaired opening.

Causes/Risk Factors of Dysphagia

  • Maternal health issues, fetal alcohol syndrome, neonatal abstinence syndrome, developmental disorders.

  • Birth factors: 3.5% full-term and 26% preterm infants face feeding issues.

Behavioral Indications

  • Problems at mealtimes may include discomfort, reduced intake, and problematic behaviors.

Assessment

  1. Case history: Medical and feeding history.

  2. Clinical feeding evaluation: Observe oral anatomy and reflexes.

  3. Instrumental evaluations: VFSS and FEES for swallow assessments.

Pediatric Healthcare Team

  • Involves multiple specialists including pediatricians, dieticians, SLPs, and occupational therapists.

Management Strategies

  • Modified Diet: Thickened fluids & solid food guidelines.

  • Positioning: Upright, side-lying, or adjustments during feeding.

  • Feeding Equipment: Specialized utensils and bottles for managing flow.

  • Behavioral Feeding Therapy: Addressing mealtime behaviors through positive reinforcement.

  • Tube Feeding: Weaning strategies for children dependent on tube feeding.

Successful Feeding Therapy Outcomes

  • Improved oral skills, variety of consumed foods, weight gain, and enhanced parent-child interaction.

Additional Resources

  • ASHA link on feeding and swallowing disorders.