Oral dysphagia refers to problems with using the mouth, lips and tongue to control food or liquid. Manual for the Videofluorographic Study of Swallowing. A General Electric (Milwaukee, WI) SFX2 table unit fluoroscope was used, and the study was recorded on a Panasonic (Division of Matsushita Electric Corporation of America, Secaucus, NJ) AG-MD830 videocassette recorder (S-VHS). Infants were fed by the parent or the clinician. Almost all infants (8 of 9) who aspirated did not cough or clear their airway. One infant had a cleft palate and consistent nasopharyngeal backflow without laryngeal penetration or aspiration. Argentum nit. Although swallowing function was not examined in this study, nasopharyngeal backflow may have been reduced by the head position. They then use their tongue to pull the liquid into the mouth. In episodes of laryngeal penetration, all patients were able to clear their airway during the swallow without a cough. Disruption of these coordinated functions can result in oral feeding difficulties leading to increased risk of apnea, bradycardia, failure to thrive, oxygen desaturation, or aspiration. In the absence of laryngeal penetration/aspiration, abnormal swallowing function characterized by material in the pyriform sinuses before initiation of the swallow may be an indication of potential aspiration. Because infants stop breathing each time they swallow, this can cause a change in heart rate. Every liquid swallow was analyzed for the following variables: Time of occurrence of laryngeal penetration as defined by material entering the vestibule or entrance of the airway to any extent down to the level of the true vocal folds12, Time of occurrence of aspiration as defined by entry of material below the true vocal folds12, Time of occurrence of nasopharyngeal backflow as defined by material posterior or superior to the soft palate, Cough in the presence of laryngeal penetration and aspiration, Ability to clear airway (penetration/aspiration), Biomechanical reason for laryngeal penetration or aspiration, Time of initiation of each swallow beginning with upward movement of the jaw during sucking or onset of tongue movement with syringe-presented material. Infants who demonstrated laryngeal penetration without aspiration could clear their airway without a cough. Discuss your concerns with the child’s pediatrician right away. Thank you for your interest in spreading the word on American Academy of Pediatrics. As the jaw moves down, it helps create suction to pull the liquid into the mouth. Following are some commonly seen health issues which often leads to swallowing disorders in children: Prematurity; Large tongue Newborns tend to have an irregular breathing pattern that alternates between fast and slow, with occasional pauses. Nasal reflux 14. Any problem related to the structural problem in the mouth, throat or oesophagus may be the culprit behind the swallowing disorders. Difficulty with suck-swallow can persist even after that age. Therefore, the objectives of this study were to determine 1) the percentage of dysphagic infants who experience laryngeal penetration, aspiration, or nasopharyngeal backflow; 2) reasons for laryngeal penetration/aspiration; 3) whether infants with laryngeal penetration/aspiration clear their airway; and 4) the relationship between swallowing disorders and medical diagnoses. Lots of answers! The decline in swallowing function may be explained by the effects of fatigue or sensory adaptation. Because of gravity, the upright position would reduce the incidence of nasopharyngeal backflow. Material in the pyriform sinuses before pharyngeal swallowing was associated with penetration/aspiration. If these are too tight, then the infant can’t get a good latch on the nipple or can’t adequately move the tongue. We do not capture any email address. This study demonstrated that most infants suspected of dysphagia showed overt abnormalities: laryngeal penetration, aspiration, and/or nasopharyngeal backflow on the videofluoroscopic swallowing study. Abnormal feeding and swallowing can be associated with serious sequelae such as failure to thrive and respiratory complications, including aspiration pneumonia. Some compensations, like frequent breaks during feeding, can help the infant be successful. Patients included 43 consecutive infants who were younger than 1 year and referred for videofluoroscopic swallow studies within a 1-year period. Examination of the reasons for penetration with or without aspiration with respect to timing of first occurrence revealed that the 3 infants who had an absent pharyngeal response experienced immediate laryngeal penetration and aspiration on the first swallow. Infants who were unable to suck had barium administered by syringe (n = 8). The results of this study revealed that most infants who were suspected of having dysphagia showed overt abnormalities: laryngeal penetration, aspiration, and/or nasopharyngeal backflow on MBS. In addition, they get better at using their lips to remove the food from the spoon and help bring the food into the mouth. However, it does not allow for thorough examination of the occurrence of dysphagia or type of swallowing disorders within specific populations. This makes it hard to eat. Initially the infant will use the same in-out suckling motion of the tongue they have been using on the bottle/breast, but by around six months of age they don’t have to move their tongue in and out of the mouth to get the food to the back of the mouth for the swallow. This site uses Akismet to reduce spam. Results. Slow motion and frame-by-frame analysis allows for evaluation of variables that are not easily visualized in real time. A swallowing evaluation, which examines only a few swallows, may miss laryngeal penetration, aspiration, or a change in the biomechanics of the swallow and may be inadequate for diagnostic purposes. Statistical analyses involved a χ2 for nonparametric data and measures of central tendency for numeric or timing data. Some people with dysphagia have problems swallowing certain foods or liquids, while others can't swallow at all. Moving to solid foods requires even more coordination of the lips, tongue and jaw to allow the child to bite food, move it to the side teeth for chewing, recollect it on the tongue and move it to the back of the mouth for swallowing. Neurological Conditions– Conditions such as Cerebral Palsy or Down syndrome, and other neurological conditions or syndromes that affect muscle tone, can make it challenging for the infant to get a good seal on the nipple or effectively pull milk from the nipple. Many of these problems can continue to affect the child’s ability to eat and swallow as they grow. Still other children may present with feeding problems without an obvious cause. Medical Diagnoses of Infants Referred for Videofluoroscopic Swallow Studies. Most infants are able to drink from a cup by six months of age. Inefficient nippling 11. In total, 22 of the 43 patients (51%) experienced laryngeal penetration, aspiration, or nasopharyngeal backflow during the study. When infants experienced laryngeal penetration without aspiration (n = 14), none of the infants coughed and all cleared their airway during the swallow. The objectives of this study were to determine 1) the percentage of infants who are suspected to have dysphagia and who experience nasopharyngeal backflow, laryngeal penetration, or aspiration; 2) the biomechanical cause of laryngeal penetration/aspiration; 3) the percentage of infants who experience penetration/aspiration and who clear their airway; and 4) the relationship between the results of the modified barium swallow (MBS) and medical diagnoses. However, there is little understanding of the biomechanics of infant swallowing disorders. The reasons for referral included the following: rule out aspiration (18); gagging, coughing, or vomiting (8); failure to thrive (7); respiratory distress (4); difficulty feeding (3); wean from gastrostomy tube (1); apnea (1); asthma (1); cleft palate (1); and bradycardia (1). A 40% wt/wt (60% wt/vol) E-Z EM premixed liquid barium suspension was administered using a bottle and Ross Similac Infant Nipple & Ring (Columbus, OH). You will be redirected to aap.org to login or to create your account. For infants who aspirated, aspiration occurred later than laryngeal penetration with a mean of 65.41 seconds into the study (n = 9; SD: 135.96 seconds; range: 0–423.49 seconds). Your healthcare provider will check the amniotic fluid for meconium at the time of birth. Of the 43 patients evaluated, laryngeal penetration was observed in 17 of 43 (40%), aspiration in 9 of 43 (21%), and nasopharyngeal backflow in 13 of 43 (30%). Interrater reliability was excellent with 100% agreement for laryngeal penetration and 98% agreement for the other variables. Premature entry of bolus 1… Patients included 43 infants who were referred for videofluoroscopic swallowing studies in a university-affiliated pediatric medical center. For instance, babies who are unable to pick up food and get it to their mouths or are unable to close their lips to keep food and drink from falling out of may potentially have a feeding disorder/issue. Most of these infants did not demonstrate abnormalities in the first few swallows but displayed deterioration in swallowing function as they continued to feed. However, there is little understanding of the biomechanics of infant swallowing disorders. Eight of the 9 infants who aspirated did not cough or clear their airway (silent aspiration). Their nutritional intake may be very limited. Infants are typically introduced to “solids” like cereals and Stage I baby foods sometime after 4 months of age. The suck-swallow-breathe sequence then starts again. Eight of the 9 infants in this study did not cough or clear their airway in response to aspiration (silent aspiration). Infant feeding disorders may include problems with grabbing food, holding liquids and foods in the mouth, sucking, and chewing. From these variables, it was possible to determine the length of time that the child was feeding until the first episode of laryngeal penetration, aspiration, or nasopharyngeal backflow from the onset of the study. There has been an increase in infant swallowing disorders as a result of improved survival for infants born prematurely or with life-threatening medical disorders. Amniotic fluid is generated mostly by baby urinating with some contribution from placental “sweating”. If there was no aspiration on the initial swallows, then the infant was allowed to suck on the bottle until there was a change in swallowing function, 2 ounces were finished, or the infant refused to suck. Disorders of sucking and swallowing in infants are the result of multiple medical problems, may further exacerbate health, and cause respiratory complications. Not all food selectivity or refusal is related to sensory problems, and any physical problems interfering with safe, successful eating must first be ruled out. Your email address will not be published. Piecemeal deglutition 15. Prematurity – Premature infants as young as 32 weeks post gestation show some emerging skills in sucking and swallowing, but generally are not ready for full oral feeding until between 34 and 37 weeks post gestation. Only 3 infants experienced laryngeal penetration and aspiration on the first swallow and all 3 had an absent pharyngeal response. Treatment of Attention-Deficit/Hyperactivity Disorder: Overview of the Evidence, Spontaneous Arousals in Supine Infants While Swaddled and Unswaddled During Rapid Eye Movement and Quiet Sleep, Prevalence of Anti-Gelatin IgE Antibodies in People With Anaphylaxis After Measles-Mumps-Rubella Vaccine in the United States, Follow American Academy of Pediatrics on Instagram, Visit American Academy of Pediatrics on Facebook, Follow American Academy of Pediatrics on Twitter, Follow American Academy of Pediatrics on Youtube. Pooling of bolus in lateral sulci 16. WHAT TO DO IF YOUR INFANT OR CHILD HAS FEEDING/SWALLOWING PROBLEMS. Physical problems might also be in the intestinal tract that prevent the child from digesting food. Children with sensory problems may develop food selectivity or food refusal. Portions of this article were presented at the VII Annual Dysphagia Research Society Meeting; October 17, 1998; New Orleans, LA. However, most infants with cleft lip/palate can feed successfully with the right intervention. The sooner a feeding/swallowing problem is identified and appropriate treatment begun, the better chance the child has to improve their skills. Dysphagia means difficulty with feeding or swallowing. It is then easily corrected with minor surgery. This restriction may not be obvious, but a speech-language pathologist who works with infants can help decide if that is the problem. Infant swallowing disorders will surface in one or more of these three stages in the eating process. Comprehensive Management of Swallowing Disorders. Oral Stage. Older babies have trouble chewing or cannot move solids. The most common swallowing symptom of dysphagia is the sensation that swallowed food is sticking, either in the lower neck or the chest. Infants gain all their nutrition through breast or bottle feeding until they are at least six months of age. 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