A Tube-Feeding Dysphagia Child Whose Swallowing Could Not Be Confirmed Because of the Change of Environment

Abstract

It is important for dysphagia children to promote their interest in eating and enjoying their mealtimes. When tube-feeding children start oral intake, the safety of their swallowing must be confirmed. In this case report, we describe a tube-feeding child who could swallow safely and start oral intake.

A 1.5-year-old boy with severe dysphagia presented to our outpatient clinic for an evaluation of swallowing function. He had severe psychomotor retardation, respiratory disturbance and gastroesophageal reflux disease. He depended on tube-feeding exclusively for taking nutrition because of previous recurrent aspiration pneumonia. He underwent tracheotomy and gastrostomy at 0.9 years and 1.3 years, respectively. Thereafter his respiratory disturbance and gastroesophageal reflux disease improved, however, he was prohibited from oral intake. At the initial examination, he presented drooling and stridor. Frequent endotracheal tube suction was necessary to clear secretions. The findings of endoscopic evaluation of swallowing indicated a little retained secretion in the laryngopharynx and no swallowing reflex during examination. The findings of videofluoroscopic examination of swallowing indicated aspiration and no swallowing reflex. The result of the initial evaluation was that he had no swallowing reflex and could not feed orally at all. We continued consultations every 1 to 2 months at his mother’s request. His mother said that he did not present stridor very often and she sometimes heard his swallowing sound at home. For the first 3 months, he always presented stridor at the consultation room, but thereafter did not always present stridor. However, even if he did not present stridor at the start of the consultation, he always began to do so whenever we performed any examination. Considering his mother’s information and his state in the consultation room, we speculated that he could swallow at home, but that he could not swallow and presented stridor in a different environment from home. After 8 months from the first consultation, we confirmed his swallowing without aspiration by videofluoroscopic examination when he did not present stridor. In contrast to the initial evaluation, our final evaluation was that he could start a little oral feeding when he did not present stridor. For 1 year since starting oral intake, he has had no aspiration pneumonia.