Difficult cases on training for ingestion in a rehabilitation clinic for disabled children

Abstract

The importance and effectiveness of a multi-disciplinary approach for handicapped children when giving training for ingestion is well-known， but some cases present great difficulties for such training．In this study，we examined children who cannot swallow or had refused to eat orally for more than a year．In 12 years，716 cases had visited our clinic for ingestion，of which 24 had swallowing difficulties and needed tube feeding absolutely (Group 1)，while 21 cases seemed to have no severe anatomical or motor problems of swallowing and managing food in their oral cavities (Group 2)．We divided Group 2 into three sub-groups．The first group had a history of surgery or treatment on their face， oral cavity or esophagus． The second group was the so-called Costello syndrome． The third group had a history of treatment for uncontrollable epilepsy with severe mental retardation． The first group had large differences among their prognosis of eating．There was a period before and after surgery when eating was inhibited．The prognosis seemed to depend on their period for which eating was inhibited．There seemed to be a critical period of eating．Their appetite of eating orally will not develop if they pass the duration being tube-fed without experiencing tasting．Costello syndrome is characterized by natural development of appetite to eat orally during school age．We did not find the reason why some cases of uncontrollable epilepsy with severe mental retardation refused to eat，but speculated that they had poor ability to adapt to even small environmental changes．