I reviewed the literature in regard to progress related to pediatric dysphagia abroad, primarily in the United States, during the past 10 years and have summarized the trends.
There are reports of feeding problems being observed in 25% to 45% of children as a whole, and in 33% to 80% of children with developmental delays, and the number of children with feeding and swallowing disorders has presumably increased as a result of advances in medical technology.
The typical abnormal findmgs observed in pediatric dysphagia are varied and include oral motor dysfunctions, food selectivity and refusal, difficulty in maneuvering boluses, aspiration, and gastroesophageal reflux disease. Oral motor dysfunctions are seen in especially high percentages of children with cerebral palsy and children with Down syndrome, whereas oropharyngeal dysphagia is not seen in children with the autistic spectrum. Their dysphagia is attributable to perceptual problems or gastrointestinal problems of unknown etiology, and they are more likely to exhibit selectivity of food type and texture.
A variety of questionnaires and a scale for systemic observation of breast and bottle feeding behavior have been developed as assessment methods. A videofluoroscopy swallow study (VFSS) and fiberscopic endoscopic evaluation of swallowing (FEES) have become widely adopted as precise examinations, and various testing manuals and guidelines have been published. Numerous comprehensive assessment forms have also been proposed.
In terms of intervention methods, reports have accumulated on modification of the texture and shape of foods and liquids, adequate formula selection for oral and non-oral feeding, modification of the meal environment, improved motor function and sensory function training, appropriate selection of nipples and bottles, optimal positioning, cheek and chin support, pacing, training in spoon, glass, and straw use, chewing training, feeding schedules, contingency management, shaping, use of gastric acid secretion blockers for gastroesophageal reflux disease, surgical management, etc. There is also a trend toward actively addressing the rehabilitation of young infants with feeding disorders in neonatal intensive care units.
View full abstract