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Paediatric Dysphagia

Paediatric Dysphagia. Grizelda Steyn Janet Smith Incorporated Audiologist & Speech Therapist St. Augustine’s Hospital. Background of Dysphagia. Feeding problems common in NICU/preterm infants Minor feeding problems in normal children 25-30%

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Paediatric Dysphagia

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  1. Paediatric Dysphagia Grizelda Steyn Janet Smith Incorporated Audiologist & Speech Therapist St. Augustine’s Hospital

  2. Background of Dysphagia • Feeding problems common in NICU/preterm infants • Minor feeding problems in normal children 25-30% • 40-70% feeding problems in premature infants and infants with chronic illness • Feeding is very complex process which involve mouth, pharynx, larynx and esophagus and sucking reflex in infants in the first phase. • Cornerstones of infant feeding –suck/swallow/breath • Sucking reflex initiates swallowing in the infant by stimulation of the lips and deeper parts of the oral cavity. • The mandible, maxilla, upper gums, lips, palate and cheeks are necessary for compression of the nipple and expression of contents

  3. General Background • Any defect of lips, tongue, palate, mandible, maxilla or cheeks may create problems in the first phase of feeding in an infant. • 3 stages of swallowing disorders – oral phase,pharyngeal phase and esopharyngeal phase)

  4. What is Dysphagia? • Difficulty swallowing • The inability of food or liquids to pass easily from the mouth, into the throat, and down into the esophagus to the stomach during the process of swallowing.

  5. What could affect successful feeding in an infant? • Conditions that impact the neurological system developing, respiration and digestion. • Medications often have side effects that could cause nausea, stomach pain and irritation. • Cardiac patients often lack the endurance to take sufficient amount of liquid in a timely manner.

  6. What about our Premature/NICU infants? • Difficult delivery • Aspiration, hypoxia • Impacts : postural control, breathing regulation, state of infant, oral and pharyngeal reflexes • Prolonged ventilation • Cardiac problems • Start with limited respiratory reserves • Difficulty regulating cardio-respiratory function • Impacts energy, endurance, intake, coordination and safety

  7. Premature/NICU infants • Congenital anomalies • Cleft lip- and palate • Hyperbilirubinemia (Jaundice) • Impacts alertness, vigor and therefore intake. • Infant of Diabetic motor( IDM) • Impact work of breathing and therefore disrupts coordination of suck-swallow-breathe sequence. • Respiratory Distress Syndrome (RDS) • Compromise the transition to nipple feeding

  8. Common feeding difficulties in NICU • Tires before finishing feeding • Lacks spontaneous mouth opening – breathing too much effort to be willing to suck. • Feeding for long periods at a time • Difficulty coordinating sucking, breathing and swallowing • Gagging during feeding • Drooling • Congestion in the chest after drinking • Coughing or choking when drinking (or very soon afterwards)

  9. Symptoms of Dysphagia • Tiredness or shortness of breath while eating or drinking • Frequent respiratory infections • Colour change during feeding, such as becoming blue or pale – silent aspiration • Spitting up or vomiting frequently • Food or liquids coming out of the nose during or after a feeding • Disorganized sucking – overall postural disorganization and poor sucking rhythm, poor tongue stability • Trouble latching – related to breathing, abnormal CNS or could be oral-tactile hypersensitivity • Weight loss

  10. Important to remember… • The reluctance to suck may be an instinctive reaction, a purposeful respond to attempt to protect their airway.

  11. Protocol for Oral feeding • 34 weeks G.A • Weight of 1.6kg • No medical conditions that would interfere with feeding • Respiratory rate: 70 breaths per minute • Effort: no change in skin colour • Able to maintain a wakeful state of 10-15 minutes • Aspiration: none (Swallowing of Oral Secretions?) • Ability to gag and reflexively protect airway. • Rhythmic, non-nutritive sucking

  12. Treatment of Dysphagia Goal of treatment plan is safe, independent feeding(swallow). • Changing bottle or teats – Premature infant – bigger teat provide internal stability. (Tongue position and mouth size). • Positioning – impacts airway maintenance, breathing, safe swallow and organization of infant • Swaddling – provides overall postural support and containment • Pacing of feeds • Flow rate – greatest obstacle to safe and successful feeding. Increased flow – poor endurance/weak suck. Reduce flow- poor coordination of SSB. Aspiration!!

  13. Treatment of Dysphagia • Oral motor & Swallowing simulation techniques • Pacifiers • Calorically dense formulas (Cardiopulmonary disorders) • NGT • PEG

  14. Outcome of our babies in NICU • Early intervention • Good prognosis for babies with no severe or chronic illness • Maturation of CNS • Alternative feeding as part of goal towards successful feeding

  15. Questions or Comments?

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