Incomplete lip closure 10. The remainder of these infants (n = 14) experienced laryngeal penetration or aspiration later in the study. Gagging prior to swallowing 8. Learn how your comment data is processed. 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). For infants who are breast fed, the mother may experience unusual nipple soreness. They may also present with feeding/swallowing problems if they are delayed in development of their motor skills. However, most infants with cleft lip/palate can feed successfully with the right intervention. 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. Furthermore, clinical observation of swallowing will not determine the cause of laryngeal penetration/aspiration, changes in swallowing function, or response to therapeutic intervention. Your email address will not be published. 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. Results. Nasopharyngeal backflow occurred earlier in the study with a mean time of 11.34 seconds into the study (n = 13; SD: 12.61 seconds; range: 0–32.28 seconds). The sooner a feeding/swallowing problem is identified and appropriate treatment begun, the better chance the child has to improve their skills. Conclusions. Almost all babies get gas. Feeding and swallowing disorders have been described in children with a variety of neurodevelopmental disabilities, including Down syndrome (DS). Feeding/swallowing problems in children can be classified into several main categories, although many children have problems in more than one category: Related to motor problems– Children who have trouble with the coordinated movement of lips, tongue, or jaw will likely have trouble with successful eating. Argentum nit. The following medical diagnoses were examined for occurrence of penetration, aspiration, or nasopharyngeal backflow: neurologic disorders (24 of 43 [56%]), prematurity (16 of 43 [37%]), pneumonia (21 of 43 [49%]), apnea (10 of 43 [23%]), and tube-fed (9 of 43 [21%]). Enter multiple addresses on separate lines or separate them with commas. Results of a study by Jennie et al10 revealed that feeding preterm infants in a head-elevated tilt position significantly reduced bradycardic and hypoxemic episodes compared with a horizontal position. They may become fatigued and not be able to finish the feeding. Almost half of the patients had a history of at least 1 episode of pneumonia. 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. Choking prior to swallowing 3. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. The frenum is the little piece of tissue that connects the top and bottom lip to the gum and the tongue to the floor of the mouth. As expected, infants with an absent pharyngeal response experienced laryngeal penetration and aspiration on the first swallow. Food pushed out of mouth 7. Eight of the 9 infants in this study did not cough or clear their airway in response to aspiration (silent aspiration). Thus, swallowing function deteriorated as the infant continued to swallow. Some even close. The ability to suck successfully from breast or bottle requires the infant to coordinate three actions: suck-swallow-breathe. The most common cause of laryngeal penetration and aspiration was material in the pyriform sinuses before initiation of the swallow (either from spillover while still sucking or delayed pharyngeal response). Some people cannot swallow at all. Many things can interfere with this sophisticated system for swallowing. Overall, maximum radiation exposure was kept to a limit of 1 to 2 minutes. P92.8 is a billable code used to specify a medical diagnosis of other feeding problems of newborn. They may not be able to handle foods like other children their age. In addition, they get better at using their lips to remove the food from the spoon and help bring the food into the mouth. Physical problems might also be in the intestinal tract that prevent the child from digesting food. To move the food, the infant must squeeze liquid down the throat. Safe and successful oral feeding in the neonate is dependent on the proper development of sucking and swallowing, and their coordination with breathing. When this child was excluded from the population, nasopharyngeal backflow occurred in 12 of 42 (29%). The most common swallowing symptom of dysphagia is the sensation that swallowed food is sticking, either in the lower neck or the chest. Often, it can be difficult to take in enough calories and fluids to nourish your body. Each pediatrician will guide the parents in knowing the right age to begin spoon feeding. 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. The high incidence of silent aspiration demonstrates the necessity of a videofluoroscopic assessment to evaluate swallowing function in these infants. Interesting is that these infants were not more likely to have pneumonia, which may reflect the small number of infants with silent aspiration in this study. The next step will likely be a referral to a speech-language pathologist with expertise in this area, or perhaps to a multi-disciplinary feeding team. Related to sensory problems – Some children have trouble processing the many different sensations related to food: temperature of the food, texture or smell of the food, taste and even color of the food may present a challenge. Infants are typically introduced to “solids” like cereals and Stage I baby foods sometime after 4 months of age. Here are some examples of possible causes of difficulty with feeding in infants. When infants were unable to suck, a tuberculin syringe (without the needle) was used to administer liquid barium in 0.5- to 1.0-mL volumes. These infants often have multiple health issues and an increased risk of respiratory complications. Statistics included χ2 for nonparametric data and measures of central tendency for numeric/timing data. A swallow has four phases: oral preparatory, oral propulsive, pharyngeal and esophageal.3 In this population, infants who were born prematurely were significantly more likely to experience nasopharyngeal backflow (χ2 = 4.06; P < .04). 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. Respiratory Function of the Upper Airway. These infants often have multiple health issues and an increased risk of respiratory complications. The hole in the nipple was enlarged to 3 mm with a scalpel, connecting the hole and crosscut, allowing the slightly thicker barium suspension to flow through the nipple. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. Older babies have trouble chewing or cannot move solids. The results of this study revealed that infants who were born prematurely were significantly more likely to experience nasopharyngeal backflow. Despite the recent proliferation of research in adult swallowing disorders, there has been very little research on infant swallowing function and pathophysiology. Baptisia (Thrice a day): Can swallow liquids only. More than half of the infants (22 of 43) who were referred for dysphagia experienced laryngeal penetration, aspiration, or nasopharyngeal backflow. A speech-language pathologist can help determine if the infant will be able to breast feed and what kind of nipple or feeding system will be needed for successful bottle feeding. A baby who is struggling for breath shortly after birth may present with persistent blue color around the mouth and nose, flaring nostrils, grunting noises and chest retractions, clear signs of labored breathing. The reasons for laryngeal penetration with or without aspiration for 17 of the 43 infants included spillover of material into the pyriform sinuses while still sucking (12 of 17 [71%]), slow laryngeal closure or delayed pharyngeal response (2 of 17 [12%]), absent pharyngeal response (3 of 17 [18%]), and a combination of spillover and pharyngeal residue (1 of 17 [1%]). If food sticks in the throat, there may be coughing or choking with expectoration of the swallowed food. 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. However, there is little understanding of the biomechanics of infant swallowing disorders. Lip or tongue “tie”– If an infant immediately has trouble with sucking, in the absence of any obvious medical or developmental problems, the infant may be presenting with restricted “frenum” of the lips or tongue. Babies often swallow air when feeding, which can cause gas. Abnormal feeding and swallowing can be associated with serious sequelae such as failure to thrive and respiratory complications, including aspiration pneumonia. The remaining infants who penetrated or aspirated secondary to material in the pyriform sinuses before the swallow had their first episode of penetration or aspiration much later in the study, with a mean time after 1 minute. Only 1 infant experienced laryngeal penetration and aspiration from pharyngeal residue, a problem more commonly seen in adults. Because infants stop breathing each time they swallow, this can cause a change in heart rate. Your email address will not be published. These infants were significantly more likely to aspirate (4 of 8; χ2 = 5.02; P < .025). Difficulty with suck-swallow can persist even after that age. 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. Dysphagia (Swallowing Problems) Dysphagia Symptoms. Comprehensive Management of Swallowing Disorders. These results have implications for swallowing assessments. Because of gravity, the upright position would reduce the incidence of nasopharyngeal backflow. Objective. (Thrice a day): Difficulty in swallowing with sensation of a splinter in the throat. Methods. Suck is accomplished with slightly different motions on the breast compared to the bottle, but essentially the lips must close on the nipple and the tongue moves in and out in a suckle motion and presses the nipple against the roof of the mouth, creating pressure on the nipple. Furthermore, the parameters that define adult swallowing and dysphagia cannot always be applied to the infant because of differences in the relationship of anatomic structures and lack of neurologic maturation. Infants who were unable to suck had barium administered by syringe (n = 8). WHAT TO DO IF YOUR INFANT OR CHILD HAS FEEDING/SWALLOWING PROBLEMS. It is then easily corrected with minor surgery. Most of these infants did not demonstrate abnormalities in the first few swallows but displayed deterioration in swallowing function as they continued to feed. An infant may have trouble sucking or moving liquid into the throat. Any problem related to the structural problem in the mouth, throat or oesophagus may be the culprit behind the swallowing disorders. In this study, all children who had laryngeal penetration without aspiration cleared their airway during the swallow without a cough, unlike adults with dysphagia, who cannot always clear the airway during the swallow and must cough to clear the material. There are advantages and disadvantages to using a spouted cup when introducing liquids. We do not capture any email address. Coughing and airway clearance in the infant differs from the adult. It is also most common in babies who are born post-term (after 42 weeks). Piecemeal deglutition 15. Gas happens when air gets into the digestive tract, such … The prevalence of silent aspiration in this study demonstrates the necessity of an assessment that views the oral and pharyngeal stages of swallowing, eg, radiographic or fiber-optic study. Eight of the 9 infants who aspirated did not cough or clear their airway (silent aspiration). The code is valid for the fiscal year 2021 for the submission of HIPAA-covered transactions. Four to 5 swallows per videotape were analyzed by another clinician at a separate time and compared to determine interrater reliability of laryngeal penetration, aspiration, and nasopharyngeal backflow; cough and ability to clear the airway; and the biomechanical reason for laryngeal penetration or aspiration. Or Sign In to Email Alerts with your Email Address, Swallowing Function and Medical Diagnoses in Infants Suspected of Dysphagia, DOI: https://doi.org/10.1542/peds.108.6.e106, Oral and Pharyngeal Swallowing in Infancy. Your healthcare provider will check the amniotic fluid for meconium at the time of birth. However, it does not allow for thorough examination of the occurrence of dysphagia or type of swallowing disorders within specific populations. Most of these infants did not demonstrate abnormalities in the first few swallows but displayed deterioration in swallowing function as they continued to feed. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Although swallowing function was not examined in this study, nasopharyngeal backflow may have been reduced by the head position. Medical charts were reviewed. This restriction may not be obvious, but a speech-language pathologist who works with infants can help decide if that is the problem. Only 1 infant coughed and was able to clear the airway. 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. The suck-swallow-breathe sequence then starts again. Many of these problems can continue to affect the child’s ability to eat and swallow as they grow. 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. Differences in the relationship of anatomic structures and neurologic immaturity account for variations in biomechanics of the infant swallow. Infants were seen for a videofluoroscopic examination (MBS) of oral, pharyngeal, and cervical esophageal transits. In contrast, infants who aspirated usually did not cough and clear their airway. Most infants are able to drink from a cup by six months of age. 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. Infant swallowing disorders will surface in one or more of these three stages in the eating process. The child may also experience pain while swallowing. These infants often have multiple health issues and an increased risk of respiratory complications. The Institutional Review Board of the University of Tennessee-Memphis and Le Bonheur Children’s Medical Center approved this retrospective study. You don’t hear frequent swallowing when your baby nurses after your milk supply has come in. The MBS captures only 1 time period, and the patient who does not aspirate during the MBS may aspirate during regular feedings. In total, 22 of the 43 patients (51%) experienced laryngeal penetration, aspiration, or nasopharyngeal backflow during the study. Cardiac problems – Infants with cardiac problems often have a hard time during feeding. Thank you for your interest in spreading the word on American Academy of Pediatrics. A speech language pathologist with training and expertise in infant swallowing and feeding problems is skilled at identifying and treating feeding problems… Feeding or swallowing problem of your infant can lead to poor weight gain, poor growth and even increased chances of speech disorders in the future. Otolaryngology-Head and Neck Surgery, University of Tennessee, 956 Court Ave, Ste B-216, Memphis, TN 38163. Each infant had more than 1 medical diagnosis as reported in the medical records and history (Table 1). Gastroesophageal reflux (GER) refers to the involuntary passage of gastric contents into the … The videotape was analyzed using a Panasonic AG-MD-830 videocassette recorder and JVC 13-inch monitor, which allowed for slow motion and frame-by-frame analysis. As aspirated material must first enter the laryngeal introitus, all swallows with aspiration were considered to have laryngeal penetration. If the child is having trouble with spouted cups, the speech-language pathologist can help determine what kind, if any, the child should use. Amniotic fluid is generated mostly by baby urinating with some contribution from placental “sweating”. One infant had a cleft palate and consistent nasopharyngeal backflow without laryngeal penetration or aspiration. Children with sensory problems may develop food selectivity or food refusal. If these are too tight, then the infant can’t get a good latch on the nipple or can’t adequately move the tongue. Discuss your concerns with the child’s pediatrician right away. This study demonstrated that most infants suspected of dysphagia showed overt abnormalities: laryngeal penetration, aspiration, and/or nasopharyngeal backflow on the videofluoroscopic swallowing study. Infant feeding disorders may include problems with grabbing food, holding liquids and foods in the mouth, sucking, and chewing. … Premature babies often are unable to coordinate suck and swallow reflexes and need supplemental tube feedings until they master this skill. Manual for the Videofluorographic Study of Swallowing. It takes those extra weeks for the infant’s neurological system to develop so it can support the coordination needed. Cleft lip/palate– Because the lips and palate (roof of the mouth) are essential in helping the infant create a good seal and suck, a cleft of the lip and/or palate can cause difficulty. There is a need for additional research to examine swallowing function in infants with specific medical diagnoses. Inefficient suck 12. The infants in this study were fed in an upright position in a Tumbleform seat. Objective: 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. Thus, radiographic assessments in infants must examine multiple swallows. Food falls from mouth 6. How to Deal with Too Much Salivation or Drooling. Some people with dysphagia have problems swallowing certain foods or liquids, while others can't swallow at all. The infants were seated approximately 45° upright in a Tumbleforms Feeder seat (Jackson, MI) and viewed in the lateral projection. All of the 14 infants had laryngeal penetration secondary to material in the pyriform sinuses before initiation of the swallow. Swallowing seems simple, but it's actually pretty complicated. Lip or tongue “tie” – If an infant immediately has trouble with sucking, in the absence of any obvious medical or developmental problems, the infant may be presenting with restricted “frenum” of the lips or tongue. Clinical observation of swallowing is not adequately sensitive to aspiration. Insufficient chewing 13. Webinar Recording: Swallowing Exercises with Biofeedback, Webinar Recording: Why We Should Care About Pill Dysphagia, Managing Dysphagia in the ICU – Webinar Recording, The Gaffigans Raise Awareness of Swallowing Disorders, My Failed Swallow: A Disability, Not a Mindset, GW Researchers Receive $6.2Mil Program Project Grant from the NIH to Research Pediatric Dysphagia, Swallowing Disorders in Infants and Children. There are various health issues which may be the cause of swallowing disorders in infants. Challenges with infants and children demonstrating complex feeding and swallowing disorders are addressed in a holistic evidence based framework that takes into account interrelating systems. As the jaw moves down, it helps create suction to pull the liquid into the mouth. The decline in swallowing function may be explained by the effects of fatigue or sensory adaptation. They may include the following: 1. Refusal to eat and difficulty eating or swallowing. More than half of the infants experienced laryngeal penetration, aspiration, or nasopharyngeal backflow; however, the first occurrence of these events was after multiple swallows. Abnormal oral phase of swallow study 2. Medical Diagnoses of Infants Referred for Videofluoroscopic Swallow Studies. Patients included 43 infants who were referred for videofluoroscopic swallowing studies in a university-affiliated pediatric medical center. Additional research is needed to determine the effect of nasopharyngeal backflow on apnea, bradycardia, and hypoxemia. Despite the recent proliferation of research in adult swallowing disorders, there has been very little research on infant swallowing function and pathophysiology. Reprint requests to (L.A.N.) The overwhelming majority of patients did not demonstrate laryngeal penetration, aspiration, or nasopharyngeal backflow on the first or even the first few swallows. Reflux. For infants who are breast fed, the mother may experience unusual nipple soreness. There were no other significant relationships between medical conditions and laryngeal penetration, aspiration, or nasopharyngeal backflow. By: Mary Earhart 13 June, 2017. When drinking from an open top cup the child must be able to sit up, hold their head up and close their jaw and lips on the edge of the cup. For minimizing radiation exposure, the fluoroscopy unit was turned on every 15 to 30 seconds to visualize 1 or 2 swallows. Pooling of bolus in lateral sulci 16. As mentioned above, the patient may not aspirate on the radiographic study yet still display abnormal swallowing function, which may be a predictor of aspiration and possible respiratory complications. Inability to clear oral cavity 9. The first occurrence of laryngeal penetration, aspiration, or nasopharyngeal backflow occurred later in the study and well beyond the first swallow for most patients. In comparison, infants without history of pneumonia showed comparable rates of penetration (9 [43%]) and aspiration (4 [19%]). Infants who demonstrated laryngeal penetration without aspiration could clear their airway without a cough. The nasal mucosa is chemosensitive as well as sensitive to touch, pain, temperature, and flow.13 In addition, human newborns and especially premature infants have apneic reflexes that arrest breathing, heart rate, and blood pressure.14,15,16 Nasopharyngeal backflow will stimulate the nasopharynx and may account for apneic responses seen during feeding in the infant. 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. In episodes of laryngeal penetration, all patients were able to clear their airway during the swallow without a cough. A Fora Video Timer (Japan) was interfaced with the videocassette recorder, which superimposed timing information (hours, minutes, seconds, and hundredths of seconds) on the videotape image. 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. It is a symptom, not a disease. The hyoid, larynx, and epiglottis (superior cartilage of the larynx) lie at a higher level than in the adult.1,2,3 The infant often collects material in the valleculae during multiple sucks with the pharyngeal stage triggering from the valleculae.4 In 2 studies of infants with normal oropharyngeal swallowing function, none of the infants exhibited any spillover of material into the pyriform sinuses before initiation of the pharyngeal response.4,5 Infants with normal swallowing function never exhibit penetration of material into the supraglottic area and do not have aspiration of material below the vocal folds.2,4,5. Children with a variety of neurodevelopmental disabilities, including down syndrome ( )! By a tightened esophagus, a procedure called esophageal dilation may be used to expand the esophagus gender for., pharynx, larynx and esophagus ( Figure 1 ) frequent breaks during.. 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