Assessment of pediatric dysphagia and feeding disorders: Clinical and instrumental approaches

Abstract

Assessment of infants and children with dysphagia (swallowing problems) and feeding disorders involves significantly more considerations than a clinical observation of a feeding. In addition to the status of feeding in the child, considerations include health status, broad environment, parent-child interactions, and parental concerns. Interdisciplinary team approaches allow for coordinated global assessment and management decisions. Underlying etiologies or diagnoses must be delineated to every extent possible because treatment will vary according to history and current status in light of all factors that are often interrelated in complex ways. A holistic approach to evaluation is stressed with a primary goal for every child to receive adequate nutrition and hydration without health complications and with no stress to child or to caregiver. Instrumental swallow examinations that aid in defining physiological swallowing status are needed for some children. Successful oral feeding must be measured in quality of meal time experiences with best possible oral sensorimotor skills and safe swallowing while not jeopardizing a child's functional health status or the parent-child relationship.

A Practical Approach to Classifying and Managing Feeding Difficulties

“…Aspiration can be "silent" or more subtle (eg, wheezing). Evaluation of dysphagia requires identifying which phase of deglutition (oral, pharyngeal, or esophageal) is disorganized 23 and is best handled by oral motor specialists. Although generally less urgent, growth failure, diarrhea, and vomiting also need resolution.…”

Alterações funcionais da deglutição em bebês de risco para o desenvolvimento neuropsicomotor

“…The literature emphasizes that, depending on the degree, prematurity might be associated with other risk factors, such as respiratory distress syndrome, bronchopulmonary dysplasia, peri/intraventricular hemorrhage, neonatal sepsis, among others 1,16,17 , causing a variety of clinical manifestations that influence on the sequential phases of the swallowing process [18][19][20][21] , which was observed in this study.…”

Dificuldades na introdução de alimentos complementares ao aleitamento materno em bebês não disfágicos: efeitos da atuação fonoaudiológica

“…Em outras residências, isto não era possível pela falta de mobiliário ou espaço físico limitado. Oferecer para o bebê vivên-cias que facilitem o seu posicionamento adequado, horários próprios e rotina das refeições realizadas em família, podem aumentar suas respostas e desenvolvimento do bebê 24 . Entretanto, nos casos atendidos, foi necessária orientação para que isto fosse adaptado às suas realidades.…”

“…Contudo, durante o acompanhamento das refeições, a pesquisadora avaliou que essas queixas estavam relacionadas a episódios nauseosos, que podem ocorrer nesta fase de adaptação do bebê diante da nova consistência alimentar e/ou utensílio 19,20,24 . Após a atuação fonoaudiológica, este dado não foi mais destacado pelas mães.…”