Consideration of Cough Reflex Development When Ordering Modified Barium Swallow Studies in Infants

Balest, Arcangela L.; White, Katherine E.; Shaffer, Amber D.; Mahoney, Amanda S.; Georg, Matthew W.; Theiss, Robert; Dohar, Joseph E.

doi:10.1007/s00455-019-10062-5

Cited by 5 publications

(2 citation statements)

References 33 publications

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“…27 Furthermore, at least one study demonstrated that aspiration of breastmilk in this population is not associated with lower respiratory tract infections or aspiration pneumonia, and the aspiration resolves over time. 28 The authors of that study suggested that silent aspiration may be an expected finding in newborns and that it is part of a continuum toward development of the laryngeal cough reflex. Aspiration was a common finding in our cohort (17/35) with an additional 7 exams where aspiration could not be ruled out.…”

Section: Discussionmentioning

confidence: 98%

“…It has been demonstrated that many healthy infants less than 51 weeks post‐menstrual age will aspirate without coughing 27 . Furthermore, at least one study demonstrated that aspiration of breastmilk in this population is not associated with lower respiratory tract infections or aspiration pneumonia, and the aspiration resolves over time 28 . The authors of that study suggested that silent aspiration may be an expected finding in newborns and that it is part of a continuum toward development of the laryngeal cough reflex.…”

Section: Discussionmentioning

confidence: 98%

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Fiberoptic Endoscopic Evaluation of Swallowing in the Breastfeeding Infant

Schroeder

2023

The Laryngoscope

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ObjectiveTo demonstrate the importance of utilizing fiberoptic endoscopic evaluation of swallowing (FEES) when evaluating breastfeeding infants with suspected dysphagia. Failure to recognize and account for the fundamentally different physiology of the primarily breastfed infant can lead to false assumptions about the safety of breastfeeding in this understudied patient population.MethodsCase‐series. The medical records of patients referred to an urban, university‐based, pediatric hospital for FEES from February 2017 to October 2020 were reviewed. Their presenting symptoms, dysphagia severity, comorbidity, dysphagia workup, and management were analyzed. The standardized Dysphagia Outcome and Severity Scale was used to appraise dysphagia severity.Results204 FEES exams were reviewed. 35 were conducted on breastfed infants. 34 of the 35 infants calmed for the FEES exam while breastfeeding. Cohorts were defined by a particular presenting sign (cough, laryngeal congestion, choking, and respiratory illness) and anatomical characteristic (laryngomalacia, vocal cord paralysis, aspiration, penetration, etc.) and then compared to all other exams. The average dysphagia score for all the exams was 2.37. Patients presenting with laryngeal congestion had an average dysphagia score of 2.81. There was no difference in dysphagia score based on comorbidities or anatomy.ConclusionsFEES is the instrumental exam of choice when evaluating a primarily breastfed infant who has suspected dysphagia. The exam is well tolerated and provides accurate, objective information while accounting for this population's unique swallowing physiology. Primarily breastfed infants presenting with laryngeal congestion are more likely to have clinically worse dysphagia than those presenting with other clinical symptoms.Level of Evidence4 Laryngoscope, 133:2803–2807, 2023

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%