Pediatric Dysphagia: Challenges and Controversies

Description

Pediatric dysphagia is a clinical problem that crosses disciplines. Children may be seen by numerous medical specialties including pediatric otolaryngology, gastroenterology, pulmonology, speech pathology, occupational therapy, and lactation consultants. The myriad approaches to the diagnosis and management of dysphagia is confusing for both clinicians and families; resulting in recurrent trips to medical professionals. Feeding is integral to socialization and to bonding between infants and parents. Disruptions in feeding development can be extremely taxing emotionally and economically for families. Children with dysphagia are some of the most challenging patients even for clinicians who specialize in their care. This text provides the reader with a comprehensive understanding of swallowing and presents a practical, evidence-based approach to the diagnosis and management of swallowing difficulties in children. It also highlights particular clinical challenges and controversies in the management of pediatric dysphagia. It is unique in that it incorporates the perspectives of multiple types of clinicians that care for these patients including otolaryngologists, gastroenterologists, pulmonologists, speech pathologists, occupational therapists and lactation consultants. In doing so, this text will encourage cross-specialty pollination of ideas and knowledge as well as stimulate further research in the field. Part 1 of the text begins with an overview of the anatomy and physiology of swallowing with a focus on normal development as we currently understand it. It also discusses new information regarding reflexive interactions between the larynx and esophagus that potentially influence swallowing. It then moves on to a discussion of the advantages and limitations of currently available diagnostic modalities and highlights current controversies regarding frame rate, radiation exposure, breastfeeding infants, and grading of studies. Additionally, it reviews the current literature regarding medical and behavioral-based therapy options, including thickening options, oromotor therapy, and controversies concerning strict NPO. Part 2 addresses specific diagnoses which can cause or be associated with dysphagia such as prematurity, velopharyngeal insufficiency, ankyloglossia, laryngeal clefts, laryngomalacia, vocal fold paralysis, and cricopharyngeal dysfunction. The text goes on to explore the pathophysiology and treatment options for each. Anatomic, inflammatory, and neuromuscular esophageal causes of dysphagia are also evaluated. In addition, it delves into the impact of craniofacial anomalies, sialorrhea and psychological factors on swallowing. Finally, it discusses how a multidisciplinary aerodigestive team can help streamline multidisciplinary care for individual patients. It will incorporate information pertinent to the different roles, tools and views of a multidisciplinary dysphagia team, including how pediatric otolaryngologists, gastroenterologists, pulmonologists, speech language pathologists, occupational therapists, and dieticians can collaborate to provide optimal evaluation and care of these often challenging patients, especially for those who are at high-risk of complications related to aspiration. Front Matter ....Pages i-xi Front Matter ....Pages 1-1 Embryology and Anatomy (Annie K. Ahn, Mary Frances Musso)....Pages 3-16 Maturation of Infant Oral Feeding Skills (Chantal Lau)....Pages 17-32 Clinical Evaluation of Breastfed Infants with Dysphagia: A Lactation Consultant’s Perspective (Nancy Hurst)....Pages 33-47 Clinical Feeding-Swallowing Evaluation: Overview for the Healthcare Provider (Christina A. Rappazzo, Catherine L. Turk)....Pages 49-65 The Videofluoroscopic Swallow Study: Introduction, Limitations, and Challenges (Christina A. Rappazzo, Catherine L. Turk)....Pages 67-86 Who Should Pass the Endoscope During a Fiberoptic Evaluation of Swallowing Procedure (Jay Paul Willging)....Pages 87-92 Fiberoptic Endoscopic Evaluation of Swallowing: Assessing Dysphagia in the Breastfeeding Patient (James W. Schroeder Jr, Susan Willette, Laura Hinkes Molinaro)....Pages 93-99 Use of Bronchoscopy and Bronchoalveolar Lavage in the Evaluation of Chronic Pulmonary Aspiration (Shailendra Das)....Pages 101-107 Diagnosis and Treatment of Pediatric Dysphagia: Radiography (William Stoudemire, Lynn Ansley Fordham, Timothy J. Vece)....Pages 109-118 Oromotor Therapy (Tsu-Hsin Howe)....Pages 119-134 Adaptive Feeding Techniques and Positioning: An Occupational Therapist’s Perspective (Cheryl Mitchell, Stacey L. Paluszak)....Pages 135-146 Treatment for Dysphagia: A Speech Language Pathologist’s Perspective (Laura Brooks)....Pages 147-161 Front Matter ....Pages 163-163 Ankyloglossia and Dysphagia (Jeffrey Cheng, Eileen Raynor)....Pages 165-170 Type 1 Laryngeal Clefts (Prasad John Thottam, Deepak K. Mehta)....Pages 171-177 Laryngomalacia, Supraglottoplasty, and Feeding and Swallowing Disorders: Is There An Association? (Hamdy El-Hakim, Andre Isaac, Wendy Johannsen)....Pages 179-189 Vocal Fold Paralysis and Dysphagia: Challenges and Controversies (Ryan Belcher, Nikhila Raol)....Pages 191-206 Cricopharyngeal Dysfunction in Children (Joshua R. Bedwell)....Pages 207-213 Esophageal Dysphagia (Rinarani Sanghavi, Rachel Rosen)....Pages 215-238 Impact of Non-oral Feeding Methods on Feeding Development (Priya Raj)....Pages 239-254 Secretion Management (Elton Lambert)....Pages 255-269 Dysphagia in Patients with Craniofacial Anomalies (Ellen E. Moore, Tara L. Rosenberg)....Pages 271-279 Psychological and Behavioral Disorders in Dysfunctional Feeding: Identification and Management (Alan H. Silverman, Andrea M. Begotka)....Pages 281-301 The Role of a Multidisciplinary Aerodigestive Program (Julina Ongkasuwan, Eric H. Chiou)....Pages 303-308 Correction to: The Videofluoroscopic Swallow Study: Introduction, Limitations, and Challenges (Christina A. Rappazzo, Catherine L. Turk)....Pages E1-E1 Back Matter ....Pages 309-316