WELCOME! Assessment and Treatment of Pediatric

Dysphagia SPHSC 543 B Website: http://faculty.washington.edu/jul2/ Syllabus

PREVALENCE Feeding disorders

… 25% in all children… 80% in children with special healthcare needs

and developmental delays… (Manikam & Perman, 2000)

Swallowing disorders… Unknown in pediatric population

ADULT VS INFANT Small mandible Tongue Sucking pads till 4-6 months Directionality of movement Preferential nose breathers Close proximity of tongue, soft palate and

pharynx Position of larynx Preserved until 3-4 mos when anatomical

changes start to take place

ANATOMICAL CHANGES Mandibular growth Sucking pads absorbed Oral cavity elongates Lip valving Neurological maturation TMJ grading New directionality Teeth Laryngeal descent

NEURAL CONTROL

EMBRYONIC PERIOD: WEEKS 1-8

3rd week

By 4th week

By 7th week

FETAL PERIOD: WEEK 9-BIRTH Weeks 12-14

Weeks 15-18

Week 24

Weeks 26-29

Weeks 30-34

Weeks 35-38

EMBRYOLOGIC ABNORMALITIES

CNS damage

Congenital malformations – both genetic (chromosomal abnormalities) and environmental factors with some a combination of both acting together

Upper airway anomalies/anatomic defects

PROBLEMS Cerebral palsy Moebus Treacher Collins, Pierre Robin, palatal clefting Beckwith-Wiedemann syndrome, Down

syndrome, ankyloglossia Tracheo-esophageal fistula, diaphragmatic

hernia, hypertrophic pyloric stenosis Tetrology of Fallot, transposition of the great

arteries, atrial septal defect, ventricular septal defect

REFLEXES RELATED TO SWALLOWING

Programmed responses to specific sensory input

Developed early in utero Allow infant to seek out and obtain nutrition

safely Interplay generally more important than

presence/absence 2 categories of oral reflexes:

… Assist in the acquisition of food… Protect the airway

ADAPTIVE Rooting

Sucking

Suck-swallow response

PROTECTIVE

Gag

Cough

Tongue protrusion

OTHER REFLEXES Phasic bite

Transverse tongue response

SUCKLING AND SUCKING Nutrition

Calming

Exploration

Physiologic flexion

SUCKING Positive pressure/compression

Negative pressure/suction

Pressures may be used differently between breast and bottle.

MECHANICS OF SUCKING Tongue

Jaw

Lips

Cheeks

Palate

SUCKING PRESSURE Variable Dependent on state Fluid flow Nipple characteristics

PROBLEMS Anatomic defects

System dysfunction

Tone/muscular control

Oral pain

BREASTFEEDING “Ideal” food

Suck/swallow sequence similar to other nipple feedings

HUMAN BREAST

BREASTFEEDING

Nipple elongates Jaw and tongue elevation Areola compressed Milk expressed Jaw lowered Lactiferous ducts refill

BREASTFEEDING Letdown reflex

Suck/swallow sequence … Bursts and pauses

Jaw and lips

Volume