Explanation
The uniqueness of dysphagia rehabilitation in children lie in the fact that the structures involved in feeding and swallowing are still growing and developing. Other structures are also growing and developing functionally, and mental and psychological development is continuing.
Healthy children with typical development acquire the basic functions required for feeding and swallowing by 3 years of age. Children with dysphagia who present with developmental delay in feeding function and swallow function due to underlying disorders in many cases require dysphagia rehabilitation.
Explanation
We need to consider the following 5 particular points in dysphagia rehabilitation for children: (1) the structures involved in feeding and swallowing are still growing and developing; (2) other structures are also growing and developing functionally; (3) mental and psychological development is continuing; (4) the characteristics of disorders that cause dysphagia in developing children should be understood; and (5) the childcare environment should be fully understood and taken into account when addressing pediatric dysphagia. It should be noted that delay in functional development is also a considerable factor.
Explanation
There are some difficulties in addressing pediatric dysphagia, including the following: there is a little reserve capacity; the developmental stage needs to be taken into account; and there is little or no cooperation from patients. So, cooperation from family members (or guardians) is crucial, and continuous and sustained multidisciplinary collaboration is necessary.
Explanation
The principles of support for pediatric dysphagia are that children's life should come first and we need to provide support for functional improvement, support to meet nutritional and flavorful requirements, and support for their growth and development.
Explanation
The causes of pediatric dysphagia are classified into the following major categories: (1) premature birth; (2) anatomical abnormalities; (3) disorders of the central nervous system, peripheral nervous systems, and muscular system; (4) functional deficits of the pharynx and esophagus; (5) systemic conditions; (6) mental and psychological problems; and (7) other. Disorders of the central nervous system, peripheral nervous systems, and muscular system are often found in pediatric patients with dysphagia.
Explanation
Factors associated with pediatric dysphagia include the following: hyperesthesia and/or hypoesthesia; psychological rejection of food and/or abnormal food habits; dependence on tube feeding due to long-term tube feeding; influence of medication; inappropriate mealtime environments; insufficient sensorimotor experience; and underlying disorders.
Explanation
Some dysphagia symptoms are characteristic of underlying disorders. For example, children with Down's syndrome tend to have a protruding tongue, and children with cerebral palsy tend to choke and can't maintain appropriate mealtime posture.
Explanation
Here we see the occurrence rates of dysphagia symptoms according to the severity of motor impairment in children with cerebral palsy. It is clear that the level of oral function is high when the body is more developed. So, we need to assess the development of the whole body as well as the type of disease.
Explanation
Here we see the occurrence rates of dysphagia symptoms according to the severity of motor impairment in children with learning (intellectual) disability. Similar to the situation in children with cerebral palsy shown in the previous slide, the occurrence rate becomes lower when the whole body is more developed. However, different from in children with cerebral palsy, each symptom occurs, even if at low frequency, in all severity levels of motor impairment.
Explanation
So, we need to understand causes of the dysphagia and the characteristic functional impairments. Among them, insufficient sensorimotor experience, impaired motor coordination, and central nervous system disorder need to be assessed closely.
Explanation
Children with Down's syndrome tend to eat as follows: while mouth breathing and with the tongue protruding during eating, chewing, and swallowing; swallow without chewing; move too much while eating, eat without closing their lips, show sucking-like (baby-like) swallows (occasionally), and have a large flaccid tongue.
Explanation
Children with intellectual disability tend to discontinue meals or refuse them, have a poor mealtime posture, eat quickly without chewing, put and push food into the mouth and swallow it without chewing, and have abnormal food habits due to obsession.
Explanation
Children with a chromosomal abnormality (Moebius syndrome) tend to have characteristic abnormal oral morphology, often requiring early support from the dentistry department.
Explanation
The process of feeding, eating and swallowing is generally said to comprise 5 phases: the pre-preparatory phase, the preparatory phase, the oral phase, the pharyngeal phase, and the esophageal phase. However, we should remember that adults have acquired the necessary functions for eating and swallowing during the developmental period in early life. So, for patients who are still in the developmental period, we actually consider 8 developmental stages related to eating and swallowing function.
Explanation
In summary: (1) primitive reflexes (sucking) play a major role in feeding and swallowing initially, and then voluntary movements become involved during the developmental period; (2) functions for eating and swallowing develop when morphological development of the oral cavity, pharynx, and larynx is noticeable; (3) the underlying causes of pediatric dysphagia include premature birth, morphological abnormalities, nervous and muscular system disorders, functional deficits of the pharynx and esophagus, and mental and psychological problems; (4) the oral cavity and pharynx that are responsible for eating and swallowing are still developing in children, and their morphological development should be always taken into consideration when addressing pediatric dysphagia; and (5) dysphagia in children who are still developing physically and functionally needs to be assessed on the basis of developmental delay so that guidance that can help their functional development is provided.
