Terms From Pathophysiology Of Swallowing In Infants

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Oral-phase disorders

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Oral-phase disorders affecting the oral preparatory and oral propulsive phases usually result from impaired control of the tongue

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oral-phase swallowing symptoms

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Cannot hold food in the mouth anteriorly due to reduced lip closure;
Cannot form a bolus or residue on the floor of the mouth due to reduced range of tongue motion or coordination;
Cannot hold a bolus due to reduced tongue shaping and coordination;
Unable to align teeth due to reduced mandibular movement;
Food material falls into anterior sulcus or residue in the anterior sulcus due to reduced labial tension or tone.

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oral-phase swallowing symptoms continued

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Food material falls into lateral sulcus or residue in the lateral sulcus due to reduced buccal tension or tone.
Abnormal hold position or material falls to the floor of the mouth due to tongue thrust or reduced tongue control;
Delayed oral onset of swallow due to apraxia of swallow or reduced oral sensation;
Searching motion or inability to organize tongue movements due to apraxia of swallow;
Tongue moves forward to start the swallow due to tongue thrust.

Front 4

oral-phase swallowing symptoms continued

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Residue of food on the tongue due to reduced tongue range of movement or strength;
Disturbed lingual contraction (peristalsis) due to lingual dyscoordination;
Incomplete tongue-to-palate contact due to reduced tongue elevation;
Unable to mash material due to reduced tongue elevation;
Adherence of food to hard palate due to reduced tongue elevation or reduced lingual strength;
Reduced anterior-posterior lingual action due to reduced lingual coordination;
Repetitive lingual rolling in Parkinson disease;
Uncontrolled bolus or premature loss of liquid or pudding consistency in to the pharynx due to reduced tongue control or linguavelar seal;
Piecemeal deglutition
Delayed oral transit time

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Pharyngeal phase

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If severely impaired, patient may not be able to injest enough food or drink to sustain life; without dysphasia, patient may retyain food into the valleculae or pyriform sinuses after swallowing; In case of weak musculature, or poor opening of the upper esophageal sphincter, patients may retain excessive amounts of food in the pharynx and experience overflow aspiration after swallowing

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pharyngeal-phase swallowing symptoms

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Delayed pharyngeal swallow
Nasal penetration during swallow due to reduced velopharyngeal closure
Pseudoepiglottis (after total laryngectomy) - Fold of mucosa at the base of the tongue
Cervical osteophytes
Coating of pharyngeal walls after the swallow due to reduced pharyngeal contraction bilaterally
Vallecular residue due to reduced posterior movement of the tongue base

Front 7

pharyngeal-phase swallowing symptoms continued

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Coating in a depression on the pharyngeal wall due to scar tissue or pharyngeal pouch
Residue at top of airway due to reduced laryngeal elevation
Laryngeal penetration and aspiration due to reduced closure of the airway entrance (arytenoid to base of epiglottis)
Aspiration during swallow due to reduced laryngeal closure
Stasis of residue in pyriform sinuses due to reduced anterior laryngeal pressure
Delayed pharyngeal transit time

Front 8

Esophageal phase

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Impaired esophageal function can result in retention of food and liquid in the esophagus after swallowing.

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Causes of retention in the esophageal phase

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This retention may result from mechanical obstruction, motility disorder, or impaired opening of the lower esophageal sphincter.

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swallowing symptoms and disorders of the esophageal phase:

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Esophageal-to-pharyngeal backflow due to esophageal abnormality;
Tracheoesophageal fistula;
Zenker diverticulum;
Reflux

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Aspiration

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Aspiration is the passage of food or liquid through the vocal folds.

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Result of aspiration

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pneumonia or other respiratory problems.

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Several factors influence the effects of aspiration

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quantity, depth, physical properties of the aspirate, and pulmonary clearance mechanisms.

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The severity of aspiration can be described in 2 ways

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(1) Estimate the percentage of the total bolus aspirated or (2) estimate the depth of bolus invasion into the airway.

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Neurologic swallowing disorders

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Stroke is the leading cause of neurologic dysphagia. Approximately 51-73% of patients with stroke have dys

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Risks of feeding and swallowing problems in infants and children

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Children with feeding and swallowing difficulties (also called dysphagia) are at risk for malnutrition, dehydration, and respiratory problems.

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Causes of feeding and swallowing problems

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Prematurity; Cerebral palsy; Autism; Head and neck abnormalities; Muscle weakness in the face and neck; Gastroesophageal reflux; Multiple medical problems; Respiratory difficulties; Medications that may cause lethargy or decreased appetite; Problems with parent-child interactions at mealtime

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Symptoms

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Poor feeding; Difficulty chewing; Difficulty drinking from a bottle or cup; Difficulty breast feeding; Refusing food or liquid; Coughing or choking while eating or drinking; Excessive drooling and food spilling from the mouth

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Symptoms continued

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Liquid leaking out the nose; Gagging; Vomiting during meals; Increased congestion during meals; Increased fussiness or crying during meals; Accepting only certain types of food;poor weight gain; frequent respiratory problems.

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Who evaluates and diagnoses dysphagia in infants and swallowing

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pediatrician

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"Silent" aspiration

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Silent" aspiration is a particularly insidious manifestation of these motor disorders in infants or neurologically abnormal older children

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Diagnostic procedures used in children suspected of oral, pharyngeal, or esophageal motor disorders

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includes radiography (particularly esophagram or videofluoroscopic swallowing study), manometry, endoscopy of the esophagus or airway (including fiberoptic endoscopic evaluation of swallowing with sensory testing), scintigraphy, esophageal pH-metry or impedance, or central nervous system imaging

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therapeutic interventions

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include a multitude of "conservative" measures, focused pharmacotherapies, and surgical interventions

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The cause of dysphagia may be organic or behavioral

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organic - because of disordered anatomy or function

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behavioral

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if it is because of disordered function, the dysfunction may have roots in neurosensory, neuromotor, or central processing functions