13.1 - Pediatric Dysphagia - Balaji Flashcards
When do disorders occur that can cause infant dysphagia?
3
Prenatally
Perinatally
Postnatally
What is often the root cause of dysphagia that occurs prenatally?
(2)
Maternal Disease
Neurologic Disorders
What kinds of Maternal Disease can result in infant dysphagia?
(4)
Disturbances in CHO metabolism (diabetic mothers)
Phenyletonuria (PKU):
Preecalmpsia
Drug use
How do Disturbances in CHO Metabolism (diabetic mothers) affect infants?
(4)
High incidence of stillbirth, neonatal deaths
Abnormally large infants (macroencephaly)
Congenital malformations [Cardiac, Skeletal, CNS Anomalies (neural tube defects)]
Hypoglycemic episodes - teratogenic
What is Phenylketonuria (PKU)?
Enzyme phenylalanine hydroxylase is deficient leading to increased phenylalanine (PA) concentrations
How does Phenylketonuria (PKU) affect infants?
2
Mental retardation
Microcephaly
What is Preeclampsia?
Hypertension associated with protein in the urine.
How does Preeclampsia affect infants?
2
Hypotonia (muscular flaccidity)
Respiratory deficits
How does Drug Use affect infants?
5
Reduced & abnormal ear development
Cleft palate
Hydrocephaly (abnormal CSF, too much pressure)
Neural tube defects
Heart anomalies
What are eight neurological causes of dysphagia in infants?
Cerebral Palsy
Hydrocephalus
Microcephaly
Intracranial hemorrhage
Seizures
Neuropathies (neural)
Myopathies (motor)
Infections
What is Hydrocephalus?
Increased cranial pressure due to excess fluid/CSF in the brain
What is Microcephaly?
Abnormally small head circumference
What two infections can cause neurological disorders in children?
Meningitis
Poliomyelities (LMN)
What are four Congenital Structural Anomalies that can contribute to dysphagia?
Cleft lip/Palate.
Mandibular hypoplasia.
Esophageal atresia.
Tracheoesophageal Fistula
What is Mandibular hypoplasia?
2
Abnormally small mandible
Creates a severly recessed chin
What is an Esophageal Atresia?
The upper esophagus ends in a pouch and does not connect to lower esophagus and/or stomach
What is a Tracheoesophageal Fistula?
2
Abnormal connection between esophageal and tracheal walls
No protection of airway
What are GI Disorders that can lead to dysphagia in children?
(2)
Necrotizing Enterocolitis
GERD
What is Necrotizing Enterocolitis?
4
Intestinal disease causing inflammation and tenderness of intestine.
Ischemia or toxic damage weakens the mucosal lining of the intestinal walls.
Bacteria react to a ingested material (breast milk/formula)
This causes explosive bowel gas that leads to necrosis.
What can issues are caused by or co-occur with GERD?
10
Abnormal muscle tone
Exaggerated gag
May not be able to rhythmically move the tongue to suckle.
Infantile bite reflexes
Drooling
Aspiration – may or may not be silent.
Poor trunk control
Behavioral feeding problems / food and texture aversions
Limited food repertoire, preference for thin liquids
Emesis, reswallowing
Oral defensiveness / delayed feeding skills
What Respiratory Disorders can contribute to dysphagia in children?
(4)
Apnea
Infant respiratory distress syndrome (IRDS)
Transient tachypenea (TTN)
Bronchopulmonary dysplasia (BPD)
What is Apnea?
Cessation of breathing for longer than 15 sec.
What is Central Apnea?
2
Apnea caused by CNS problem
Characterized by no respiratory gas flow and no respiratory effort.
How can Apnea contribute to dysphagia in children?
5
Reduced endurance
Uncoordinated suck-swallow-breathe sequence
Weak suck
Increased number of sucks per swallow
Agitation during feedings
What is Infant Respiratory Distress Syndrome (IRDS)?
3
When the infant first begins to breathe, the alveoli open, then collapse and stick together after each breath.
Inhibits pulmonary gas exchange is inhibited increasing respiratory work load
Surfactant deficiency.
What can Infant Respiratory Distress Syndrome (IRDS) lead to?
Apnea with subsequent hypoxemia (low levels of oxygen in the blood stream)
What os Transient tachypnea (TTN)?
Is this a permanent condition?
How is this treated?
Poor clearance of lung fluid during birth.
Not, it’s temporary
No oral feeding during the first few days.
What is Bronchopulmonary Dysplasia (BPD)?
2
Broad term used to define chronic lung disease (CLD) due to prematurity.
Damage to lung tissue.
What is the most common cause of Bronchopulmonary Dysplasia (BPD)?
(2)
Mechanical ventilation
Oxygen therapy
What are five Cardiac Disorders that can contribute to dysphagia in Children
Congenital Heart Disease (CHD)
Congestive Heart Failure (CHF)
Atrioventricular Septal Defect (AVSD)
Patent Ductus Arteriosus
Tetralogy of Fallot
What is Congenital Heart Disease (CHD)?
A generic term used to identify any malformations of the cardiovascular system in infants
What is Congestive Heart Failure (CHF)?
Stress to the heart due to edema and an overload of fluid
What is Atrioventricular Septal Defect (AVSD)?
A malformation of the heart resulting from failure of the ventricular inlet to separate
In what condition is Atrioventricular Septal Defect (AVSD) often seen?
What can happen if it remains untreated?
Characteristic feature of Down syndrome (also seen in other syndromes)
Congestive heart failure
What is Patent Ductus Arterioles?
The duct that is open and used to bypass the lungs in the fetus remains open after birth,
Oxygenated blood from the aorta flows into the pulmonary artery and then returns to the lungs leading to Congestive Heart Failure
What is Tetralogy of Fallot?
The combination of four anomalies (pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy) causes deoxygenated blood to mix with oxygenated blood
What are a Genetic Syndrome that are often accompanied by dysphagia?
Down Syndrome
How does Down Syndrome contribute to dysphagia?
4
Hypotonia (muscle flaccidity) leading to poor postural control, neck control, and weak suck.
GERD is common
Respiratory compromise and reduced tolerance to feeding caused by heart problems.
Developmental delays are also a source of feeding problems
What does C.H.A.R.G.E. stand for in regards to down syndrome?
Caloboma (Cleft of the iris of the eye),
Heart disease
Atresia of the nasal cavity,
Retardation
Genital abnormalities
Ear disorders including deafness.
