Pediatric Dysphagia

Question 1

What is an APGAR score?

Answer 1

A - Activity
G - Grimace 
P - Pulse
A - Appearance
R - Respiration

Anything below 7 is concerning.

Question 2

What are some prenatal causes of pediatric dysphagia?

Answer 2

Maternal disease

Drug & Alcohol use/abuse

Question 3

What is Preeclampsia? What can it cause?

Answer 3

Hypertension associated with protein in the urine.

Causes Hypotonia and respiratory deficits in the infant.

Question 4

What is Phenylketonuria (PKU)? What can it cause?

Answer 4

Enzyme phenylalanine hydroxylase is deficient leading to increased phenylalanine (PA) concentrations

Intellectual disability
Microcephaly

Question 5

What can drug use cause in infants?

Answer 5

Reduced & abnormal ear development
Cleft palate
Hydrocephaly
Neural tube defects
Heart anomalies

Question 6

What can Disturbances in CHO metabolism (diabetes) cause?

Answer 6

High incidence of stillbirth, neonatal deaths

Abnormally large infants

Congenital malformations
Cardiac, Skeletal, CNS Anomalies (neural tube defects)

Hypoglycemic episodes

Question 7

What are some neurogenic causes (6 listed) of dysphagia in infants?

Answer 7

Hydrocephalus – Water in the brain. CSF regulation affected.

Microcephalus – Small head circumference.

Intracranial hemorrhage.

Seizures.

Neuropathies, Myopathies

Infections – Meningitis, Poliomyelitis

Cerebral Palsy

Question 8

What is hydrocephalus? What is affected?

Answer 8

Water in the brain building intracranial pressure to increase.
CSF regulation affected.

Question 9

What is microcephalus?

Answer 9

Small head circumference.

Question 10

What are three congenital structural anomalies?

Answer 10

Cleft lip/Palate.

Esophageal atresia.

Mandibular hypoplasia.

Question 11

What kind of swallowing problems will a cleft lip/palate cause?

Answer 11

Oral pressure will not be able to build up due to a lack of a seal.

Nasal regurgitation.

Question 12

What does atresia mean?

Answer 12

absence or abnormal narrowing of an opening or passage in the body.

Question 13

What is the difference between Esophageal atresia and Tracheo-esophageal Fistula?

Answer 13

Atresia is when the esophagus ends in a completely closed pouch.
Fistula is when there is a communication between the trachea and the esophagus.

Question 14

What is esophageal atresia?

Answer 14

When there is communication between the esophageal and tracheal wall.
Failure of the laryngotracheal tube to successfully separate from the esophagus during the embryonic development.
Upper two thirds of the esophagus ends in a completely closed pouch
Liquids enter the trachea - Choking, coughing, gag or cyanosis.

Question 15

What is mandicular hypoplasia?

Answer 15

Overbite/underbites

Question 16

Describe Necrotizing Enterocolitis.

Answer 16

Intestinal disease – Inflammation and tenderness of intestine.

Ischemia or toxic damage weakens the mucosal lining of the intestinal walls. Bacteria then react to a substrate (breast milk/formula) followed by explosive bowel gas that leads to necrosis.

Question 17

How can GERD affect infants?

Answer 17

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 (vomitting), reswallowing
Oral defensiveness / delayed feeding skills

Question 18

What are the two gastro-intestinal disorders mentioned in class?

Answer 18

Necrotizing Enterocolitis and GERD

Question 19

When is apnea concerning?

Answer 19

When cecessation of breathing lasts longer than 15 seconds.

Question 20

What characterizes Apnea?

What dysphagia symptoms can apnea cause?

Answer 20

Characterized by no respiratory gas flow and no respiratory effort.

Reduced endurance
Uncoordinated suck-swallow breathe sequence
Weak suck
Number of sucks per swallow increases 
Agitation during feedings

Question 21

What causes central apnea?

Answer 21

CNS problems

Question 22

What does IRDS stand for?

Answer 22

Infant respiratory distress syndrome

Question 23

What is Infant respiratory distress syndrome?

Answer 23

When the infant first begins to breathe, the alveoli open, then collapse and stick together after each breath.

Surfactant deficiency.

Question 24

How does infant respiratory distress syndrome affect a child?

Answer 24

Inhibits pulmonary gas exchange, increase the workload of respiration and leads to apnea with subsequent hypoxemia.

Question 25

What happens to cause Transient tachypenea (TTN)?

Answer 25

Poor clearance of lung fluid during birth.

Temporary condition. No oral feeding during the first few days.

Question 26

Bronchopulmonary dysplasia (BPD) is a broad term used to define what?

Answer 26

chronic lung disease (CLD) of prematurity.

Question 27

What is Bronchopulmonary dysplasia (BPD)

Answer 27

Damage/collapse to lung tissue.

The most common cause is mechanical ventilation and oxygen therapy.

Question 28

Define Congenital Heart Disease (CHD).

Answer 28

This is a generic term used to identify any malformations of the cardiovascular system in infants.

Question 29

Define Congestive Heart Failure (CHF).

Answer 29

Stress to the heart from an overload of fluid and edema.

Question 30

Describe Atrioventricular Septal Defect (AVSD).

Answer 30

A malformation of the heart that results from failure of the normal separation of the ventricular inlet.
Characteristic feature of Down syndrome and is seen in other syndromes as well. If untreated it can lead to congestive heart failure.

Question 31

Are there any behavioral disorders associated with dysphagia?

Answer 31

Autism Spectrum Disorder but this is more of a feeding issue than a swallowing issue.

Question 32

What dysphagia symptoms could we see in an individual with Down Syndrome?

Answer 32

Hypotonia leading to poor postural control, neck control, weak suck. Tongue thrust. GERD is common.