Pediatric dysphagia and HNC

Question 1

What are etiologies for pediatric dysphagia?

Answer 1

oral-motor impairments, iatrogenic complications (e.g., tube feeding or tracheostomy), ASD, sensory processing disorder, maternal or prenatal complications, illness and hospitalizations due to neurogenic disorders and respiratory illness, congenital abnormalities

Question 2

What are the unique parts of a pediatric assessment?

Answer 2

feeding history, medical history, developmental history, positioning, equipment, oral mech exam, observation of their meal times to see their oral motor skills, caregiver interactions, a checklist for informal assessments

Question 3

When do infants grow?

Answer 3

when they have sufficient feeding skills to eat enough

Question 4

In infants, which parts of swallowing are involuntary?

Answer 4

oral phase, trigger of the pharyngeal phase, pharyngeal phase, and esophageal phase

Question 5

What reflexes help with oral feeding?

Answer 5

brainstem mediated reflexes

Question 6

What reflexes are considered adaptive?

Answer 6

rooting (i.e., turn their head towards the side of the cheek/lip that is being stimulated and open their mouth) and suckling

Question 7

What reflexes are considered protective?

Answer 7

sticking tongue out, moving it side to side, gag reflex, swallow, phasic bite

Question 8

What are the unique clinical signs of aspiration in pediatric populations?

Answer 8

Wet voice/cry; unexplained fever or respiratory issues (chest infections or pneumonias); coughing during or after feeding; don’t gain much weight despite intaking lots of food; face changes colour; breathing is disrupted or apnea occurs during feeding; stress cues (e.g., staring, forehead furrowing, eye tearing, finger splaying)

Question 9

What is the primary way to manage pharyngeal problems in infants?

Answer 9

thickened fluids (to help them better coordinate swallowing and breathing; to help prevent reflux or regurgitation)

Question 10

What are alternative ways to manage pharyngeal problems in infants?

Answer 10

special feeding equipment, changing their position (e.g., have them sit upright and eat rather than lying down), and active pacing (impose break to disrupt flow of food)

Question 11

What are the goals of behavioural feeding therapy?

Answer 11

reducing parental stress; helping the child grow; improve intake of foods vs supplements; improving the variety of the child’s diet

Question 12

What are the non-toxicity effects of radiation therapy?

Answer 12

limited tolerance for exercise, altered mood, need more bed rest, painful dermatitis, loss of appetite

Question 13

What are the toxicity effects of radiation therapy?

Answer 13

xerostomia and associated eating discomforts, dental caries, mucositis and edema, difficulty swallowing and chewing, altered speech and voice, fibrosis, pain in the face or oral cavity, dysguesia (distorted sensation of the face)

Question 14

What are the effects of radiation on swallowing?

Answer 14

increased pharyngeal residue; decreased pharyngeal constriction, reduced HLE; reduced laryngeal vestibular closure; reduced epiglottic deflection

Question 15

How is QOL for HNC pts?

Answer 15

QOL may be diminished pre and post surgery as they experience changes in their appearance, mental health, nutrition, speech, and swallowing. These negative feelings are pronounced in patients with bilateral resections than unilateral. Thus, counseling is important pre and post surgery.

Question 16

What are key anatomical differences in infancy?

Answer 16

cheeks have fat pads that support oral movement; larynx is high up in the throat and level with their hyoid bone, it will drop by the end of the 1st year; larynx is soft; head and neck are unstable; mandible moves downward and forward; tongue makes up most of the oral cavity; velum touches the tip of the epiglottis; shallow valleculae and pyriform sinuses;

Question 17

How does the CNS develop in utero?

Answer 17

It develops from the botton up: 1st trimester is when synapses in the spinal cord form; 2nd trimester is when brainstem begins to mature (digestion, sleeping, blood pressure, breathing, and heart rate); 3rd trimester is an increase in cerebral volume and surface area (functional for cerebral life)

Question 18

What are the effects of resectioning as a result of an oral cavity tumor on swallowing?

Answer 18

weak/delayed pharyngeal swallow; aspiration before swallow; oral residue; reduced ROM; reduced tongue driving force; reduced mastication; increased oral transit time

Question 19

What are the effects of resectioning as a result of oropharyngeal cancer on swallowing?

Answer 19

reduced pharyngeal contraction; post-swallow residue; nasal regurgitation; reduced tongue base retraction and reduced tongue propulsion; weakened or delayed pharyngeal swallow;; aspiration before,during, or after swalow; reduced epiglottic deflection and reduced laryngeal elevation

Question 20

What are the effects of resectioning from a hemilaryngectomy or supraglottic hemilaryngectomy on swallowing?

Answer 20

aspiration during and after swallow; reduced epiglottic deflection; reduced pharyngeal constriction; reduced laryngeal elevation and closure; reduced UES opening; post swallow residue

Question 21

What are the effects of resectioning from a total laryngectomy on swallowing?

Answer 21

permanent separation of airway and digestive track, thereby removing risk of aspiration; esophageal prominence or esophageal scarring may occur which narrows the esophagus. Thus, a GI doctor may be needed to rectify that