13.1 - Pediatric Dysphagia - Balaji

Question 1

When do disorders occur that can cause infant dysphagia?

3

Answer 1

Prenatally

Perinatally

Postnatally

Question 2

What is often the root cause of dysphagia that occurs prenatally?

(2)

Answer 2

Maternal Disease

Neurologic Disorders

Question 3

What kinds of Maternal Disease can result in infant dysphagia?

(4)

Answer 3

Disturbances in CHO metabolism (diabetic mothers)

Phenyletonuria (PKU):

Preecalmpsia

Drug use

Question 4

How do Disturbances in CHO Metabolism (diabetic mothers) affect infants?

(4)

Answer 4

High incidence of stillbirth, neonatal deaths

Abnormally large infants (macroencephaly)

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

Hypoglycemic episodes - teratogenic

Question 5

What is Phenylketonuria (PKU)?

Answer 5

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

Question 6

How does Phenylketonuria (PKU) affect infants?

2

Answer 6

Mental retardation

Microcephaly

Question 7

What is Preeclampsia?

Answer 7

Hypertension associated with protein in the urine.

Question 8

How does Preeclampsia affect infants?

2

Answer 8

Hypotonia (muscular flaccidity)

Respiratory deficits

Question 9

How does Drug Use affect infants?

5

Answer 9

Reduced & abnormal ear development

Cleft palate

Hydrocephaly (abnormal CSF, too much pressure)

Neural tube defects

Heart anomalies

Question 10

What are eight neurological causes of dysphagia in infants?

Answer 10

Cerebral Palsy

Hydrocephalus

Microcephaly

Intracranial hemorrhage

Seizures

Neuropathies (neural)

Myopathies (motor)

Infections

Question 11

What is Hydrocephalus?

Answer 11

Increased cranial pressure due to excess fluid/CSF in the brain

Question 12

What is Microcephaly?

Answer 12

Abnormally small head circumference

Question 13

What two infections can cause neurological disorders in children?

Answer 13

Meningitis

Poliomyelities (LMN)

Question 14

What are four Congenital Structural Anomalies that can contribute to dysphagia?

Answer 14

Cleft lip/Palate.

Mandibular hypoplasia.

Esophageal atresia.

Tracheoesophageal Fistula

Question 15

What is Mandibular hypoplasia?

2

Answer 15

Abnormally small mandible

Creates a severly recessed chin

Question 16

What is an Esophageal Atresia?

Answer 16

The upper esophagus ends in a pouch and does not connect to lower esophagus and/or stomach

Question 17

What is a Tracheoesophageal Fistula?

2

Answer 17

Abnormal connection between esophageal and tracheal walls

No protection of airway

Question 18

What are GI Disorders that can lead to dysphagia in children?

(2)

Answer 18

Necrotizing Enterocolitis

GERD

Question 19

What is Necrotizing Enterocolitis?

4

Answer 19

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.

Question 20

What can issues are caused by or co-occur with GERD?

10

Answer 20

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

Question 21

What Respiratory Disorders can contribute to dysphagia in children?

(4)

Answer 21

Apnea

Infant respiratory distress syndrome (IRDS)

Transient tachypenea (TTN)

Bronchopulmonary dysplasia (BPD)

Question 22

What is Apnea?

Answer 22

Cessation of breathing for longer than 15 sec.

Question 23

What is Central Apnea?

2

Answer 23

Apnea caused by CNS problem

Characterized by no respiratory gas flow and no respiratory effort.

Question 24

How can Apnea contribute to dysphagia in children?

5

Answer 24

Reduced endurance

Uncoordinated suck-swallow-breathe sequence

Weak suck

Increased number of sucks per swallow

Agitation during feedings

Question 25

What is Infant Respiratory Distress Syndrome (IRDS)? | 3

Answer 25

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.

Question 26

What can Infant Respiratory Distress Syndrome (IRDS) lead to?

Answer 26

Apnea with subsequent hypoxemia (low levels of oxygen in the blood stream)

Question 27

What os Transient tachypnea (TTN)? Is this a permanent condition? How is this treated?

Answer 27

Poor clearance of lung fluid during birth. Not, it's temporary No oral feeding during the first few days.

Question 28

What is Bronchopulmonary Dysplasia (BPD)? | 2

Answer 28

Broad term used to define chronic lung disease (CLD) due to prematurity. Damage to lung tissue.

Question 29

What is the most common cause of Bronchopulmonary Dysplasia (BPD)? (2)

Answer 29

Mechanical ventilation Oxygen therapy

Question 30

What are five Cardiac Disorders that can contribute to dysphagia in Children

Answer 30

Congenital Heart Disease (CHD) Congestive Heart Failure (CHF) Atrioventricular Septal Defect (AVSD) Patent Ductus Arteriosus Tetralogy of Fallot

Question 31

What is Congenital Heart Disease (CHD)?

Answer 31

A generic term used to identify any malformations of the cardiovascular system in infants

Question 32

What is Congestive Heart Failure (CHF)?

Answer 32

Stress to the heart due to edema and an overload of fluid

Question 33

What is Atrioventricular Septal Defect (AVSD)?

Answer 33

A malformation of the heart resulting from failure of the ventricular inlet to separate

Question 34

In what condition is Atrioventricular Septal Defect (AVSD) often seen? What can happen if it remains untreated?

Answer 34

Characteristic feature of Down syndrome (also seen in other syndromes) Congestive heart failure

Question 35

What is Patent Ductus Arterioles?

Answer 35

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

Question 36

What is Tetralogy of Fallot?

Answer 36

The combination of four anomalies (pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy) causes deoxygenated blood to mix with oxygenated blood

Question 37

What are a Genetic Syndrome that are often accompanied by dysphagia?

Answer 37

Down Syndrome

Question 38

How does Down Syndrome contribute to dysphagia? | 4

Answer 38

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

Question 39

What does C.H.A.R.G.E. stand for in regards to down syndrome?

Answer 39

Caloboma (Cleft of the iris of the eye), Heart disease Atresia of the nasal cavity, Retardation Genital abnormalities Ear disorders including deafness.