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[Radiological studies of feeding disorders in severely retarded children]
Insights
Children with severe intellectual and physical impairments often struggle with feeding. Videofluoroscopy revealed that liquid consistency and sitting position increase aspiration risk in these patients, highlighting the need for swallowing function assessment.
Area of Science:
- Pediatric Gastroenterology
- Neurology
- Speech-Language Pathology
Context:
- Feeding difficulties are prevalent in children with severe physical and intellectual impairments.
- Videofluoroscopy is a key diagnostic tool for evaluating swallowing function in this population.
Purpose:
- To investigate the videofluoroscopic findings associated with feeding difficulties in severely impaired children.
- To identify predisposing factors for aspiration and gastro-esophageal reflux.
- To assess the safety and efficacy of low osmolality water-soluble contrast media.
Summary:
- Videofluoroscopy revealed that liquid consistency and the sitting position increase aspiration risk compared to paste and the supine position, respectively.
- Predisposing factors include poor bolus formation, delayed swallowing reflex, incomplete laryngeal closure, and inadequate pharyngeal pressure.
- Nasogastric tube-fed patients demonstrated impaired swallowing, with some aspirating contrast media, suggesting potential saliva aspiration and recurrent respiratory infections.
- Low osmolality water-soluble contrast media proved safe and effective, with no complications reported.
Impact:
- Findings underscore the importance of assessing and maintaining swallowing function in children with severe impairments, particularly those receiving nasogastric tube feeding.
- Identifies specific risk factors to guide clinical interventions and improve patient outcomes.
- Recommends safer contrast media for videofluoroscopic evaluations in at-risk populations.
Abstract:
Feeding difficulty is a major problem in severely retarded children. Fourteen patients aged from 5 to 36 years with physical and intellectual impairments who had feeding difficulties were investigated by videofluoroscopy. Video-fluoroscopic findings showed that the liquid was easier to be aspirated than the paste, and that in the sitting position aspirations were more frequent than in the supine. The predisposing factors of feeding difficulties were thought to be poor bolus formation by the tongue, delayed swallowing reflex, incomplete closure of the larynx and poor pharyngeal pressure. Of ten cases that showed markedly gulped air, three of them had gastro-esophageal reflux, which was very likely caused by the increased intragastric pressure. Seven patients fed by nasogastric tube feeding were examined their swallowing ability by dropping contrast medium into the oral cavity. Three patients aspirated contrast media into bronchi. This suggests that they also generally aspirated saliva which resulted in recurrent respiratory infection. It is therefore important to maintain the swallowing function in patients fed by nasogastric tube. Low osmolality water soluble contrast medium was used in this study. There were no complications. This medium is thought to be safer than the standard media of barium solutions or other high osmolality contrast media, especially for the patients who suffer from aspiration.