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Dysphagia progression and feeding skills following pediatric alkali ingestion injury: two case reports
Anna M Follent1, Anna F Rumbach1, Elizabeth C Ward1,2
1a School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , QLD , Australia.
Insights
Children with alkali ingestion injuries often experience prolonged dysphagia and feeding issues, impacting oral intake and requiring ongoing support. Early feeding assessments and interventions are crucial for recovery and family support.
Area of Science:
- Pediatric gastroenterology
- Swallowing disorders
- Chemical injury rehabilitation
Background:
- Limited data exists on dysphagia and feeding difficulties post-alkali ingestion.
- Understanding these challenges is vital for effective multidisciplinary intervention in pediatric cases.
Observation:
- Two children with severe alkali ingestion injury presented with complex, heterogeneous oral motor and feeding deficits.
- These included delayed oral motor skills, limited dietary variety, and challenging mealtime behaviors.
Findings:
- Both children required ongoing diet/fluid modification and gastrostomy feeding 2 years post-injury.
- Recovery of age-appropriate oral intake was protracted due to persistent feeding issues.
Implications:
- Alkali ingestion can lead to long-term pediatric dysphagia and feeding difficulties, irrespective of initial injury severity.
- Early feeding assessments, targeted rehabilitation, and family-centered care are essential for optimizing recovery and minimizing long-term effects.
Purpose:
There is limited information regarding the nature of dysphagia and feeding difficulties following alkali ingestion injury to inform multidisciplinary intervention. The aim was to describe the history and nature of chronic dysphagia and feeding difficulties in two children following severe alkali ingestion injury.
Methods:
Medical records, primary caregiver report, and clinical assessment were used to compile detailed case histories and assess current dysphagia and feeding skills.
Results:
Both cases demonstrated heterogeneous oral motor and feeding outcomes, including delayed oral motor skills, restricted dietary variety, and difficult mealtime behaviors that contributed to protracted recovery of age-appropriate PO intake. Both children required ongoing diet and/or fluid modification and supplemental non-PO feeding via gastrostomy at the time of review, that is, 2-year post-injury.
Conclusions:
Recovery from dysphagia post-alkali ingestion is protracted and complex. Dysphagia, delayed oral motor skills, and difficult mealtime behaviors may persist secondary to ingestion injury and its associated complications. These cases highlight the importance of considering early referral for feeding assessment and intervention to assist children and families with recovery. Progression through safe and effective oral (per os, PO) intake is needed, as well as provision of support for primary caregivers. Implications for Rehabilitation Pediatric chemical ingestion injury can cause long-term dysphagia and long-term feeding difficulties Initial injury severity does not reliably correlate with eventuating level of aerodigestive impairment. Clinical and instrumental assessment is required to monitor swallow function to enable commencement of targeted rehabilitation when appropriate. Early involvement of a feeding therapist is recommended to minimize the long-term effects on oral motor skill development, progression to age-appropriate diet, and provision of family-centered care.
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