Related Experiment Video

Updated: Oct 18, 2025

A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis ALS

A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis ALS

Published on: February 21, 2011

Isolated bulbar palsy and dysphagia in children with respiratory symptoms

Stacey Zimmels¹, Ian M Balfour-Lynn², Loucas Christodoulou³

¹Department of Speech & Language Therapy, Royal Brompton Hospital, London, UK.

Developmental Medicine and Child Neurology

|October 3, 2021

Insights

Isolated bulbar palsy in children can cause significant swallowing difficulties and respiratory issues. This under-recognized condition, identified via genioglossus electromyography, requires specific management strategies.

Area of Science:

Pediatric Neurology
Gastroenterology
Speech-Language Pathology

Background:

Oropharyngeal dysphagia in children often necessitates identifying underlying causes to manage chronic aspiration and respiratory symptoms.
Dysphagia evaluation typically involves a search for neurological or neurodevelopmental disorders.

Observation:

A case series of 15 children (6 months to 5 years) diagnosed with dysphagia over 6 years.
Electromyography revealed isolated bulbar palsy in some children, with no other neurological or neurodevelopmental issues.
Eight children presented with dysphagia but had normal electromyography results.

Findings:

Isolated bulbar palsy was identified as a potential cause of pediatric dysphagia.
Management strategies included thickened fluids, and in severe cases, nasogastric or gastrostomy tube feeding.
Follow-up indicated resolution or improvement in dysphagia and respiratory symptoms in over half of the affected children.

Implications:

Isolated bulbar palsy is an under-recognized cause of pediatric dysphagia and associated respiratory problems.
Genioglossus electromyography is a valuable tool for diagnosing this specific condition.
Further research is warranted to understand the etiology and long-term prognosis of isolated bulbar palsy in children.

Read full analysis

Abstract:

Oropharyngeal dysphagia can cause chronic aspiration leading to significant respiratory symptoms. When dysphagia is diagnosed, an underlying cause is sought. We present a case series of 15 children diagnosed aged 6 months to 5 years (mean 2y 5mo; 11 males, four females) over a 6-year period, who were found to have an isolated bulbar palsy on genioglossus electromyography, with no accompanying neurological or neurodevelopmental disorder. Eight children had dysphagia but a normal EMG. In those with isolated bulbar palsy, management included thickened fluids (n=13), cooled boiled water (n=1), and nasogastric tube feeding (n=1). Follow-up over 1 to 8 years (mean 5y) showed complete resolution in six children, improvement in four children, and no improvement in five children (including two requiring fluids via a gastrostomy). Eight children no longer had any respiratory symptoms. Isolated bulbar palsy is under-recognized and has not been reported previously as a cause of significant dysphagia in children.

More Related Videos

Minimally Invasive Murine Laryngoscopy for Close-Up Imaging of Laryngeal Motion During Breathing and Swallowing

Minimally Invasive Murine Laryngoscopy for Close-Up Imaging of Laryngeal Motion During Breathing and Swallowing

Published on: December 1, 2023

Nasal Brushing Sampling and Processing Using Digital High Speed Ciliary Videomicroscopy – Adaptation for the COVID-19 Pandemic

Nasal Brushing Sampling and Processing Using Digital High Speed Ciliary Videomicroscopy – Adaptation for the COVID-19 Pandemic

Published on: November 7, 2020

Related Concept Videos

Pulmonary Cycle: Exhalation

Pulmonary Cycle: Exhalation

In terms of human respiration, the act of expelling air, known as exhalation (or expiration), operates on the principle of pressure gradients. During expiration, the pressure within the lungs exceeds that of the surrounding atmosphere. Under normal conditions, quiet breathing involves passive exhalation and is free of muscular contractions. This is because the exhalation process is driven by the natural elastic recoil of the lungs and chest wall, both of which have an inherent tendency to...

Respiratory System Abnormal Finding II: Palpation and Auscultation

Respiratory System Abnormal Finding II: Palpation and Auscultation

In assessing respiratory abnormalities, palpation and auscultation are critical tools for detecting and interpreting various pathophysiological changes. These techniques provide insight into underlying disorders by evaluating tactile sensations and sounds produced by the respiratory system.
Palpation Findings
During a respiratory assessment, palpation can reveal several vital abnormalities:

Respiratory System Abnormal Finding I: Inspection and Percussion

Respiratory System Abnormal Finding I: Inspection and Percussion

Respiratory system abnormalities are a significant concern in healthcare due to their potential to indicate underlying severe conditions like Chronic Obstructive Pulmonary Disease (COPD), asthma, and pneumonia. These abnormalities can often be detected through physical examination methods like inspection and percussion.
Inspection Findings
During an inspection, several findings may suggest the presence of respiratory distress or disease. Pursed-lip breathing, where exhalation is slowed by...

Pneumonia I: Introduction

Pneumonia I: Introduction

Pneumonia is an acute respiratory infection that targets the lungs, specifically the alveoli. These tiny air sacs, essential for oxygen exchange, become engorged with pus and fluid, severely hindering breathing, decreasing oxygen absorption, and causing significant pain and discomfort during respiration.
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...

Assessment of Airway, Skin Color, and Use of Accessory Muscles

Assessment of Airway, Skin Color, and Use of Accessory Muscles

A thorough assessment of respiratory health is paramount in clinical settings to identify and manage respiratory distress and ensure adequate oxygenation. This article elaborates on the critical aspects of respiratory evaluation, including airway assessment, skin color examination, and the observation of accessory muscle use, which are integral to effectively diagnosing and managing patients with respiratory conditions.
Introduction
The initial evaluation of a patient's respiratory system...

Pneumonia II: Pathophysiology

Pneumonia II: Pathophysiology

The pathophysiology of pneumonia involves the following steps:

Articles linked to this work by shared authors, journal, and citation graph.

Effectiveness of Early Physiotherapy Interventions with Guided Parental Involvement on Motor Development in Preterm Infants: A Systematic Review.

Pediatric reports·2026

Disease characteristics of SEPSECS deficiency: an international, retrospective, multicenter cohort study.

Genetics in medicine : official journal of the American College of Medical Genetics·2026

From first seizure to specific antiseizure medication in Dravet syndrome: Quantifying delays in the DS'coverED study.

Epilepsia open·2026

Broadening the inherited ASXL3 spectrum and unveiling molecular mechanisms through detailed genotypic-phenotypic analyses.

Genetics in medicine open·2026

Gillespie Syndrome: Greek Patient with Novel Mutation and Atypical Presentation - Expansion of the Phenotype and Literature Review.

Molecular syndromology·2026

Neonatal developmental and epileptic encephalopathy with movement disorder and arthrogryposis: A shared phenotype across brain-expressed sodium channelopathies.

Epilepsia·2026

See all related articles