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Exploring swallowing, feeding and communication characteristics of toddlers with severe acute malnutrition
Casey J Eslick1, Esedra Krüger, Alta Kritzinger
1Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria. cjeslick10@gmail.com.
Insights
Severe acute malnutrition (SAM) in toddlers presents with oral-motor dysfunction and feeding challenges, alongside language delays. Early speech-language therapy intervention is crucial for improving outcomes in these vulnerable children.
Area of Science:
- Pediatric Nutrition
- Speech-Language Pathology
- Developmental Pediatrics
Background:
- Severe acute malnutrition (SAM) is linked to cognitive and motor deficits.
- Limited understanding of swallowing, feeding, and communication in hospitalized toddlers with SAM hinders early intervention.
- Speech-language therapists require more data to effectively support these children.
Purpose of the Study:
- To investigate the swallowing, feeding, and communication characteristics of toddlers with SAM during inpatient nutritional rehabilitation.
- To provide insights into the oral-motor skills and language development of children with SAM.
- To inform early intervention strategies for speech-language therapists.
Main Methods:
- An exploratory, prospective, collective case-study design was employed.
- Three hospitalized toddlers (12-18 months) diagnosed with SAM were assessed after transitioning to oral feeding.
- Data collection included medical file review, parent interviews, and bedside assessments using standardized scales (Rossetti Infant-Toddler Language Scale, Schedule for Oral-Motor Assessment).
Main Results:
- Participants exhibited a history of feeding difficulties, oral-sensorimotor dysfunction, and disruptive feeding behaviors.
- Despite intact pharyngeal swallows, risks for oropharyngeal dysphagia necessitated dietary modifications.
- Mild-to-moderate language delays were observed, particularly in interaction-attachment, play, and comprehension, with an atypical receptive-expressive profile.
Conclusions:
- Speech-language therapists can play a vital role in addressing oral-sensorimotor functioning, feeding issues, and communication delays before discharge.
- Early intervention focusing on these areas can improve community-based management of SAM.
- Further research with larger sample sizes is recommended to validate these findings.
Background:
Severe acute malnutrition (SAM) is associated with cognitive and motor deficits. Little is known about the swallowing, feeding and communication characteristics of hospitalised toddlers with SAM, limiting the abilities of speech-language therapists to provide effective early intervention.
Objective:
To explore the background, swallowing, feeding and communication characteristics of toddlers with SAM during in-patient nutritional rehabilitation.
Method:
An exploratory, prospective, collective case-study was conducted with three hospitalised toddlers who were 12-18 months old and independently diagnosed with SAM, at least 1 week after transitioning to oral feeding. Detailed case histories were compiled through medical file perusal and parent interviews. Cross-sectional clinical bedside assessments were completed with the Rossetti Infant-Toddler Language Scale and Schedule for Oral-Motor Assessment.
Results:
All three participants had a history of feeding difficulties before admission. Despite intact pharyngeal swallows, heterogeneous oral-sensorimotor dysfunction and disruptive feeding behaviours were identified. Risk for oropharyngeal dysphagia indicates the need to modify dietary consistencies to prevent prolonging recovery or SAM relapse. Participants had mild-to-moderate language delays, particularly in interaction-attachment, play and language comprehension, with an atypical moderate receptive and mild expressive language delay profile. None of the participants were referred for speech-language therapy.
Conclusion:
This exploratory research showed the oral-sensorimotor skills, swallowing and communication characteristics of children with SAM. Speech-language therapists could address oral-sensorimotor functioning, feeding difficulties and communication interaction delays before discharge to community-based management for SAM. Further investigation with a larger sample size is recommended.Contribution: Novel description of the oral-sensorimotor skills for feeding and the communication development of three severely malnourished toddlers with HIV and tuberculosis co-infection was presented. The complexity of the three cases is highlighted.
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