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Identifying Paediatric Populations with Increased Risk for Oropharyngeal Dysphagia in Acute and Critical Care
Christie Grunke1, Jeanne Marshall2,3, Anna Miles4
1School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia. Christie.grunke@uq.net.au.
Insights
Oropharyngeal dysphagia (swallowing difficulty) is prevalent in hospitalized children, particularly after surgery or critical illness. Key risk factors include younger age, intubation, and airway issues, highlighting the need for better screening.
Area of Science:
- Pediatric critical care medicine
- Swallowing disorders
- Hospitalized child health
Background:
- Dysphagia is a frequent complication in hospitalized children, impacting their recovery and care.
- Accurate prevalence data is essential for optimizing service provision and support for affected children.
- Understanding risk factors is crucial for early identification and intervention.
Purpose of the Study:
- To determine the prevalence of oropharyngeal dysphagia in children admitted to acute or critical care.
- To identify patient characteristics associated with oropharyngeal dysphagia in these settings.
- To synthesize existing research on pediatric dysphagia in hospital settings.
Main Methods:
- Systematic review of five electronic databases (EMBASE, CINAHL, Cochrane, PubMed, Scopus).
- Inclusion of peer-reviewed studies reporting prevalence data for new-onset or worsening oropharyngeal dysphagia in children (0-16 years) in acute/critical care.
- Screening of 7,522 studies, with 67 ultimately meeting inclusion criteria.
Main Results:
- Highest dysphagia prevalence observed in children post-posterior fossa tumor resection with tracheostomy, those using nasal CPAP, and post-ischemic stroke.
- Significant associated characteristics include younger age, lower weight, prolonged intubation, upper/middle airway dysfunction, and comorbidities.
- Commonly researched populations involved congenital heart disease surgery, posterior fossa tumor resections, stroke, and post-extubation dysphagia.
Conclusions:
- Oropharyngeal dysphagia is a widespread issue among hospitalized children across various acute and critical care scenarios.
- Further research is needed to refine understanding of risk factors for improved screening and early detection.
- Enhanced identification strategies are vital for better management and support of pediatric dysphagia in hospital settings.
Abstract:
Dysphagia is common in hospitalised children. Clarity regarding its prevalence is required to direct service needs. This review reports oropharyngeal dysphagia prevalence in children admitted to acute and/or critical care, following acute illness, medical or surgical intervention. It also explores patient characteristics significantly associated with oropharyngeal dysphagia in these settings. Five electronic databases (EMBASE, CINAHL, Cochrane, PubMed, Scopus) were searched. Studies identified for inclusion involved children (0-16 years), in acute or critical care settings, where prevalence data for new-onset or worsening oropharyngeal dysphagia was reported. Peer reviewed journal articles, including systematic reviews were included. Data was extracted and synthesised using a purpose designed extraction tool. A total of 7,522 studies were screened and 67 studies met criteria. The most researched populations included congenital heart disease surgeries, posterior fossa tumour resections, stroke and post-extubation dysphagia. Populations with the highest documented dysphagia prevalence were children after posterior fossa tumour resection with a new tracheostomy, children using nasal continuous positive airway pressure, and children following ischemic stroke. Characteristics significantly associated with oropharyngeal dysphagia were younger age, lower weight, longer intubation, upper/middle airway dysfunction (e.g., vocal paresis), and presence of additional comorbidities. This review presents synthesised prevalence data for children in acute and critical care settings with new-onset or worsening oropharyngeal dysphagia. It highlights the broad nature of oropharyngeal dysphagia in hospitalised children and the need for more rigorous research into characteristics associated with increased risk to better support screening and early identification of oropharyngeal dysphagia in these settings.
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