Characteristics, predictors, and management of post-extubation dysphagia in critically Ill children: a scoping review

Post-extubation dysphagia (PED) is a common complication in critically ill children, associated with aspiration, malnutrition, and prolonged hospitalization. Standardized pediatric-specific assessment and management pathways are lacking, and published studies show substantial heterogeneity in diagnostic criteria, assessment timing, and intervention strategies.

This scoping review maps available evidence on pediatric PED, addressing: (1) incidence and clinical characteristics; (2) categories and effect sizes of independent predictors; and (3) the current state of prediction tools, bedside screening instruments, and management strategies.

Nine databases were searched systematically-PubMed, Embase, Cochrane Library, Web of Science, CINAHL, CNKI, Wanfang, VIP, and CBM-with a search cutoff of 12 March 2026. Fifteen studies were included, encompassing cohort studies, randomized controlled trials, quasi-experimental studies, and scale-development studies. Data were synthesized narratively following the JBI scoping review methodological framework.

Included studies were published between 2018 and 2026; 73.3% (11/15) appeared after 2022, originating primarily from mainland China (n = 10) and Brazil (n = 3). The clinical apparent incidence ranged from 28.36% to 68.94%. No included bedside assessment instrument was validated against VFSS or FEES,representing a central methodological gap in the current evidence base.Independent predictors were categorized into three evidence tiers: Tier 1: intubation duration, age, and IWS; Tier 2: neurological comorbidities and number of intubations ≥2; Tier 3:delirium.The CRISPED score is the only prediction tool with temporal internal validation (C-statistic 0.85-0.86). No assessment instrument has been validated against an instrumental gold standard. Interventions centered on oral motor training, with no standardization in frequency, intensity, or multidisciplinary integration.

Pediatric PED incidence is high and core risk factors have been repeatedly reported across multiple multivariable models, but the field shows substantial heterogeneity in diagnostic definitions, assessment tools, and intervention protocols. The absence of instrumental validation for bedside assessment tools is the central limitation. Key gaps include the absence of gold-standard diagnostic accuracy studies, externally validated prediction models, and standardized intervention pathways. Future research should prioritize multicenter prospective studies to unify diagnostic criteria, develop age-appropriate bedside screening tools, and establish a nurse-led multidisciplinary management framework.

Open Science Framework (OSF), identifier doi: 10.17605/OSF.IO/XSJ9B.