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[Syndrome of delayed maturation of the sucking-swallowing reflex]
V Leroy-Malherbe1, B Husson, P Landrieu
1Service de neurologie, hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Insights
Infants with neurological conditions may experience delayed sucking and swallowing, indicating a late maturation of these functions. These transient issues typically resolve by age five without long-term effects.
Area of Science:
- Neurodevelopmental Pediatrics
- Pediatric Neurology
- Speech-Language Pathology
Context:
- Neonates with neurological diseases frequently exhibit difficulties with sucking and swallowing.
- This study focuses on infants with normal development presenting with these challenges, suggesting a potential delay in maturation.
Purpose:
- To describe the clinical presentation and diagnostic investigations of transient sucking and swallowing difficulties in infants.
- To highlight the suggested underlying cause as late maturation of praxis.
Summary:
- Seven infants experienced aspiration, airway obstruction, or weak sucking/swallowing from birth.
- Manifestations included facial expression deficits, abnormal tongue movements, bradycardia, drowsiness, respiratory infections, and stridor.
- Investigations involved cineradiography, laryngoscopy, pH monitoring, barium swallow, polysomnography, and brainstem MRI.
- Difficulties resolved by age five in all cases, with no reported sequelae or speech disorders.
Impact:
- These findings suggest that transient sucking and swallowing difficulties in infants may indicate a delayed maturation of praxis.
- Early clinical investigation and specialized, prolonged education are crucial for managing these cases.
- Understanding this developmental trajectory can inform clinical management and parental support.
Background:
Neonates with neurological diseases often have difficulty in sucking or swallowing. This report describes such difficulties in a group of infants with normal development, suggesting late maturation of sucking and swallowing.
Population And Methods:
Seven infants (four girls, three boys) had suffered from aspiration since their first day of life (four cases) with severe asphyxia (two cases), late repeated episodes of airway obstruction by accumulated secretions (two cases), and weak isolated sucking and swallowing (one case). The lack of sucking and swallowing or difficulty with them were the main manifestations in these newborns: the face lacked expression and the tongue movements were abnormal with, in two cases, hyper-extension of the neck. A second phase during the first months of life was marked by episodes of bradycardia and/or drowsiness. A third phase during the first years of life was characterized by repeated episodes of respiratory infections, recurrent stridor and accumulation of saliva. These manifestations required prolonged hospitalization (mean: 2.5 months), nasogastric feeding, and in two cases, surgery. The investigations during the acute phases included a cineradiographic study of swallowing, laryngoscopy, monitoring of the distal esophagus pH, a barium swallow, polygraphic recording during sleep and MR imaging of the brain stem. The difficulties in sucking or swallowing disappeared before the age of 6 months (two cases), between 6 and 12 months (one case), between 1 and 5 years (four cases) without any sequelae or speech disorders.
Conclusion:
These transient sucking or swallowing difficulties suggest late maturation of praxis. They required specialized prolonged education after careful, essentially clinical, investigation.