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Hypoxemia during oral feeding of children with severe cerebral palsy
B T Rogers1, J Arvedson, M Msall
1Division of Developmental Pediatrics, Children's Hospital of Buffalo, State University of New York 14209.
Insights
Oral feeding can cause hypoxemia in children with severe dysphagia and disabilities. Pulse oximetry monitoring during meals is crucial for identifying and managing this risk.
Area of Science:
- Pediatric Medicine
- Neurology
- Gastroenterology
Background:
- Children with severe dysphagia and multiple disabilities often face feeding challenges.
- Oral feeding in this population can lead to serious complications like hypoxemia.
Observation:
- Pulse oximetry monitored hemoglobin saturation (SpO2) in five children during oral feeding.
- These children exhibited food refusal, coughing, or fatigue during meals.
- Modified barium videofluoroscopic swallow studies revealed deglutition abnormalities.
Findings:
- While SpO2 was normal at rest, oral feeding induced significant hypoxemia.
- All five children had abnormal pharyngeal swallowing.
- Hypoxemia severity correlated with food texture in three children.
Implications:
- Mealtime hypoxemia awareness informed the decision for gastrostomy-tube feeding in two children.
- Pulse oximetry during oral feeding is recommended for children with severe dysphagia and multiple disabilities.
- This monitoring can prevent critical respiratory events during feeding.
Abstract:
Oral feeding of children with severe dysphagia and multiple disabilities may result in hypoxemia. Pulse oximetry was used to monitor hemoglobin saturation (SpO2) during oral feeding of five children with multiple disabilities who were referred because of food refusal or coughing and fatigue during feeding. Modified barium videofluoroscopic swallow studies demonstrated deglutition abnormalities. SpO2 values were within the normal range at rest, but routine, upright oral feeding resulted in significant degrees of hypoxemia. The pharyngeal stage of deglutition was abnormal in all five children. In three, the periods of hypoxemia were dependent on food texture. Awareness of meal-time hypoxemia contributed to the decision to use gastrostomy-tube feedings for the other two children. Pulse oximetry during oral feeding should be considered for all children with severe dysphagia and multiple disabilities.