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Pediatric Feeding Swallowing: Dysphagia – Health Complications Joan C. Arvedson, PhD, BC-NCD Childrens Hospital of Wisconsin-Milwaukee Department of Pediatrics Medical College of Wisconsin-Milwaukee Major Functions of Larynx Protection of lower airways (most important) Respiration Phonation Pathophysiology: Chronic Aspiration May be more insidious than acute aspiration (direct and indirect) Most prone: Swallowing dysfunction neuromuscular disease Clinical indicators may be scarce Laryngeal penetration (deep) Endangerment to airway from aspiration Life threatening physiologic alterations Timing of Aspiration with Swallow Before: Delay in onset of pharyngeal swallow or abnormal tongue movements During: Ineffective laryngeal closure or timing incoordination After: Results in residue from multiple factors (e.g., decreased tongue base movement, reduced sensation, incoordination of pharyngeal constrictors) Protection from Aspiration Normal swallow Cough Not reliable predictor even in infants with normal swallows By 1 mo., 90% of infants have cough reflex Other protectors of lung (e.g., mucociliary clearance, phagocytosis by alveolar macrophages, lymphatic drainage, gag) Aspiration Dx Management Diagnostic studies Suggested decision tree Management options Noninvasive Medical Surgical GI Tract Issues and Gastroesophageal Reflux Disease Swallowing Problems GI Disease Esophageal structural abnormalities (TEF) Dysmotility disorders Inflammatory diseases Constipation aggravates in neuro disorders 74% of CP Multiple causes (e.g., decreased oral feeding with reduced fluid) Mechanisms for Esophageal Dysmotility Disorders Lack of contractions Absent relaxations Excessive contractions (spasms) Uncoordinated contractions Reasons for Esophageal Motility Disorders Neurologic impairment Abnormal muscle function Mucosal/muscle replacement GERD can be a major detriment to adequate nutrition GERD Respiratory Complications Ap