Whereas children with severe dysphagia may require alternative feeding methods such as nasogastric or gastrostomy tube feeding, fluid thickeners may be used to facilitate enteral nutrition in less severe cases. 5 Aspiration of fluids into the lungs can result in pneumonia, bronchiectasis, and respiratory compromise. Alternatively, aspiration may be “silent,” without any obvious signs or symptoms. ![]() 1, 3, 4 Aspiration may present with cough, wheeze, apneas, or respiratory issues. 1, 2 This is likely due to improvements in perinatal care, particularly in infants with premature birth, low birth weight, and medically complex conditions. The incidence of pediatric patients with aspiration as a result of oropharyngeal dysphagia is increasing. Impairment in any component may lead to dysphagia and aspiration. Swallowing is a complex neuromuscular process that requires the development and coordination of voluntary and involuntary processes. The SWP presents a safe and effective way of gradually returning children to a more normal diet. Using this method, most children tolerated a reduction in thickeners and a thin-fluid diet. The SWP uses small incremental steps to gradually reduce the amount of thickener. Overall, 46 (92%) of children required 2 or fewer videofluoroscopic swallow study evaluations.Ĭonclusions and Relevance Patients with oropharyngeal dysphagia and aspiration should be gradually weaned off of thickened fluids. Only 2 (5%) developed pneumonia while all other successfully weaned patients (n = 37 ) did not experience any substantial respiratory issues. Of the 39 successfully weaned patients, 14 (36%) experienced a temporary stall but eventually tolerated thin fluids. Of those whose weaning failed, 2 patients developed pneumonia. For 6 patients, weaning failed and they continued to receive thickened fluids. Five patients tolerated a reduction in thickener but not a full wean to thin fluids. The mean (SD) duration of a successful wean was 0.9 (0.6) years. A successful wean from thickened fluids to thin fluids was completed in 39 (78%). Results Of 50 children (32 male median age, 0.7 y at presentation and 1.8 y at start of wean) using the SWP, 44 (88%) were able to reduce the amount of thickener used. ![]() Main Outcomes and Measures Number of patients weaned to a thin-fluid diet. ![]() Caregivers progressed to the next incremental level if there were no signs or symptoms of aspiration. A 10% reduction in thickness was made every 2 weeks based on clinical symptoms. All patients were initially receiving thickened fluids. Objective To describe the use of a systematic weaning process (SWP) for children who received thickened liquids owing to oropharyngeal dysphagia and identified risk of aspiration.ĭesign, Setting, and Participants Retrospective case series (2010 to 2015) at a tertiary care center of 50 children with documented aspiration by clinical swallowing assessment, airway evaluation, and videofluoroscopic swallow study with at least 4 months of follow-up. ![]() Weaning children from thickened fluids safely can be challenging, and novel methods are required. Importance Thickening of fluids is a common strategy for feeding patients with oropharyngeal dysphagia but has known risks and should be stopped once it is safe to do so. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |