Assessment of functional feeding and swallowing biomechanics in normal children

ABSTRACT

There has been little research on functional feeding and swallowing pathophysiology in children. Ftuthermore, the parameters that define adults swallowing can not always be applied to the children because of differences in the relationships of anatomic structures and lack of neurological maturation. The aims of the study were to assess the functional feeding and swallowing biomechanics of normal children in order to understand when feeding and swallowing vary or deviate and also to provide a frame of reference for creating therapeutic programs for the children with impaired deglutition. This study was conducted on 10 normal children [7 females and 3 males] with their ages ranged between 3.2-10.3 [mean 6.8 +/- 2.3] years. All children were observed during eating using. "The Pediatric Feeding Assessment checklist". The feeding domains assessed were spoon feeding, cup and straw drinking, biting, chewing, and drooling. Behaviors in each domain are rated as normal and abnormal. The swallowing function was then evaluated for all children using Videofluoroscopy. The child was asked to swallow different bolus consistencies [thin and thick liquids, semisolid and solid] in small and large volumes [3 and 5 ml]. The selected swallowing observations and measures were [1] Number of swallows per bolus in different consistencies and volumes. [2] Temporal measures of bolus and hyoid movements during swallowing; [3] Oro-pharyngeal residue; [4] Laryngeal penetration/aspiration observation and [5] Oropharyngeal Swallow Efficiency [OPSE] score. All Children demonstrated a 100% competence on all feeding behaviors. Multiple swallows per boius were observed as the bolus consistency increases especially with large volumes. Most of the children [60-90%] demonstrated oropharyngeal residue in both thick liquid and semisolid consistencies regardless the volume of the bolus. No laryngeal penetration and/or aspiration were observed in different bolus consistencies and volumes. All the temporal measures of swallowing demonstrated statistically significant increases as the bolus volume and/or consistency increase. Normal OPSE score was recorded for all children with different bolus consistencies and volumes. A normative data for the functional feeding and swallowing biomechanical parameters for normal children was presented. Further research is recommended to apply these data in children with oropharyngeal dysphagia due to different etiologies