Pediatric dysphagia is a clinical problem that crosses disciplines. Children may be seen by
numerous medical specialties including pediatric otolaryngology gastroenterology pulmonology
speech pathology occupational therapy and lactation consultants. The myriad approaches to the
diagnosis and management of dysphagia is confusing for both clinicians and families resulting
in recurrent trips to medical professionals. Feeding is integral to socialization and to
bonding between infants and parents. Disruptions in feeding development can be extremely taxing
emotionally and economically for families. Children with dysphagia are some of the most
challenging patients even for clinicians who specialize in their care.This text provides the
reader with a comprehensive understanding of swallowing and presents a practical
evidence-based approach to the diagnosis and management of swallowing difficulties in children.
It also highlights particular clinical challenges and controversies in the management of
pediatric dysphagia. It is unique in that it incorporates the perspectives of multiple types of
clinicians that care for these patients including otolaryngologists gastroenterologists
pulmonologists speech pathologists occupational therapists and lactation consultants. In
doing so this text will encourage cross-specialty pollination of ideas and knowledge as well
as stimulate further research in the field. Part 1 of the text begins with an overview of the
anatomy and physiology of swallowing with a focus on normal development as we currently
understand it. It also discusses new information regarding reflexive interactions between the
larynx and esophagus that potentially influence swallowing. It then moves on to a discussion of
the advantages and limitations of currently available diagnostic modalities and highlights
current controversies regarding frame rate radiation exposure breastfeeding infants and
grading of studies. Additionally it reviews the current literature regarding medical and
behavioral-based therapy options including thickening options oromotor therapy and
controversies concerning strict NPO. Part 2 addresses specific diagnoses which can cause or be
associated with dysphagia such as prematurity velopharyngeal insufficiency ankyloglossia
laryngeal clefts laryngomalacia vocal fold paralysis and cricopharyngeal dysfunction. The
text goes on to explore the pathophysiology and treatment options for each. Anatomic
inflammatory and neuromuscular esophageal causes of dysphagia are also evaluated. In addition
it delves into the impact of craniofacial anomalies sialorrhea and psychological factors on
swallowing. Finally it discusses how a multidisciplinary aerodigestive team can help
streamline multidisciplinary care for individual patients. It will incorporate information
pertinent to the different roles tools and views of a multidisciplinary dysphagia team
including how pediatric otolaryngologists gastroenterologists pulmonologists speech language
pathologists occupational therapists and dieticians can collaborate to provide optimal
evaluation and care of these often challenging patients especially for those who are at
high-risk of complications related to aspiration.
