Disorders of Sucking and Swallowing

Functional feeding skills, which depend on the integrity of anatomic structures, undergo change based on neurologic maturation and experimental learning. Eating/feeding requires active effort by infants who must have exquisite timing and coordination of sucking, swallowing, and breathing to be efficient. A variety of neurological, neuromuscular conditions in children and infants can impair the physiological phases of sucking/swallowing and cause disorders of feeding and dysphagia. The causes of feeding and swallowing problems include combinations of structural deficits, neurologic conditions, respiratory compromise, feeder-child interaction dysfunction, and numerous medical conditions, such as genetic, metabolic, and degenerative disease. The true epidemiology of pediatric dysphagia remains largely unassessed because of the lack of a standardized reporting system evaluating dysphagia in all of the possible contexts that may occur in infants and children. The differential diagnosis of dysphagia in children is wide. The diagnostic workup can be extremely difficult and exhaustive in many cases. Because of this complexity, multidisciplinary team evaluations should be conducted. Optimal management strategies are critical for infants and children with feeding and swallowing problems. The management of swallowing dysfunction involves a team approach. Individuals involved in addition to the medical team include a swallowing expert (speech-language pathologist or occupational therapist), a nutritionist, and the family. Since swallowing abnormalities arise from a diverse group of underlying disorders, management techniques must be individualized.