Feeding Difficulties in Infants

In this episode of BackTable ENT, Dr. Gopi Shah interviews Ashley Brown, a speech language pathologist (SLP) at Children’s Health Hospital in Dallas, about the evaluation and management of the infant with dysphagia.

An infant with dysphagia, or difficulty in swallowing, can present with many symptoms, but most commonly failure to thrive, refusing to feed, incomplete feeding, and aspiration. When primarily assessing these patients, a complete history must be taken. Standard questions cover the chief complaint, the birth history, observations of a typical feed routine, and parent concerns. Next, a holistic exam is conducted. Speech language pathologists will often observe an infant’s posture, tone, trunk support, and range of motion of the mouth and tongue. If necessary, instrumental studies, like a flexible endoscopic evaluation of swallowing (FEES) or a videofluoroscopic swallow study, can be performed. A FEES visualizes the pharyngeal space and is recommended for breastfeeding babies, NPO babies, head and neck cancer babies. A videofluoroscopic swallow study visualizes the oral and esophageal space and gives a better picture of flow rate consistency.

Infant dysphagia can result from many etiologies, but some of the most common roots are: abnormalities in oral structure (e.g. tongue tie). problems with tone (e.g. injury to the recurrent laryngeal nerve), syndromes (e.g. Trisomy 21, DiGeorge Syndrome), laryngeal cleft, and laryngomalacia. Furthermore, GERD and nasal obstruction (e.g. pyriform aperture stenosis, choanal atresia) can also cause dysphagia.

Although some deformities can be surgically fixed, most infants with dysphagia will either improve with maturity or through feeding therapy sessions with speech language pathologists. In these sessions, SLPs work with infants to train their sensory cues and motor skills through exercises such as oral motor stretches, sour/cold stimulation, facial taping, lip rounding, and neuromuscular stimulation. It is just as important to provide family counseling and parent training as it is to train the infant patients during these sessions.