BackTable / ENT / Podcast / Episode #48
Feeding Difficulties in Infants
with Ashley Brown, SLP
We talk with Ashley Brown, SLP about how to approach the infant with feeding difficulties, including common causes and workup, therapeutic options, and the importance of family counseling and education.
BackTable, LLC (Producer). (2022, February 8). Ep. 48 – Feeding Difficulties in Infants [Audio podcast]. Retrieved from https://www.backtable.com
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Ashley Brown, SLP
Ashley Brown, SLP is a pediatric speech language pathologist at Children's Health in Dallas.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
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.
[Dr. Gopi Shah]
For infants, and again, we're talking about infants under a year, how do they usually present to you when they're feeding difficulties?
Whether it be in clinic or just a PCP referral from the community to our outpatient clinic, generally the infants present to us because they're a failure to thrive. They're not gaining weight. They are pulling off breast or bottle frequently. Maybe some reports of coughing, watery eyes, red eyes when they're eating, not completing their feeds, super fussy during feeds, refusing is I would say the general referral reasons that we get when it comes to infants.
[Dr. Gopi Shah]
How old are they usually? Are they usually early on, like a couple of weeks, a couple of days, or do some of them present a little bit later on?
We will get them when they are a few days, maybe a couple of weeks old, all the way up until, like you mentioned, that 12-month-old mark. Probably our youngest patients are seen within our craniofacial weight check clinics that we have, because when those babies are born with cleft lip and palate, they need to get in immediately, see the surgical team and the speech therapist, because they require such specialized feeding systems. Those are probably our youngest patients, but I've done swallow studies on a baby that's about two weeks old.
[Dr. Gopi Shah]
There's quite a range.
A very large range and within that range, you are looking at rapid developmental changes. A two-week-old infant does not equate a six-month-old infant.
[Dr. Gopi Shah]
When these babies come to you, how do you organize your thought process? Or like what kinds of questions? Are there the same basic handful of questions that you ask and then you tease it apart? How do you look at these and then what kinds of questions are you asking?
We definitely start with a standard set of questions, probably very similar to questions you would ask in your practice, asking about birth history and then getting into what brought you in today. What are your concerns? Tell me what a feed looks like in terms of quality, quantity, the time it takes the baby to finish. From there, then you start delving into specific questions that apply to that patient but there are definitely a set of standard questions that you start with that give you a good clue of what do I need to ask next.
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