Pediatric Dysphagia: Challenges and Controversies

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. 

Table of contents (24 chapters):

Embryology and Anatomy

Pages 3-16

Ahn, Annie K. (et al.)

Maturation of Infant Oral Feeding Skills

Pages 17-32

Lau, Chantal

Clinical Evaluation of Breastfed Infants with Dysphagia: A Lactation Consultant’s Perspective

Pages 33-47

Hurst, Nancy

Clinical Feeding-Swallowing Evaluation: Overview for the Healthcare Provider

Pages 49-65

Rappazzo, Christina A., M.A., CCC-SLP/BCS-S (et al.)

The Videofluoroscopic Swallow Study: Introduction, Limitations, and Challenges

Pages 67-86

Rappazzo, Christina A. (et al.)

Who Should Pass the Endoscope During a Fiberoptic Evaluation of Swallowing Procedure

Pages 87-92

Willging, Jay Paul

Fiberoptic Endoscopic Evaluation of Swallowing: Assessing Dysphagia in the Breastfeeding Patient

Pages 93-99

Schroeder, James W., Jr (et al.)

Use of Bronchoscopy and Bronchoalveolar Lavage in the Evaluation of Chronic Pulmonary Aspiration

Pages 101-107

Das, Shailendra

Diagnosis and Treatment of Pediatric Dysphagia: Radiography

Pages 109-118

Stoudemire, William (et al.)

Oromotor Therapy

Pages 119-134

Howe, Tsu-Hsin

Adaptive Feeding Techniques and Positioning: An Occupational Therapist’s Perspective

Pages 135-146

Mitchell, Cheryl (et al.)

Treatment for Dysphagia: A Speech Language Pathologist’s Perspective

Pages 147-161

Brooks, Laura

Ankyloglossia and Dysphagia

Pages 165-170

Cheng, Jeffrey (et al.)

Type 1 Laryngeal Clefts

Pages 171-177

Thottam, Prasad John (et al.)

Laryngomalacia, Supraglottoplasty, and Feeding and Swallowing Disorders: Is There An Association?

Pages 179-189

El-Hakim, Hamdy (et al.)

Vocal Fold Paralysis and Dysphagia: Challenges and Controversies

Pages 191-206

Belcher, Ryan (et al.)

Cricopharyngeal Dysfunction in Children

Pages 207-213

Bedwell, Joshua R.

Esophageal Dysphagia

Pages 215-238

Sanghavi, Rinarani (et al.)

Impact of Non-oral Feeding Methods on Feeding Development

Pages 239-254

Raj, Priya

Secretion Management

Pages 255-269

Lambert, Elton

Dysphagia in Patients with Craniofacial Anomalies

Pages 271-279

Moore, Ellen E. (et al.)

Psychological and Behavioral Disorders in Dysfunctional Feeding: Identification and Management

Pages 281-301

Silverman, Alan H. (et al.)

The Role of a Multidisciplinary Aerodigestive Program

Pages 303-308

Ongkasuwan, Julina (et al.)

Correction to: The Videofluoroscopic Swallow Study: Introduction, Limitations, and Challenges

Pages E1-E1

Rappazzo, Christina A. (et al.)