From the Guidelines
For a child with coloboma, aspiration issues, and failure to thrive, the most appropriate next step would be a video swallow assessment. This specialized radiographic study allows direct visualization of the swallowing process to identify the exact nature and timing of any aspiration. The test involves feeding the child barium-containing substances of different consistencies while recording fluoroscopic images, providing crucial information about oral, pharyngeal, and esophageal phases of swallowing. This assessment is essential because aspiration can lead to recurrent pneumonia and further compromise nutritional status.
According to the guidelines for cardio-facio-cutaneous syndrome 1, children with feeding and/or swallowing difficulties, failure to thrive, constipation, gastroesophageal reflux, and intestinal malrotation should undergo a nutrition assessment and growth measurements by a primary physician. Additionally, referral to a gastroenterologist in early infancy for feeding difficulties, gastroesophageal reflux, and poor growth is recommended.
The American Thoracic Society clinical practice guidelines 1 also emphasize the importance of evaluating swallowing dysfunction in infants and children with respiratory symptoms, including wheezing. The guidelines suggest that videofluoroscopic swallowing studies can identify aspiration due to swallowing dysfunction, and that treatment with a thickened diet or temporary cessation of oral feedings can improve outcomes.
Other studies 1 have also highlighted the importance of assessing and managing swallowing dysfunction in children with various conditions, including Pompe disease, tracheostomy, and oral-pharyngeal dysphagia. These studies emphasize the need for a multidisciplinary approach to managing swallowing dysfunction, including speech-language therapy, dietary modifications, and surgical interventions when necessary.
In summary, a video swallow assessment is the most appropriate next step for a child with coloboma, aspiration issues, and failure to thrive, as it allows for direct visualization of the swallowing process and identification of any aspiration. This assessment is essential for developing an effective feeding plan to address both the aspiration risk and poor weight gain.
From the Research
Assessment and Management of Dysphagia
The management of a child with coloboma, aspiration, and failure to thrive requires a multidisciplinary approach. The following steps can be taken:
- Assess the child's swallowing function using instrumental evaluations such as Video Fluoroscopic Swallow Study (VFSS) or Fiberoptic Endoscopic Evaluation of Swallowing (FEES) 2, 3
- Identify the underlying causes of dysphagia and aspiration, such as neurodevelopmental disorders or anatomical abnormalities 4, 5
- Develop a personalized feeding plan that takes into account the child's nutritional needs and swallowing abilities 2, 6
Instrumental Evaluations
Instrumental evaluations such as VFSS and FEES can help diagnose dysphagia and aspiration in children. These evaluations can:
- Assess the child's swallowing function and identify any abnormalities 2, 3
- Provide information on the child's oral and pharyngeal anatomy and function 6
- Help develop a personalized feeding plan that reduces the risk of aspiration 5, 3
Multidisciplinary Approach
A multidisciplinary approach is essential in the management of dysphagia and aspiration in children. This approach should involve:
- A child neurologist to assess and manage any underlying neurodevelopmental disorders 4
- A speech-language pathologist to assess and manage the child's swallowing function and develop a personalized feeding plan 2
- A radiologist to interpret instrumental evaluations such as VFSS and FEES 4, 3
- A dietician to ensure the child's nutritional needs are met 4