Identification of Swallowing Patterns Associated with Dysphagia

UM Technology Enhanced Learning Project Description

 

Disordered Swallow - Child


The anatomic relationship between structures in the oral cavity and pharynx is different than that in adults. The tongue fills the oral cavity, the fat pads in the cheeks narrow the oral cavity laterally, and the hyoid bone and larynx are much higher than in adults, which provides more protection of the airway. The velum usually hangs lower, with the uvula often resting inside the epiglottis.

When sucking from a nipple, the infant repeatedly pumps the tongue to express milk from the nipple with each pump collecting liquid at the faucial arches or in the valleculae. Each infant tends to use a pattern of specific number of tongue pumps. Normal infants use from 2 to 7 tongue pumps.

When a bolus of adequate size has been formed, the pharyngeal swallow triggers, which is similar to that of an adult.

These two videofluroscopic segments are of a child with dysphagia. The child is a 3 year, 6 month old male with a diagnosis of seizure disorder - infantile spasms. He was referred for a modified barium swallow because questions had arisen regarding the safety of oral feeding due to possible aspiration. His mother reports episodes of raspiness and coughing during feeding.

Bottle Feeding

The first segment is of bottle feeding. The child was positioned in his wheelchair with all his support straps in place. Neck hyperextension was evident throughout the evaluation. In this segment, note the overall uncoordinated, arrhythmical oral motor movements and the uncoordinated suck/swallow/breathe pattern.

Note that this child used an up and down suckling movement of the jaw and tongue as a unit. This is normal in younger children, however, eventually children use the tongue independent of the jaw to suck from a nipple.

The pharyngeal phase is delayed with material tending to pool in the valleculae and pyriform sinuses. Because of the hyperextended neck position, gravity assisted in moving the bolus backwards into the pharynx. Coating of the pharynx can also be observed.

Cracker softened with gravy

In this segment, the child had been given a piece of cracker which had been softened with gravy. Food remained in the pharynx and in the larynx. He attempted to cough, but when he inhaled to gain pressure for a cough , he aspirated the material .

 

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Special thanks to St.Mary's/Duluth Clinic (SMDC) Radiology and Speech Pathology departments for providing the videofluroscopy studies of the normal adult.