Current Issue

Dysphagia is a complex condition that can significantly impair feeding and nutritional intake. As defined by Dodrill and Gosa (2015), dysphagia refers to any disruption in the swallowing sequence, which may occur at any stage of the swallowing process. In pediatric populations, compromised swallowing can hinder adequate nutrition and hydration, leading to adverse outcomes such as impaired growth, developmental delays, and increased morbidity and mortality (Horton et al., 2018). The prevalence of pediatric dysphagia has been rising, a trend attributed in part to improved survival rates among infants with complex medical conditions (Saad et al., 2021). As more children with significant health challenges survive infancy, the need for a comprehensive understanding and management of dysphagia becomes increasingly crucial.

Several demographic studies have explored the prevalence and characteristics of pediatric dysphagia. For instance, Horton et al. (2018) analyzed over six million pediatric admissions from the kids’ inpatient database (KID) between 1998 and 2012, identifying a notable increase in dysphagia diagnoses, particularly among premature and low birth weight infants. Similarly, Dewi et al. (2024) examined 40 preterm infants using oral motor assessments and flexible endoscopic evaluation of swallowing (FEES), finding that 25.0% had dysphagia and 15.0% experienced aspiration. The study also highlighted the high prevalence of comorbidities, including cardiopulmonary (92.5%), gastrointestinal (57.5%), and central nervous system (45.0%) conditions.

In another study, Sadd et al. (2023) evaluated 60 infants with dysphagia, aged 2 to 19 months, and found that 78.0% had comorbidities, such as recurrent chest infections, neurological disorders, gastrointestinal issues, congenital heart disease, and structural laryngeal abnormalities. Aspiration was observed in 60.0% of the infants, with 55.6% experiencing silent aspiration.

Across these studies, common etiologies and comorbidities associated with pediatric dysphagia include prematurity, low birth weight, neurological impairments, gastrointestinal disorders, structural abnormalities, and respiratory conditions. These factors often occur in combination, increasing the complexity of diagnosis and treatment. While previous research has focused on prevalence and demographic characteristics, less attention has been given to the management of dysphagia, particularly in relation to nutritional support.

Tube feeding is a critical intervention for children who are unable to safely consume food orally. When children are entirely dependent on tube feeding, they are classified as NPO (nothing by mouth). As their condition improves, a gradual transition to oral feeding may occur, often involving a combination of oral and tube feeding (Arvedson et al., 2019). The type and duration of tube feeding vary based on clinical needs. Short-term options include oral gastric tubes (OG tubes) and nasogastric tubes (NG tubes), typically used in hospital settings. For long-term nutritional support, percutaneous endoscopic gastrostomy tubes (PEG tubes), jejunostomy tubes (J-tubes), and levin tubes (L-tubes) are commonly used (Arvedson et al., 2019).

Despite the clinical importance of pediatric dysphagia, data on its prevalence and management remain limited, which may hinder effective treatment planning and resource allocation (Bhattacharyya, 2015). To address this gap, the present retrospective cross-sectional study examines the demographic characteristics, etiologies, and management strategies of pediatric patients with dysphagia at Seoul National University Hospital. Specifically, the study analyzes data from 200 patients, aged 0 to 5 years and 7 months who underwent videofluoroscopic swallowing studies (VFSS). The study explores the presence of dysphagia and aspiration, the use of various tube feeding methods, and the broader implications for clinical care.

This study employed a retrospective cross-sectional design to examine the demographic characteristics, etiologies, and management strategies of pediatric patients diagnosed with dysphagia. Data were collected from medical records at Seoul National University Hospital over eight years, from January 2011 to December 2018. The Seoul National University Hospital is a tertiary hospital in South Korea.

The current study examined the demographic characteristics of pediatric patients with dysphagia, including etiologies and the presence of tube feeding. Moreover, the study investigated the presence of dysphagia and aspiration through VFSS. Among the patients, the majority were infants (0~24 months old). This study found that the most frequent comorbidities were neurological disorders (37.0%), genetic conditions (24.5%), and a mix of etiologies (18.0%). Neurological disorders and other comorbidities are highly related to the occurrence of dysphagia in pediatric populations. It is important for clinicians to observe and screen these vulnerable populations closely. Increasing awareness and access to services for pediatric swallowing disorders is necessary because less than 25% of patients have received clinical services (Bhattacharyya, 2015). Furthermore, VFSS data confirmed that the pediatric population who were referred for dysphagia diagnosis showed dysphagia signs predominantly (81.5%). On the other hand, 33.0% of the patients displayed aspiration, while 61.0% did not aspirate. These patients showed other dysphagia signs, like residue or poor lip control. Additionally, 45.5% of the population were reliant on tube feeding for nutritional intake, and 14.0% were managing partially by mouth and tube feeding. The nutritional support for these populations was primarily provided through a feeding tube. This data suggests that clinicians and caregivers need to know more about tube feeding and its management for nutritional support.

This study reported a variety of etiologies and their relation to dysphagia diagnosis and tube feeding. A closer look at some of the specific neurological disorders of this study included hypoxic-ischemic encephalopathy, cerebral palsy, encephalitis, brain tumor, neuromuscular disease, seizure, spinal cord disease, and pachygyria. The population with neurological disorders may experience numerous difficulties in other areas of the body systems because global neural development impacts the body’s development and growth. Specifically, lesions within the central nervous system may disrupt global development. Further, several specific genetic conditions, such as Edward syndrome, Down syndrome, DiGeorge syndrome, congenital myopathy, and genetic myopathy, have a significant effect on swallowing difficulties. Lastly, patients with multiple etiologies tend to show more difficulties with swallowing and nutritional intake than others. An example from the mixed category was a patient with a structural abnormality and genetic condition, such as laryngomalacia and congenital myopathy. Given the various, complex etiologies present within this study, the findings reveal the importance of an interdisciplinary approach for each case. Having a team of professionals helps foster a holistic approach to evaluating and developing intervention strategies that can lead to more positive long-term outcomes.

There was a discrepancy between the prevalence of dysphagia diagnoses and the occurrence of aspiration for those individuals who are diagnosed with dysphagia but who do not aspirate. They may be having difficulties with feeding, such as difficulty with sucking and tongue coordination. In addition to the instrumental examinations, it is necessary to determine the clinical findings that affect swallowing disorders. Understanding the entire swallowing process is imperative because other concerning swallowing challenges, besides aspiration, may be occurring. Furthermore, it is worth knowing that 12 (6.0%) patients within the aspiration group and 37 (18.5%) patients within the dysphagia diagnosis group could not be evaluated. These patients showed the inability to swallow, rejection of the substance, or lack of evidence due to insufficient substance quantity. Edwards et al. (2022) and Saad et al. (2021) suggested more accurate evaluation tools or assessments for identifying vulnerable groups. Furthermore, with more longitudinal research on this population, the long-term impacts of this disorder would be revealed and could be correlated with dysphagia in adulthood (Lefton-Greif, 2008). For future studies, it may be beneficial to analyze sucking performance and bolus transition, as well as examine other components of swallowing physiology and pathophysiology to gather more information that could suggest other swallowing challenges.

Feeding is essential for growth, development, and nutritional intake. 14.0% of patients within this study required feeding assistance, partially by mouth and tube feeding. They may only be able to have a small amount of food orally while obtaining the rest of the necessary nutrients through their tube feeding. These patients may be fed only orally during therapy sessions as a trial or during transition stages. With the help of tube feeding, the clinician can focus on oral and pharyngeal swallowing with trial foods. This study found that a large group (45.0%) of patients rely on tube feeding. It is important to know that collaborative intervention should be based on an understanding of swallowing difficulty, nutritional intake abilities, and the developmental process of the patients.

A deep understanding of dysphagia in the pediatric population, a lack of knowledge on the long-term impacts of this disorder, and interventions on health and development are critical in pediatric dysphagia (Bhattacharyya, 2015; Dodrill & Gosa, 2015; Lefton-Greif, 2008). The prevalence of pediatric dysphagia is increasing. Clinical research and a comprehensive understanding of pediatric dysphagia and its related diseases are still limited. The current study examined demographic information like etiologies, types of management through tube feeding, and the presence of aspiration and dysphagia among pediatric patients with dysphagia. The findings revealed that pediatric dysphagia involves complicated etiologies because the individuals may be experiencing multiple comorbidities and challenges. In addition, these patients are heavily reliant on tube feeding for nutritional intake, so this population requires involvement from multidisciplinary healthcare teams.

A few limitations of the present study are important to consider. First, this study would benefit from incorporating a larger patient population to increase the reliability of conclusions and suggestions. Further, it would be advantageous to conduct a longitudinal rather than a retrospective cross-sectional study to examine and report patient progress and development. Lastly, analyzing different swallowing physiologies would help obtain more detailed information about the patient’s swallowing challenges.