title: Clinical Characteristics of Dysphagia in Children with Down Syndrome.
abstract: Aspiration is an often unrecognized comorbidity in children with Down syndrome with serious medical consequences. This retrospective chart review of swallow study reports characterizes oral and pharyngeal phase dysphagia and diet modifications on videofluoroscopic swallow studies (VFSS) in a large cohort of children with Down syndrome. A total of 158 pediatric patients (male = 95; female = 63; mean age 2.10 years, SD 3.17 years) received an initial VFSS at a pediatric teaching hospital as part of their medical care. A total of 56.3 % (n = 89) children had pharyngeal phase dysphagia with aspiration and deep laryngeal penetration occurring most frequently. Of the 61 patients who aspirated, 90.2 % (n = 55) did so silently with no cough or overt clinical symptoms. In 76.7 % of cases of pharyngeal phase dysphagia, a functional feeding plan, with use of thickened liquids or change in feeding system to control flow rate and/or bolus size, was able to be established, which allowed children to continue eating by mouth. Thickened liquids (76.7 %, n = 46) were the most effective adaptation, with change in feeding system alone effective in only 8.3 % (n = 5) cases. Oral phase dysphagia was reported in the majority of patients (63.8 %, n = 88/138); however, this was not predictive of pharyngeal phase dysphagia. Age, sex, and reason for referral, including prior clinical symptoms, did not have a statistically significant impact on the presence of dysphagia. This comprehensive review has application to clinical understanding and management of dysphagia in children with Down syndrome.
authors.affiliation: Audiology, Speech Pathology and Learning Services Department, Children's Hospital Colorado, 13123 East 16th Avenue, Box 745, Aurora, CO, 80045, USA. arwen.jackson@childrenscolorado.org.|Sie Center for Down Syndrome, Children's Hospital Colorado, 13123 East 16th Avenue, Box 745, Aurora, CO, 80045, USA. arwen.jackson@childrenscolorado.org.
authors.forename: Arwen
authors.identifier: 0000-0003-0359-8565
authors.initials: A
authors.lastname: Jackson
authors.affiliation: Audiology, Speech Pathology and Learning Services Department, Children's Hospital Colorado, 13123 East 16th Avenue, Box 745, Aurora, CO, 80045, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Maybee
authors.affiliation: Sie Center for Down Syndrome, Children's Hospital Colorado, 13123 East 16th Avenue, Box 745, Aurora, CO, 80045, USA.
authors.forename: Maura K
authors.initials: MK
authors.lastname: Moran
authors.affiliation: Sie Center for Down Syndrome, Children's Hospital Colorado, 13123 East 16th Avenue, Box 745, Aurora, CO, 80045, USA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Wolter-Warmerdam
authors.affiliation: Sie Center for Down Syndrome, Children's Hospital Colorado, 13123 East 16th Avenue, Box 745, Aurora, CO, 80045, USA.
authors.forename: Francis
authors.initials: F
authors.lastname: Hickey
mesh_terms: D002675:Child, Preschool; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D004314:Down Syndrome / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007223:Infant; D007830:Larynx / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D010608:Pharyngeal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D010614:Pharynx / Q000000981:diagnostic imaging / Q000503:physiopathology; D053120:Respiratory Aspiration / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D012189:Retrospective Studies; D014741:Video Recording
keywords: Aspiration; Down syndrome; Dysphagia; Feeding; Swallow study; VFSS