The implications of upper-airway obstruction on successful infant feeding.

Oral feeding in infants requires highly integrated sucking, swallowing, and respiratory sequencing controlled by the neurologic system. Rapid neuromuscular coordination of oral, pharyngeal, and esophageal phases of swallowing must be coordinated with respiration in the swallowing process. When obstruction is present in the upper airway secondary to anatomic or physiologic anomalies, disruption to the oral feeding process may occur. The infant will likely be unable to coordinate sucking and swallowing with breathing in an advantageous sequence. Inefficient feeding and difficulty with airway protection during swallowing may have serious implications regarding the infant's respiratory health as well as ability to gain weight adequately. A stable and patent airway is always the first priority in the management of the infant with upper-airway obstruction. Evaluation of the infant's potential for oral feeding may occur simultaneously with the initial evaluation of the degree of airway obstruction or it may occur following medical or surgical intervention for the airway obstruction. The evaluation process and management options for oral feeding will depend upon the method used to establish a patent airway. Clinical assessment by the speech-language pathologist includes a thorough assessment of oral sensory and motor mechanics, recognition of clinical signs and symptoms of swallowing dysfunction, and consideration of referral for instrumental assessment to obtain objective information regarding airway protection and swallowing function. A variety of medical and feeding interventions may be used to help support oral feeding to whatever extent is safe and efficient. Infants with significant oral feeding problems in the presence of airway obstruction may require a period of supplemental tube feeding and non-nutritive oral stimulation.