Management of oropharyngeal dysphagia in the neurologically intact and developmentally normal child.

PURPOSE OF REVIEW: An enigmatic group of children with normal development and intact neurologic function display clinical, radiographic, and endoscopic evidence of persistent laryngeal penetration and/or aspiration during feeds, known as oropharyngeal dysphagia (OPD). Identifying the etiology of OPD in this patient population and designing the appropriate management has been difficult. As a result, many healthy children with OPD remain on thickened diets late into childhood. RECENT
FINDINGS: Reports of OPD in neurologically intact children have emerged but are limited in providing clinical guidelines. Oropharyngeal dysphagia is best detected by instrumental evaluations of swallowing function but a correlation with clinical signs and symptoms is critical for therapy. The novel, but controversial, 3-oz. water swallow challenge in children can be a useful tool in clinic for persistent OPD. Physiologic conditions linked to pharyngolaryngeal sensory blunting may explain OPD in many neurologically intact children. Unexplained OPD in these children often improves with time and reflux therapy. Proving subtle anatomic anomalies as the source of OPD, such as type I laryngeal clefts, cricopharyngeal achalasia, and tonsillar hypertrophy, remains difficult. Surgical management for these entities may be the final step in the therapeutic tree. Despite the etiology and treatment, the return to a normal diet in children with OPD requires a graduated approach. This allows systematic neuromuscular training of the pharyngeal phase of swallowing.
SUMMARY: OPD in the neurologically intact child is underrepresented in the literature. This review examines pediatric dysphagia and recent reports of OPD in developmentally normal children to extrapolate basic clinical guidelines for managing OPD in this population.