Pediatric emergency medicine trisk 1100 1100
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FIGURE 56.1 Six-month-old who came to the ED for choking episode and later abnormal
breathing and drooling. AP (A) and lateral radiographs (B) of the neck showed open safety pin
in the hypopharynx area.
EVALUATION AND DECISION
The evaluation of dysphagia in the pediatric patient begins with a detailed history,
including pregnancy and delivery, family history, feeding history, growth and
development, and a history of other illness ( Table 56.4 ). An accurate and
complete history should suggest the diagnosis in approximately 80% of patients.
Prenatal polyhydramnios, maternal infection, maternal drug or medication use,
bleeding disorders, thyroid dysfunction, toxemia, or irradiation may lead to or
indicate swallowing problems in the newborn or infant. Association between
decreased rate of fetal suckling and digestive tract obstruction or neurologic
damage is well known. Maternal myasthenia gravis may also cause temporary
feeding problems in the newborn.
A history of traumatic delivery may result in neurologic injury or laryngeal
paralysis. Newborn intubation may be associated with trauma to the trachea,
larynx, or esophagus, as well as hypoxic brain injury. A history of prematurity,
developmental delay, failure to thrive, hypotonia, or associated congenital
abnormalities may indicate a neuromuscular cause for dysphagia. The feeding
history should include acute or chronic onset of symptoms, age at onset, weight
loss, failure to thrive, and type and amount of food the child eats. Presence of
fever, pain, respiratory symptoms, facial color, stridor, liquid or solid food
intolerance, vomiting, regurgitation, drooling, voice change, position during
feeding, and the timing of symptoms in relation to feedings should also be
documented. For example, the infant with an upper airway obstruction may
become fatigued or begin coughing and choking shortly after beginning to eat.
Choking during feeding in an infant may be due to an underlying anatomic
