Pediatric emergency medicine trisk 1105 1105
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Thyroid dysfunction
Polyhydramnios
Fetal irradiation
Food allergy
Birth history
Birth trauma
Hypoxia
Endotracheal intubation or resuscitation
Cough/gag/cyanosis/fatigue/stridor/irritability with feeding
Feeding times greater than 30 min
Respiratory distress associated with feeding
Vomiting or regurgitation
Level of alertness
Weight gain or failure to thrive
Nasal regurgitation
Refusal to eat age-appropriate foods
Recurrent pneumonias
Family history of neuromuscular disease
Provided oral intake is not contraindicated by an expected procedure or
intervention, observation of a typical feeding, given by a parent or primary
caregiver, may help elucidate the cause of dysphagia. The manner of presentation
of food to the patient, the consistency and amount given, patient position,
duration of feeding, regurgitation (oral or nasal), agitation or behavior change, or
the development of respiratory symptoms may further guide the diagnostic
evaluation. Patients with upper airway obstruction may have an exacerbation of
symptoms when attempting to drink. Patients with lesions such as
tracheoesophageal fistula, vascular rings, or esophageal obstruction may begin
coughing and choking soon after drinking without any initial difficulty. However,
esophageal disorders such as extrinsic compression, strictures, tumors, or altered
motility commonly are clinically silent and typically require use of radiographic
or direct visual techniques for diagnosis.
Evaluation of the stable dysphagic patient may proceed on the basis of age and
acute versus chronic onset of symptom development ( Fig. 56.2 ). The neonate
and young infant will require evaluation techniques and consideration of the agerelated differential diagnoses outlined in Table 56.2 , whereas the older child with
