Pediatric emergency medicine trisk 1091 1091
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Finally, the differential diagnosis includes several systemic conditions that may
affect the normal swallowing process. In a large case series of pediatric patients
who underwent fiberoptic evaluation of swallowing function after presenting with
dysphagia, 36% were found to have structural abnormalities of the aerodigestive
tract or airway, 26% had neurologic diagnoses, 12% had gastrointestinal
disorders, 8% had genetic syndromes, 5% had prematurity, 3% had
cardiovascular anomalies, and 2% had metabolic issues.
In the adult patient, dysphagia most commonly results from a variety of
neuromuscular disorders, whereas the pediatric patient more often has swallowing
difficulty from congenital, infectious, inflammatory, or obstructive causes ( Table
56.2 ). Dysphagia occurs in 85% of cerebral palsy patients, and is directly related
to the severity of their overall neuromuscular impairment. In the newborn or
infant, swallowing may be disturbed as a result of prematurity, often associated
with respiratory and neurologic disabilities. Gastroesophageal reflux is common
in infants, although in a small percentage of patients, it may persist into childhood
with reflux esophagitis. Eosinophilic esophagitis has recently been identified as
an important cause of dysphagia, particularly in adolescents and young adults
with environmental allergies, atopy, and food allergies. Ingestion or aspiration of
a foreign body must always be considered in an infant or toddler who has either
the acute or chronic onset of dysphagia ( Fig. 56.1 ). Swallowing dysfunction is a
common complication following pediatric head injury. In a review of 1,145
pediatric head injury patients, 68% of those with severe injury and 15% of those
suffering moderate injury were found to have dysphagia requiring intervention.
Postoperative dysphagia is also common after laryngotracheal reconstruction
surgery or cardiovascular surgery. These patients are predisposed to aspiration
due to impaired airway protection.
