Clinical identification of feeding and swallowing disorders in 0-6 month old infants with Down syndrome

Abstract

Feeding and swallowing disorders have been described in children with a variety of neurodevelopmental disabilities, including Down syndrome (DS). Abnormal feeding and swallowing can be associated with serious sequelae such as failure to thrive and respiratory complications, including aspiration pneumonia. Incidence of dysphagia in young infants with DS has not previously been reported. To assess the identification and incidence of feeding and swallowing problems in young infants with DS, a retrospective chart review of 174 infants, ages 0-6 months was conducted at a single specialty clinic. Fifty-seven percent (100/174) of infants had clinical concerns for feeding and swallowing disorders that warranted referral for Videofluroscopic Swallow Study (VFSS); 96/174 (55%) had some degree of oral and/or pharyngeal phase dysphagia and 69/174 (39%) had dysphagia severe enough to warrant recommendation for alteration of breast milk/formula consistency or nonoral feeds. Infants with certain comorbidities had significant risk for significant dysphagia, including those with functional airway/respiratory abnormalities (OR = 7.2). Infants with desaturation with feeds were at dramatically increased risk (OR = 15.8). All young infants with DS should be screened clinically for feeding and swallowing concerns. If concerns are identified, consideration should be given to further evaluation with VFSS for identification of dysphagia and additional feeding modifications.

Keywords: Down syndrome; dysphagia; failure to thrive; respiratory aspiration; swallow study; trisomy 21.

Figure 1

Odds ratios of traits comorbid with oral and/or pharyngeal phase dysphagia with alterations in feeding strategies in infants with DS. A significant risk for oral and/or pharyngeal phase dysphagia requiring alterations in feeding strategies was seen with respiratory/airway abnormalities and desaturation with feeds (p<0.0001). An increased risk of dysphagia was found in infants who were premature or underweight. No significant increased risk was seen with severe CHD. Confidence intervals (CI) are listed above each category.