Characteristics of children with dysphagia: comparing clinical and fiberoptic endoscopic evaluation of swallowing

RESUMO

INTRODUÇÃO: Swallowing disorders in children have increased and are closely related to progress in neonatal and pediatric care, which have improved prognosis of premature infants and those with complex medical conditions. Swallowing dysfunction in children can lead to aspiration, chronic lung disease, and poor weight gain or malnutrition. Therefore, early diagnosis is crucial in order to prevent negative impacts.Determining the cause is essential to guide appropriate treatment, and it is common to observe the convergence of different comorbidities. Clinical evaluation of swallowing usually performed by a specialized speech-language pathologist (SLP) can help identify signs of swallowing dysfunction, but it is not a reliable tool to detect silent aspiration.

OBJETIVOS: The aim of this study is to analyze clinical and epidemiological characteristics of children with suspected dysphagia and compare findings of laryngeal aspiration on fiberoptic endoscopic evaluation of swallowing (FEES) with clinical evaluation of dysphagia.

MÉTODOS: A prospective cohort study was carried out on a sample of 60 children who presented signs and symptoms of dysphagia. These children underwent clinical evaluation and FEES, and demographic and clinical data were collected. Subsequently, the findings of both assessments were analyzed and compared.

RESULTADOS: The median age of the children was 2.8 years, and 49 (81.6%) had neurological disorders while 35 (58.3%) had chronic pulmonary disease. The most prevalent complaints were choking (41.6%) and sialorrhea (23.3%). Clinical swallowing evaluation was normal in 7 patients, while 36 (60%) had moderate to severe dysphagia. All patients with moderate and severe dysphagia had neurological disorders. Twenty-five patients presented aspiration in FEES and another 10 presented penetration. Seven (20%) of the 35 patients with positive FEES were not considered to have suspected aspiration on clinical evaluation. Primary upper airway pathologies were observed, with immobility of vocal folds being the most common. Additionally, 31.67% had a tracheostomy, and 11.67% depended on supplemental oxygen.

CONCLUSÃO: Children with dysphagia symptoms have a high prevalence of underlying diagnoses and comorbidities, requiring multidisciplinary evaluation and follow-up. The findings demonstrate that clinical evaluation alone may not be sufficient to accurately diagnose aspiration, and instrumental evaluation such as FEES should always be considered particularly in the neurologically impaired patients. FEES is a reliable and accessible in-office procedure that can aid multidisciplinary decision-making in diagnosing, treating, and monitoring children with dysphagia.

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PALAVRA-CHAVE: deglutition disorders, child, endoscopy, feeding and eating disorders, pediatrics