Incidence of trachs in the pediatric population
~4,861 trachs performed each year – > 1/2 of those are children between birth & 11 months
Indications for trach in pediatric population
- Providing access for prolonged ventilation
- Bypassing airway obstruction
- Subglottic stenosis
- Facilitating tracheobronchial toilet
Common diagnosis that result in peds w/trachs
- Prematurity
- Pierre Robin Syndrome, Bronchopulmonary Dysplasia (BPD), Tracheomalacia, Spinal bifida, Muscular dystrophy, Cystic fibrosis, Craniofacial abnormalities
- Accidents, abuse, trauma
Pierre Robin Syndrome
- Congenital, infant has a smaller than normal lower jaw, a tongue that falls back in the throat, and difficulty breathing
- Aspiration is a common risk w/this population
- Severe cases may require a trach
Bronchopulmonary Dysplasia (BPD)
- Chronic lung condition that affects newborn babies who were either put on a breathing machine after birth or were born very early
- risk factor: severe respiratory or lung infection
Symptoms of bronchopulmonary dysplasia
- Bluish skin color
- Chronic cough
- Rapid breathing
- Shortness of breath
Signs/tests for bronchopulmonary dysplasia
- Arterial blood gas
- Chest CT scan
- Chest x-ray
- Pulse oximetry
Bronchopulmonary dysplasia treatment (in the hospital)
- Vent required to send pressure to lungs to keep them inflated & deliver more oxygen
- Pressure & oxygen slowly reduced - weaned from vent but may need mask or nasal cannula
- Usually fed by NG tubes
- Need extra calories due to effort of breathing
- May need to limit fluids or use diuretics to keep lungs from filling w/fluid
- Medications: corticosteroids, bronchodilators, surfactants
Bronchopulmonary dysplasia treatment (at home)
- May need oxygen therapy for weeks/months after leaving hospital
- Need to receive enough calories
- May need tube feeds / special formulas
- Prevent child from getting colds / other respiratory infections (respiratory RSV virus)
Do preterm infants stop breathing because of swallowing?
NO
What is the most frequent swallow & respiration pattern with preterm infants?
Inspiration –> swallow –> expiration
Do infants with bronchopulmonary dysphasia often demonstrate sucking difficulties?
YES
What do you need to evaluate with infants with bronchopulmonary dysplasia?
- Suck –> swallow –> breath
- Sucking endurance
Literature on swallowing in infants suggest that the movement of the supra glottis structures during the act of bolus swallowing is _____ and tends to be ____________ in young children w/ long term trachs
slower; more restrictive
__% of pediatric patients with a trach had swallowing problems. (Arvedson & Brodsky – Rosingh & Peek)
48% (A & B)
*Many of these patients also had an underlying neurophysiological factor that may be affecting the swallow
91% (R & P)
Marianjoy Pediatric Study: Was there a difference between the acquired group and the congenital group?
Nope
Marianjoy Pediatric Study: Aspirators were significantly ____ than the non-aspirators
OLDER (10 y/o vs. 3 y/o)
What do you use for clinical swallow evaluations of infants?
Formula
What do you use for clinical swallow evaluations of older children?
Use age appropriate / developmentally appropriate foods
Can you use blue food coloring during CSE with infants?
NO - their digestive system probably is not able to handle blue dye foods
Can you use blue food coloring during CSE with older children?
MAYBE - blue popsicles, suckers, kool-aide, yogurt, etc.
*Many children have a sensitivity to “blue” foods - need to be careful
May be able to gather some information during the CSE that will…
Help direct your instrumental examination, determine appropriate timing for an instrumental examination with this patient, radiation exposure / FEES tolerance
The inability to palpate laryngeal movement with young child or infants with a trach during a CSE may warrant _______________.
An instrumental examination of the swallow.
Specific deficits to rule out during a VFSS include: (3)
- Slowing of laryngeal vestibule closure
- Reduced laryngeal excursion
- Airway contamination / penetration / aspiration
