Printza Athanasia, Sdravou Katerina, Triaridis Stefanos
First Otolaryngology Department, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
Children (Basel). 2022 Nov 29;9(12):1857. doi: 10.3390/children9121857.
Dysphagia is any impairment of swallowing that compromises the safety, efficiency, or adequacy of nutritional or liquid intake. It is common in children, especially in some clinical populations, and may result in failure to thrive and respiratory problems due to pulmonary aspiration. Swallowing disorders have a severe impact on children's health, growth, and development, and on the quality of life of the child and family. Clinical evaluation cannot validly predict aspiration, which is mostly silent. A team management approach is advocated, including instrumental swallowing assessments. FEES has been proven to be safe and valid and is increasingly used in children of all ages. It allows the identification of structural abnormalities, assessment of the child's diet with real-life food and liquids while the child holds the optimal or preferred position, examination during breastfeeding, and assessment of fatigue and treatment strategies. FEES is carried out following a protocol that comprises three parts: the evaluation of the anatomical and physiological parameters of swallowing, testing of food and liquids of a range of different consistencies, and evaluation of treatment methods. Pediatric FEES involves adaptations for infants, and special considerations about readiness for nutritive trials and the infant's ability to sustain a coordinated feeding pattern. Varying consistencies and volumes of food or liquids are tried. Care of the dysphagic child involves team work. FEES, as a part of the assessment and management of dysphagia, enables the evaluation of the safety, efficiency, and adequacy of oral food and liquid intake. Future perspectives include standardized training in clinical FEES protocols to ensure clinical competency of the pediatric FESS team members and the development and validation of standardized examination and interpretation protocols for pediatric FEES.
吞咽困难是指任何影响吞咽功能的障碍，这种障碍会损害营养或液体摄入的安全性、效率或充足性。它在儿童中很常见，尤其是在一些临床人群中，可能会导致发育不良以及因肺部误吸而引发呼吸问题。吞咽障碍对儿童的健康、生长和发育以及儿童及其家庭的生活质量都有严重影响。临床评估无法有效预测大多为无症状的误吸情况。提倡采用团队管理方法，包括仪器吞咽评估。纤维内镜吞咽功能检查（FEES）已被证明是安全有效的，并且越来越多地用于各年龄段的儿童。它能够识别结构异常，在儿童保持最佳或偏好姿势时，使用实际食物和液体评估儿童饮食，在母乳喂养期间进行检查，以及评估疲劳和治疗策略。FEES是按照包含三个部分的方案进行的：吞咽的解剖和生理参数评估、一系列不同黏稠度食物和液体的测试以及治疗方法评估。儿科FEES需要针对婴儿进行调整，并特别考虑营养试验的准备情况以及婴儿维持协调喂养模式的能力。会尝试不同黏稠度和体积的食物或液体。吞咽困难儿童的护理需要团队协作。FEES作为吞咽障碍评估和管理的一部分，能够评估口服食物和液体摄入的安全性、效率和充足性。未来的发展方向包括对临床FEES方案进行标准化培训，以确保儿科FEES团队成员具备临床能力，以及开发和验证儿科FEES的标准化检查和解读方案。
