Neurologic Deficits

1. Careful physical exam is imperative to rule out decompensation in baseline status underlying swallowing dysfunction.

3. Thickening of feedings, modification of textures presented, and upright positioning may decrease aspiration potential.

VI. Problem Case Diagnosis. The 2-year-old child had had a recent febrile illness with GI symptoms, leading to decreased appetite and food refusal over several days. In most children, such presentations are self-limiting. If declining appetite and frank food refusal were to persist, however, clinician should begin to suspect other processes. Unmasked reflux esophagitis with pain during and immediately following feeding may present as dysphagia. Suspicion for this should be higher in children with developmental disabilities, in whom chronic reflux can present atypically with poor weight gain in the setting of intercurrent irritability, nighttime restlessness, or disruptive mealtime behavior.

VII. Teaching Pearl: Question. If the safety of feeding integrity is in doubt, what is the most definitive examination that can be obtained to assess swallowing safety?

VIII. Teaching Pearl: Answer. With acute food refusal, a history of infectious process, reflux symptoms, or ingestion will determine workup and clinical management. Suspicion of chronic dysphagia, neurologic decompensation, or underlying developmental disabilities should prompt an MBS study to delineate aspiration risks.

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