Abstract
The chapter highlights the feeding and swallowing issues seen in children with neuro-developmental disorders, types, and extent of the problem across different disorders; its relation with the neuro-development of the child; effect on the quality of life of the parents/caregivers along with the child, specifically in the Indian context. It also focuses on the importance of assessment, team approach, and review of available tests for the assessment of feeding and swallowing problems in these children. The chapter is also going to give a few insights into the challenges faced by speech-language pathologists during the assessment of the feeding and swallowing issues in these children in the Indian scenario. The chapter will also include a section on applications of ICF model to feeding and swallowing issues in children with neurodevelopmental disorders.
TopIntroduction To Feeding And Swallowing
Feeding, in general, is a basic skill which exists from the beginning of infancy. It provides nutrition for normal growth and development; satisfies hunger and maintains the homeostasis, gives opportunities for sensory and motor stimulation, and oro-motor skill development, etc., thus serving to fulfill the biological functions of the body. Feeding also has a deep impact on the psychological aspect of a developing child. The behaviors of both parent/caregiver and child during feeding contribute significantly to the overall success of the feeding interaction as well as feeding performance, which in turn strengthen the mother-child bonding. Mealtimes with the family as well as outside the family play an important role in the social life of the child (Morris & Klein, 1987; Kummer, 2008).
The development of feeding in infancy depends on the maturation of gut, lungs and neural system. The functional and anatomic development of gut includes improvement in esophageal and intestinal motility, the functioning of the lower esophageal sphincter (LES), the process of ejection of stomach contents and development of the absorptive surface area of the gut. The respiration becomes more efficient by 32 to 34 weeks of gestation and continues to develop until two years of age. Our central nervous system matures in a peripheral to central sequence and our brainstem begins to mature by the second trimester. The brainstem controls our vital functions such as heart rate, blood pressure, digestion and sleep; and cerebral cortex regulates our functional life such as voluntary actions, thought process, memory etc. During early infancy, brainstem plays a major role in controlling all our life-sustaining reflexes (including breathing, suckling etc.) (Kliegman & Stanton, 2011; Kenner & McGrath, 2010; Gardner & Merenstein, 2002; Stiles & Jernigan, 2010).
Key Terms in this Chapter
Oral Reflexes: These are reflex actions originating in the central nervous system that are exhibited by normal infants at birth, in response to particular stimuli. These reflexes are later suppressed due to the development of higher centers in the brain during the first three to twelve months of postnatal life. The oral reflexes include rooting, sucking/suckling, swallowing, tongue protrusion, tongue lateralization, phasic bite, gag, and cough.
Autism Spectrum Disorder: Autism spectrum disorder is a group of disorders characterized by deficits in social and communication functioning along with behavioral and sensory issues.
Cerebral Palsy: Cerebral palsy is a motor disorder that occurs due to damage in the developing brain resulting in issues with the development of movement, posture, balance and coordination that in turn affects the execution of activities of daily living.
Feeding Handicap Index for Children: This is a 38-item parent/caregiver reported tool designed to assess the nature of feeding problems and their impact on different domains of life (physical, functional, and emotional) in children with developmental disabilities in the age group of 2-10 years.
Intellectual Deficit: Intellectual deficit refers to the limitations in intellectual functioning leading to inadequate social and daily living skills.
Feeding: This refers to the process of placing food in the mouth, manipulation of food, and the propulsion of food backward by the tongue.
Swallowing: It is one process in the broader context of feeding, which allows the safe transfer of food and liquid from the mouth to the stomach.