Clinical characteristic of oropharyngeal dysphagia and swallowing safety in children with dystonia: a preliminary report

Objectives: To describe clinical characteristics of oropharyngeal dysphagia (OPD) and swallowing safety in children with dystonia.

Methods: Eight children with dystonia diagnosis (3G, 5B) were included in the study. Medical and feeding histories were recorded. Oral structures and hygiene were evaluated. Dysphagia Disorders Survey (DDS) was used to evaluate OPD. Dysphagia Management Staging Scale (DMSS) was used to determine dysphagia severity. The Mastication and Observation Evaluation was used to assess chewing functions. Paediatric version of the Eating Assessment Tool-10 (PEDI-EAT-10) and the 3-ounce water swallow test were used to evaluate swallowing safety.

Results: Five children (62.5%) had open mouth posture at rest, 5 (62.5%) had open bite, 5 (62.5%) had high arched palate and 4 (50.0%) had tongue thrust. Eight children (100%) had oral hygiene problems. The OPD was prevalent in all children determined by DDS. Dysphagia severity classified to the DMSS showed mild (n=1), moderate (n=2), severe (n=4) and profound (n=1) severity. Chewing function was impaired in all children. Abnormal swallowing (PEDI-EAT-10 score ≥4) and increased aspiration risk (PEDI- EAT-10 score ≥13) were found in 87.5% and 75% of children, respectively. Six children (75.0%) failed the 3-ounce water swallow test.

Conclusion: Problems with oral structures/hygiene, chewing and swallowing function can be seen in almost all children with dystonia. OPD also associated with increased risk of aspiration in a subpopulation. Therefore, assessments of oropharyngeal swallowing function and swallowing safety should be included in routine clinical evaluations. Also, instrumental-swallowing assessments might be planned for children with increased risk of aspiration.