Risk Factors of Aspiration in Pediatric Dysphagia: A Videofluoroscopic Swallowing Study Analysis

Abstract

Objectives: This study examined to identify effective temporal measures to distinguish between aspirators and non-aspirators in young children with dysphagia.Methods: Fortytwo children aged from 1 year to 3 years 11 months were included in this study. All children were referred to Videofluoroscopic Swallowing Study (VFSS) at a tertiary hospital in South Korea. The children were divided into two groups depending on the presence of aspiration: aspirators (N=16) and non-aspirators (N=26). Seven temporal measures were measured to identify swallowing physiologies by using frame-by-frame analysis. A multilevel model with binomial distribution was used to examine which temporal measures better predict group membership.Results: Delayed pharyngeal swallow (DPS), pharyngeal transit time (PTT), and initiation of laryngeal closure (ILC) were significant factors in distinguishing the aspirators from the non-aspirators. DPS was the most useful temporal measure to distinguish between the groups. ILC placed second, followed by PTT. A model including DPS and PTT was the best model to predict the group membership. A model with PTT and ILC ranked second.Conclusion: The findings indicated that an aspiration risk appeared to increase when the bolus stayed longer in the pharynx and initiation of pharyngeal swallow was delayed. Also, the bolus remained in the pharynx for an abnormally longer time while the airway was open in the aspirators. This study suggests that clinicians should not only recognize pathophysiological factors that may increase the aspiration risk but also determine which abnormal physiology is a main factor of aspiration during VFSS.