Recorded incidence and management of dysphagia in an outpatient paediatric neurodevelopmental clinic

Abstract

In recent years there has been an increase in the number of children diagnosed with neurodevelopmental disorders. Dysphagia is believed to be a co-morbid condition in up to 90% of children with neurodevelopmental disorders, and is potentially life threatening. Objectives. To describe the medical diagnoses of children attending a state outpatient neurodevelopmental clinic; to determine the involvement of allied health professionals in the management of children with neurodevelopmental impairments; and to compare the reported incidence of feeding difficulties with the number of referrals made for feeding assessments. Setting. State hospital outpatient neurodevelopmental clinic in South Africa. Subjects and methods. Retrospective audit of a systematic sample of 100 files from 1 472 patients aged 0 - 14 years attending the clinic between June 2008 and April 2009. Data were tabulated and analysed quantitatively using descriptive statistics. Results. Diagnoses recorded in the files included developmental delay (32%), genetic syndrome (24%), cerebral palsy (19%), autism spectrum disorder (15%), learning disability (4%), microcephaly (1%), hydrocephalus (1%), dysmorphic features (1%), neuropathy (1%), traumatic brain injury (1%) and specific language impairment (1%). Of the sample 79% had been referred for at least one type of therapeutic intervention including speech and language therapy. Feeding difficulties were mentioned in only 29% of files, and less than half of these children (14% of the total sample) had been referred for a feeding assessment. Conclusion. A minority of children with neurodevelopmental disorders and recorded feeding difficulties are referred for feeding assessments. This supports the suggestion of mandatory dysphagia screening in clinics and regular follow-up feeding assessments, as well as improved multidisciplinary teamwork.