Pediatric Feeding and Swallowing Impairment in a Child with a Craniofacial Disorder
Pediatric speech-language pathologists (SLPs) practicing in a variety of clinical settings encounter a wide range of disorders that impact the normal progression of feeding and swallowing skills starting in infancy and beyond. This case describes the process of diagnosis and the clinical management required when working with a child with a craniofacial disorder.
JL was a 4-week-old female infant who presented with failure to thrive and increased difficulty breathing at a tertiary medical center. JL was diagnosed shortly after birth with Pierre Robin sequence with cleft palate and moderate-to-severe retro-micrognathia. She had been discharged home from the neonatal intensive care unit on full oral feeds. Shortly after discharge, she was seen by her pediatrician. Her pediatrician referred her to the aerodigestive clinic due to failure to gain weight, noisy and labored breathing, feeding difficulties, and “choking” with feeds. Physical examination revealed respiratory distress with suprasternal, substernal, and intercostal retractions as well as inspiratory noise with breathing. Her weight was well below the first percentile. JL was admitted directly to the pediatric intensive care unit from the aerodigestive clinic. Nasogastric tube feedings were initiated for supplemental nutrition and hydration, as it was clear that the baby was not meeting nutritional requirements.