Article

Children with traumatic brain injury (TBI) may develop swallowing
impairment or dysphagia with possible deleterious consequences of compromised
nutritional intake or aspiration with subsequent respiratory complications.
OBJECTIVE: To examine the evidence base for clinical management of dysphagia by
reviewing empirical data on the epidemiology, assessment and diagnosis, and
prognosis for dysphagia associated with childhood TBI.
METHODS: A systematic
review of the literature on dysphagia in children with TBI was conducted.
Non-data driven studies or studies including data on individuals 18 years and
over were excluded. RESULTS: Available data was sparse. Only nine studies met
inclusion criterion. Current preliminary data revealed that acute dysphagia
incidence is high (68-76%) for children with severe TBI. Children with severe
injury (GCS or=1.5 days following motor
vehicle accident are at increased risk for dysphagia. Resolution of dysphagia is
typically achieved by 12 weeks in children with cortical injury. CONCLUSION:
There is a clear need for multi-centre prospective research studies in this
field, however preliminary evidence can be used to inform aspects of clinical
practice. First, routine swallowing screening may be implemented for children
meeting criterion for being 'at risk' for dysphagia. Systematic referral of
targeted patients is lacking in paediatric rehabilitative care, but early
screening of these cases would optimize early dysphagia identification and
management. Secondly, the positive prognosis for most cases with cortical injury
suggests that long-term feeding options (i.e. gastrostomy) may not be indicated
until at least 3 months have passed with minimal change in function.

Langue : ANGLAIS