Dysphagia in childhood traumatic brain injury: a reflection on the evidence and its implications for practice.

BACKGROUND

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= 8) and a ventilation period of >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.