Oropharyngeal dysphagia OPD is a challenging and relatively common condition in children. Both developmentally normal and delayed children may be affected. The etiology of OPD is frequently multifactorial with neurologic, inflammatory, and anatomic conditions contributing to discoordination of the pharyngeal phase of swallowing. This article details current understanding of the mechanism and potential sources of OPD in children while providing an algorithm for managing it in the acute and chronic setting.
Key Points. Initial evaluation of a child with noisy breathing involves assessment of phase and character of noisy breathing; distress in relation to states of sleep, wakefulness, and feeding; overall color and oxygen saturation; growth and weight gain; and awake fiberoptic laryngoscopy. The most common cause of stridor in infants is laryngomalacia, but not all stridor can be assumed to be due to laryngomalacia. Laryngomalacia improves spontaneously with increasing age in most children, but when surgery is needed, aryepiglottoplasty supraglottoplasty is highly successful to resolve the symptoms. All children with congenital anterior laryngeal webs should undergo genetic testing for abnormalities of chromosome 22q
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