The need for speech and language therapy intervention for infants and toddlers with tracheostomies : a retrospective study

Abstract

There has been a worldwide increase in the number of tracheostomies performed on the paediatric population, particularly during the first year of life, which has also been evident at Red Cross Children’s Hospital in South Africa. Infants and toddlers with tracheostomies present with multiple risk factors for having or developing dysphagia and/or communication difficulties, due to the effects of the tracheostomy on the development of feeding, speech and communication, as well as the underlying medical conditions that necessitated the tracheostomy, and associated medical, social and environmental factors. There is, however, a dearth of literature in the area of paediatric tracheostomies in the South African context, particularly with regard to feeding and communication. The purpose of this study was to determine the incidence and describe the nature of dysphagia and communication difficulties in infants and toddlers with tracheostomies in the South African context, and detail the need for speech-language therapy intervention. It also attempted to determine whether there was an association between the underlying medical condition and the incidence of dysphagia and/or communication difficulties. A retrospective, descriptive survey of the folders of infants and toddlers with tracheostomies within the age range of 0 – 3 years from 2002 – 2004 at Red Cross Children’s Hospital was conducted. A checklist for dysphagia and communication difficulties in infants and toddlers with tracheostomies was developed and used to collect data from participants’ medical records. Results indicated that 80% of the study population presented with dysphagia. Oral phase difficulties were documented in 81.25%, pharyngeal phase difficulties in 60.9% and oesophageal phase difficulties in 79.7% of the dysphagic sample. Communication difficulties were recorded in 94% of the sample population. Speech production difficulties were documented in 78%, receptive language delays in 87% and expressive language delays in 96% of the sample population with communication difficulties. No statistically significant association was established between the underlying medical condition and the incidence of either dysphagia or communication difficulties. The results in the present study support the limited available literature, and the need for early speech-language therapy intervention for infants and toddlers with tracheostomies.