Abstract:
BACKGROUND : Severe acute malnutrition (SAM) is associated with cognitive and motor deficits.
Little is known about the swallowing, feeding and communication characteristics of
hospitalised toddlers with SAM, limiting the abilities of speech-language therapists to provide
effective early intervention.
OBJECTIVE : To explore the background, swallowing, feeding and communication characteristics
of toddlers with SAM during in-patient nutritional rehabilitation.
METHOD : An exploratory, prospective, collective case-study was conducted with three hospitalised
toddlers who were 12–18 months old and independently diagnosed with SAM, at least 1 week
after transitioning to oral feeding. Detailed case histories were compiled through medical file
perusal and parent interviews. Cross-sectional clinical bedside assessments were completed
with the Rossetti Infant-Toddler Language Scale and Schedule for Oral-Motor Assessment.
RESULTS : All three participants had a history of feeding difficulties before admission. Despite
intact pharyngeal swallows, heterogeneous oral-sensorimotor dysfunction and disruptive
feeding behaviours were identified. Risk for oropharyngeal dysphagia indicates the need to
modify dietary consistencies to prevent prolonging recovery or SAM relapse. Participants had
mild-to-moderate language delays, particularly in interaction-attachment, play and language
comprehension, with an atypical moderate receptive and mild expressive language delay
profile. None of the participants were referred for speech-language therapy.
CONCLUSION : This exploratory research showed the oral-sensorimotor skills, swallowing and
communication characteristics of children with SAM. Speech-language therapists could
address oral-sensorimotor functioning, feeding difficulties and communication interaction
delays before discharge to community-based management for SAM. Further investigation with a larger sample size is recommended.
CONTRIBUTION : Novel description of the oral-sensorimotor skills for feeding and the
communication development of three severely malnourished toddlers with HIV and
tuberculosis co-infection was presented. The complexity of the three cases is highlighted.
