Swallowing and oral-sensorimotor characteristics in a sample of young hospitalised children with severe acute malnutrition

Abstract

AIM : To describe swallowing and oral-sensorimotor characteristics in a sample of young hospitalised children with severe acute malnutrition (SAM). METHODS : The Schedule of Oral-motor Assessment was used to compare oral-sensorimotor skills of 45 hospitalised patients with SAM (M = 15.98 months; SD = 8.03), to pairwise-matched controls (M = 15.96 months; SD = 8.08). Participants were matched for age, gender, TB, HIV-status, socio-economic status including maternal education, paternal employment, housing and transport access. Caregivers reported demographic information, feeding practices and behaviours during feeding. RESULTS : In comparison to controls (n = 6; 13.3%), participants with SAM (n = 25; 55.6%) presented with significantly more oral-sensorimotor difficulties (p < 0.001), across all consistencies except liquids from the trainer cup and bottle. Difficulties included jaw opening and stabilisation, tongue and lip control for chewing, bolus formation and transport, sustained bite and uncoordinated swallowing. Delayed sitting development significantly correlated with uncoordinated swallowing and head extension on puree and cup drinking, and multiple swallows on puree and semi-solids. Force-feeding and slow swallow initiation in semi-solids significantly correlated. Disruptive feeding behaviours and higher levels of food refusal at the beginning of meals were reported. Clinical signs of aspiration were identified. CONCLUSIONS : Oral-sensorimotor dysfunction and possible aspiration were observed in 55.6% of participants with SAM. Safe swallowing function for overall health and nutritional recovery is emphasised. Under-identification of oral-sensorimotor difficulties, lack of referral to speech-language therapists and disruption to continuity of care warrants further research.

SUMMARY What is already known? ○ Young children with severe acute malnutrition (SAM) present as weak, hypotonic and lethargic, contributing to motor delays and reduced appetite during in-patient SAM recovery. ○ Mealtimes have been described as disruptive including food refusal in children with SAM. ○ Oral-sensorimotor dysfunction hinders functional feeding abilities and is an associated risk for undernutrition. ○ Limited information exists on swallowing and oral-sensorimotor characteristics of young children with SAM to guide early feeding intervention. What this paper adds? ○ This paper describes oral-sensorimotor skills and swallowing characteristics of young children with SAM, highlighting a potential bidirectional relationship between malnutrition and oral-sensorimotor dysfunction. ○ The research group showed significantly more oral-sensorimotor difficulties than matched controls, across all consistencies except liquids from the trainer cup and bottle. ○ Gross motor milestone delay for sitting correlated with uncoordinated swallowing and head extension on puree and cup drinking, and multiple swallows on puree and semi-solids, emphasising the interplay of nutrition, feeding, and motor development. ○ This study highlights that oral-sensorimotor dysfunction often remains unidentified in young children with SAM, which can delay early intervention for this population.