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Swallowing - Swallowing,Impaired pharyngeal, RelatedFactors...

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Swallowing, Impaired Abnormal functioning of the swallowing mechanism associated with deficits in oral,  pharyngeal, or esophageal structure or function Related Factors  Congenital Deficits  • Upper airway anomalies; mechanical obstruction (e.g., edema, tracheostomy tube, tumor); history of tube feeding • Neuromuscular impairment (e.g., decreased or absent gag reflex, decreased strength or excursion of muscles involved in mastication, perceptual impairment, facial paralysis); conditions with significant hypotonia • Respiratory disorders; congenital heart disease • Behavioral feeding problems; self-injurious behavior • Failure to thrive; protein energy malnutrition Neurological Problems  • Nasal or nasopharyngeal cavity defects; oropharynx, upper airway, or laryngeal anomalies; tracheal, laryngeal, or esophageal defects • Gastroesophageal reflux disease; achalasia • Traumas; acquired anatomical defects; cranial nerve involvement; traumatic head injury; developmental delay; cerebral palsy • Prematurity Defining Characteristics  Subjective  Esophageal Phase Impairment  • Complaints [reports] of "something stuck"; odynophagia • Food refusal; volume limiting • Heartburn; epigastric pain • Nighttime coughing or awakening Objective  Oral Phase Impairment  • Weak suck, resulting in inefficient nippling • Slow bolus formation; lack of tongue action to form bolus; premature entry of bolus • Incomplete lip closure; food pushed out of or falls from mouth • Lack of chewing • Coughing, choking, or gagging before a swallow • Piecemeal deglutition; abnormality in oral phase of swallow study • Inability to clear oral cavity; pooling in lateral sulci; nasal reflux; sialorrhea; drooling • Long meals with little consumption Pharyngeal Phase Impairment  • Food refusal • Altered head positions; delayed or multiple swallows • Inadequate laryngeal elevation; abnormality in pharyngeal phase by swallow study
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• Choking; coughing; gagging; nasal reflux; gurgly voice quality • Unexplained fevers; recurrent pulmonary infections Esophageal Phase Impairment  • Observed evidence of difficulty in swallowing (e.g., stasis of food in oral cavity, coughing/choking); abnormality in esophageal phase by swallow study • Hyperextension of head (e.g., arching during or after meals) • Repetitive swallowing; bruxism • Unexplained irritability surrounding mealtime • Acidic smelling breath; regurgitation of gastric contents (wet burps); vomitus on pillow; vomiting; hematemesis
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