Pediatric Dysphagia

In 1997, Seminars in Speech and Language published two issues focused on pediatric dysphagia because it was considered a rapidly growing patient care focus for speech-language pathologists. Flash-forward 20 years, and this area of patient care is still growing and evolving. The complexity of working clinically in this area is appreciated by all clinicians for whom it is a focus, as well as those clinicians who find themselves responsible for this population but feel unprepared to provide evidence-based services. Our master's degree is still considered an entry-level degree, and pediatric dysphagia is typically covered as a topic within the larger discussion of dysphagia. Consequently, special issues such as this one continue to be critically important to the continuing education of practicing clinicians.

The prevalence of newborns, infants, and children with feeding and swallowing problems continues to be difficult to estimate because of the different populations impacted (i.e., typically developing children versus children with a range of developmental disorders) and the variety of etiologies and related prognoses that may be associated with a diagnosis of pediatric dysphagia (e.g., an acquired structural anomaly versus a neurologic etiology). What is known is that the prevalence of pediatric dysphagia is on the rise as a result of the increased survival rates of children born prematurely and those born with complex medical conditions; speech-language pathologists remain integrally involved in the assessment and management of newborns, infants, and children with dysphagia.

This 20th anniversary issue highlights the “state of the science” for the respective areas covered. In looking back over the inaugural issues, as well as the 10th anniversary issue, several conclusions are clear: (1) a team approach remains the gold standard for treating newborns, infants, and children with pediatric dysphagia, regardless of etiology, prognosis, or service delivery setting, and (2) parents are central to the team because we have an advanced knowledge base regarding the short- and long-term impact of feeding and swallowing disorders on the emotional and financial well-being of families. The topics covered here include consideration of complex dynamical systems as a theoretical foundation for clinically framing pediatric dysphagia (Goldfield, Perez, and Engstler), neonatal coordination of respiration and swallowing (Gross and Trapani-Hanasewych), and developmentally supportive newborn feeding in the neonatal intensive care unit and beyond (Shaker). The next three articles focus on pediatric feeding disorders for children with significant developmental disabilities (Kleinert), managing pediatric dysphagia in the school setting (O'Donoghue and Nottingham), and advances in instrumental assessment of pediatric dysphagia (Arvedson and Lefton-Grief). The final article provides a glimpse into the technology that may help us better identify, as early as possible, those neonates with pediatric feeding challenges who are at greatest risk for poor developmental outcomes (Capilouto et al).

As guest editor, it is my hope that this special anniversary issue will highlight the advances in pediatric feeding and swallowing of the previous decade, expand clinical knowledge for practicing clinicians, and stimulate readers to contribute to the evidence base supporting assessment and treatment of pediatric dysphagia. I thank all of the authors for their outstanding contributions to this landmark issue, Stacy Wagovich for her encouragement and help all along the way, and Thieme New York for recognizing the need to revisit this topic as the numbers of speech-language pathologists specializing in the management of children with feeding and swallowing challenges continues to grow.