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.