Dr. Sarah Hegyi Szynkiewicz and colleagues published their investigation of two forms of external sensory stimulation on the effect of swallowing frequency in two age groups of typically-developing infants under 10 months of age in The Journal of Applied Physiology. Speech-language pathologists (SLPs), such as Dr. Hegyi Szynkiewicz, are experts in feeding and swallowing disorders.
One such disorder, dysphagia, involves difficulty swallowing and is most common in infant and geriatric populations. We know much more about swallowing disorders in adults than in infants and children. As it is a complex motor and sensory skill that requires practice, humans actually begin practicing swallowing in utero as a fetus develops prior to birth.
The practice, or what we call activity-dependent sensory experiences, helps the infant’s neurological system that controls swallowing develop and mature. Dysphagia in pediatric years commonly results from conditions such as development disability, neurological disorders, structural abnormalities, and heart and lung disease but even typically-developing infants and children can experience feeding and swallowing disorders.
Premature infants often experience dysphagia as their neurological and neuromuscular systems are immature and many receive food and drink primarily through tube feedings. This leads to less swallowing, meaning many premature infants are not receiving that experience-dependent swallowing practice.
Critically, as the prevalence of dysphagia in pediatrics is growing, speech-language pathologists are learning more about normal infant swallowing and therapeutic intervention for infants with dysphagia.SLPs need evidence-based treatment options for infants with dysphagia. Currently, therapy focuses on strategies that compensate for a swallowing disorder but do not fix the swallowing problem.
Using research on external swallowing stimulation helping adult patients re-gain swallowing function following neurological damage (e.g. stroke) as a guide, Dr. Hegyi Szynkiewicz’s work focuses on the typically-developing infant population in order to find out if external swallowing stimulation increases swallowing frequency in a normal infant swallowing system. Specifically, this work studied how a small vibratory device applied to the neck area effects swallowing frequency compared to an infant sucking on a pacifier. The team found that both devices significantly increased the frequency of swallowing in both infant age groups.
The study was ground-breaking in the area of pediatric dysphagia for several reasons. Both the vibratory device and pacifier may provide infants with immature swallowing skills a way to practice swallowing and neither of the external devices interfered with the infants’ breathing patterns. Importantly, both devices may facilitate appropriate development of the neurological pathways critical to feeding and swallowing by providing infants with motor practice for swallowing.
One key advantage that the vibratory device has over the pacifier is that it may be used during feeding to elicit and improve swallowing. Research shows that earlier oral feeding trials are important. Her work also contributed new knowledge of normal infant swallowing frequency. Although future research is needed to address the effect of the vibratory device with premature infants with immature swallowing skills, this innovative research may lead to new ways for SLPs to help infants with swallowing problems and help reduce the tremendous cost of prolonged hospital stays in the neonatal intensive care unit due to feeding difficulties.
Dr. Hegyi Szynkiewicz’s work offers a number of possible applications in the community including collaborations with SLPs working with infants and children with immature and disordered swallowing skills in local neonatal intensive care units such as Sarasota Memorial Health and St. Joseph’s Women’s Hospital.
Such collaborations may allow for enriched early intervention feeding and swallowing programs. In addition, local elementary schools serving young children with feeding and swallowing disorders may see benefits of this work. Clinician-research collaborations in our community would enhance our ability to drive research that may benefit our local infants and children experiencing trouble with feeding and swallowing.