Pediatric Dysphagia; Etiologies, Diagnosis, and Management

Review by L Flood
Middlesborough, UK

Once more, this publisher has come up with a very novel topic for a new textbook, and their catalogue does show quite a range of very recent publications on paediatric swallowing disorders. Throughout, the need for a multidisciplinary approach is stressed and, indeed, the chapter entitled ‘Role of the Pediatric Otolaryngologist’, in nine pages, tells us that this is largely to exclude an associated airway disorder. That is not unreasonable, when we then see nine consecutive chapters similarly labelled as ‘the Role of…’, this ranging from the pulmonologist to the social worker.

Paediatric dysphagia is a highly specialised and centralised issue, and all contributors illustrate the expertise that has developed since 1987 in Cincinnati, Ohio, as is stressed in the Foreword by Robin Cotton. This is a substantial text of over 700 pages, taking the reader through the basic science of swallow and especially its maturation in infancy, and then onto the many disorders, whether structural or behavioural. There is many a genetic syndrome described of course, even if frequently illustrated with what to this reader looked like perfectly normal, delightful children! I did like the ‘molar tooth sign’ of Joubert’s syndrome, however. There follows extensive coverage of assessment, stressing individual roles, as outlined above, and then chapters on radiological and endoscopic investigations. Five chapters concentrate on the neonatal intensive care unit. The final 200 pages cover treatment strategies, whether for craniofacial anomalies, neurogenic and sensory processing disorders, or behavioural issues. A relatively short, but welcome, closing section addresses evidence-based practice and even ethical dilemmas.

The text is well set out throughout, with headed paragraphs, nicely reproduced tables and line diagrams, and a comprehensive index. Boxed and highlighted pearls of wisdom can seem fairly simplistic (e.g. in feeling a need to define iatrogenic disease, eosinophilia or hyperbilirubinaemia), until one recalls that this is aimed at a very diverse readership. Photography and the resulting illustrations can be less than convincing, with some very dark and grainy images, which sometimes defy interpretation (e.g. a contrast bolus swallow (page 343) or a disappearing baby (page 446)). Any problem with the pictures is more than compensated for by the quality and comprehensive nature of the text, however. This is not claiming to be an atlas.

This book should have a very wide appeal, addressing as it does a largely neglected topic, which requires an input from a host of specialists. Its greatest value in our specialty will be to those training in, or with an established practice in, paediatric otolaryngology.

Amazon Link: Pediatric Dysphagia; Etiologies, Diagnosis, and Management
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