• Nyla Claire Lamm, Amy De Felice, and Abba Cargan.
• Department of Pediatrics, Division of Gastroenterology and Nutrition, New York Columbia Presbyterian Children's Hospital, New York, NY 10032, USA. nl13@columbia.edu
• Dysphagia. 2005 Jan 1;20(4):311-24.

AbstractThere is a scarcity of empirical evidence on effective treatments of swallowing dysfunction in young children who do not suck or swallow. There is no literature testing the effects of shaping a reflex or specifically shaping a swallow reflex. The purpose of this retrospective study was to investigate and isolate the specific regional mechanical functions of the tongue during swallowing. This study included 45 patients who did not swallow because of multiple congenital anomalies and gastroenterologic dysfunctions before and after corrective surgery and had histories of unsuccessful traditional feeding therapies. Evaluation included clinical gastroenterologic, nutritional, and neurologic examination, routine laboratory tests, and radiologic swallowing studies. A ten-year study analyzed the behavioral science procedures shaping both a swallow reflex and lingual surface geometry. Treatment variables were (1) a tactile stimulus to the posterior tongue and (2) sequential tactile stimuli to varied locations on the lingual surface. There were significant differences in lingual responses for all patients who were transferred from artificial feedings to independent prototypical swallowing capability and acquired oral consumption of recommended daily hydration and nutrition in 5-7 days of treatment. The initial tactile stimulus and six-level sequential stimuli resulted in six sequential lingual responses within each wavelike swallow reflex. Results of stimuli shaping varied lingual responses across 45 patients with severe multiple medical and anatomical deficits in swallowing, suggest that the etiology was not relevant in this population. These behavioral science approaches are novel treatment for pediatric lingual dysphagia.

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