LATE MATURATION OF SUCKING AND SWALLOWING

Background. - Neomates with neurological diseases often have difficult y in sucking or swallowing. This report describes such difficulties in a group of infants with normal development, suggesting late maturatio n of sucking and swallowing. Population and methods. - Seven infants ( four girls, three boys) had suffered from aspiration since their first day of life (four cases) with severe asphyxia (two cases), late repea ted episodes of airway obstruction by accumulated secretions (two case s), and weak isolated sucking and swallowing (one case). The lack of s ucking and swallowing or difficulty with them were the main manifestat ions in these newborns: the face lacked expression and the tongue move ments were abnormal with, in two cases, hyperextension of the neck. A second phase during the first months of life was marked by episodes of bradycardia and/or drowsiness. A third phase during the first years o f life was characterized by repeated episodes of respiratory infection s, recurrent stridor and accumulation of saliva. These manifestions re quired prolonged hospitalization (mean: 2.5 months), nasogastric feedi ng, and in two cases, surgery. The investigations during the acute pha ses included a cineradiographic study of swallowing, laryngoscopy, mon itoring of the distal esophagus pH, a barium swallow, polygraphic reco rding during sleep and MR imaging of the brain stem. The difficulties in sucking or swallowing disappeared before the age of 6 months (two c ases), between 6 and 12 months (one case), between 1 and 5 years (for cases) without any sequelae or speech disorders. Conclusion. - These t ransient sucking or swallowing difficulties suggest late maturation of praxis. They required specialized prolonged education after careful, essentially clinical, investigation.