Challenges and Controversies in Feeding Children With Congenital Heart Disease

presented by Hema Desai, MS, CCC-SLP, BCS-S, CLEC, NTMTC and Karli Negrin, MS, CCC-SLP

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Disclosure Statement:

Financial: Hema Desai is an employee for CHOC Children’s Hospital. She also receives compensation from MedBridge for this course.
Nonfinancial: Hema Desai is a vice-chair for Cardiac Newborn Neuroprotective Network (CNNN). She has no other competing nonfinancial interests or relationships with regard to the content presented in this course.

Financial: Karli Negrin is an employee for Nemours Children’s Health. She also receives compensation from MedBridge for this course.
Nonfinancial: Karli Negrin is a vice-chair for Cardiac Newborn Neuroprotective Network (CNNN) and is a part of the steering committee for Cardiac Neurodevelopmental Outcome Collaborative (CNOC). She has no other competing nonfinancial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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Video Runtime: 63 Minutes; Learning Assessment Time: 43 Minutes

The management of congenital heart disease is a relatively new science and was initially focused on infant survival. There is now a rising concern for the impact of surgical interventions on feeding development. The literature available for dysphagia and feeding management in this specialized population remains scarce in comparison to literature on the neonatal population, lending to controversies in feeding management in infants with congenital heart disease. This intermediate course will benefit clinicians working with this population by analyzing current trends and controversies in dysphagia management in this unique population, identifying research gaps, and describing practice variability in feeding management.

Learning Objectives

Compare the timing of three common surgical interventions for infants born with congenital heart disease (CHD) to the approximate developmental feeding milestone
Recognize two controversies to application of research in preoperative feeding for infants born with congenital heart defects
Analyze three factors in opposing views on feeding infants with CHD on high-flow respiratory support
Examine two controversies in the management of dysphagia in infants with vocal fold paresis
Analyze three challenges to feeding interventions to support infants with CHD who are experiencing hypermetabolism
Examine three controversies in the use of thickened oral liquids for dysphagia management for infants with reduced mesenteric blood flow
Analyze three challenges in early breastfeeding introduction for infants born with congenital heart defects
Examine three key factors of the social-emotional impact of infant feeding challenges on parental mental health

Meet Your Instructors

Hema Desai, MS, CCC-SLP, BCS-S, CLEC, NTMTC

Hema Desai is an inpatient speech pathologist who has worked with infants and children with feeding and swallowing disorders since 2000. She has her board-certification specialties in swallowing and swallowing disorders (BCS-S) and neonatal touch and massage (NTMTC) and is a clinical lactation education counselor (CLEC). Hema is a clinical supervisor for graduate students, as…

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Karli Negrin, MS, CCC-SLP

Karli Negrin is an international public speaker and researcher in the areas of cardiac neurodevelopment, cardiac neuroprotection, and cardiac aerodigestive science. Her primary area of research emphasizes preserving the critical relationship of the parent-child dyad for infants born with congenital heart disease. Karli is a leader in her science and is internationally recognized for her…

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Chapters & Learning Objectives

1. Juxtaposition Between Development and Recovery

Infants with congenital heart disease often require surgical intervention within the first weeks or months of life to survive. This is a time usually dedicated to foundational feeding skills development. Infants with CHD often are in a period of recovery and development at the same time.

2. Challenges and Controversies in Preoperative Feeding for Infants Born With CHD

Infants born with single-ventricle heart defects, such as hypoplastic left heart syndrome, may be restricted in oral feeding opportunities prior to surgical intervention. There are conflicting views on preoperative oral feeding and gastric feeding opportunities in this unique population due to an underlying concern for necrotizing enterocolitis. This chapter will discuss opposing views of preoperative feeding risk in this high-risk population.

3. Feeding Infants With CHD on Noninvasive Respiratory Support

Infants born with CHD often require respiratory support in the perioperative period of their surgical course. Currently, the trend of feeding on high-flow respiratory support is controversial, with practices borrowed from the neonatal intensive care population.

4. Controversies in Management of Aspiration and Vocal Fold Paresis

Vocal fold paresis is a common postoperative complication following surgeries surrounding the aortic arch. This discussion will encourage critical thinking in both timing and utilization of instrumental evaluation of swallow, dysphagia management, enteral nutrition decisions, and the application of the airway assessment into clinical decision-making regarding dysphagia management.

5. CHD and Hypermetabolism

In this chapter, we’ll analyze three challenges to feeding interventions to support infants with CHD who are experiencing hypermetabolism.

6. Utilization of Thickened Liquids for Infants With Reduced Mesenteric Blood Flow

Infants born with CHD may experience higher resting metabolism than infants who are born without CHD. This chapter will discuss challenges with weight gain in this population as well as support the clinician in prioritization of feeding goals.

7. Challenges With Exclusive Breastfeeding for Infants Born With CHD

Although the benefits of breastfeeding are well supported in the literature, there are challenges with implementation of exclusive breastfeeding in the pre- and postoperative management of infants with congenital heart defects. Given the finite balance of intake and output, fluid restrictions, postoperative holding restrictions, and requirement for increased caloric density for nutrition management, perioperative exclusive breastfeeding remains a challenge in this population.

8. Social and Emotional Impact of Feeding Challenges for Parents of Children With CHD

Parents of infants with congenital heart disease are at risk for depression and posttraumatic stress, in part due to parental role alteration. Parents of infants with CHD report feelings of helplessness in caring for the basic needs of their infants, such as holding, calming, and feeding.

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