Dysphagia in Children With Congenital Heart Defects

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.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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Video Runtime: 46 Minutes; Learning Assessment Time: 49 Minutes

Infants and children with congenital heart defects are at high risk for dysphagia due to altered cardiac physiology and developmental delays as well as consequences of surgical intervention and timing. These early challenges can result in persistence of feeding and swallowing difficulties into early childhood, affecting the parent/child relationship and overall development. This intermediate course will benefit clinicians working with this population by helping them understand modifiable and unmodifiable risk factors for dysphagia and how to manage and facilitate improved oral feeding and swallowing development before and after cardiac intervention.

Learning Objectives

Identify at least four risk factors for dysphagia in children with CHD
Examine two modifiable and two nonmodifiable factors when determining a management plan for oral feeding for children with CHD
Apply knowledge of cardiac physiology to understand impact on respiration and ventilation in infants with CHD
Implement a feeding plan for an infant with vocal fold injury following cardiac surgery
Determine appropriate timing and intensity of feeding therapy depending on the post cardiac intervention course

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. Overview of Dysphagia in CHD

Dysphagia is common in children with congenital heart defects, affecting up to 50% of infants and persisting into early childhood. The risk factors for dysphagia include younger age, evidence of aspiration, reflux, and more complex cardiac surgery.

2. Nonmodifiable and Modifiable Risk Factors for Feeding and Swallowing Disorders

Infants and children with CHD are at high risk for neurodevelopmental delays due to pre-, peri-, and postoperative factors. Nonmodifiable factors (patient specific) and modifiable factors (environment) influence each other and may contribute to neurodevelopmental challenges that impact feeding and swallowing skill development.

3. CHD and Respiration: Impact on Dysphagia

Cardiac defects causing increased blood flow to the lungs are one of the primary lesions resulting in increased respiratory rate and work of breathing. Oftentimes, these defects are not repaired in the newborn stage, increasing risk of learning aberrant motor patterns due to delayed surgical intervention. Infants who have early cardiac surgery may require noninvasive respiratory support, impacting development of appropriate neuromotor pathways for suck/swallow/breathe coordination.

4. CHD and Vocal Fold Injury: Impact on Dysphagia

Various cardiac lesions require intervention on or near the aortic arch, which can result in nerve injury and subsequent vocal fold paresis, placing the child at high risk for aspiration. Prognosis for recovery and treatment strategies vary for each child and must be managed individually.

5. CHD and Developmental Delays: Impact on Dysphagia

Infants with CHD are tasked with recovery from cardiac surgery and learning neurodevelopmental skills, including oral feeding, at the same time. Stress from the intensive care unit environment, side effects from sedation weaning, and missed milestones due to surgical timing at critical windows of development are all high-risk factors for delayed or disordered feeding and swallowing skills.

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