Dysphagia in paediatric acquired brain injury: Prevalence, outcomes, and impact of lesion sites on recovery

Children with an acquired brain injury can develop swallowing difficulties, known as dysphagia. Dysphagia can make eating and drinking unsafe and may lead to chest infections, poor nutrition, dehydration, and the need for tube feeding. Although dysphagia is recognized after some types of brain injury, little is known about how recovery differs depending on the cause and location of the injury in children. This study explored swallowing difficulties in 85 children aged 6 months to 16 years who were admitted to a specialist neurorehabilitation service following moderate to severe acquired brain injury. The study included children with traumatic brain injury (TBI), stroke, hypoxic brain injury (caused by lack of oxygen to the brain), infection, autoimmune conditions, and other acquired neurological conditions. Brain scans were reviewed to investigate whether specific injury patterns were linked to swallowing recovery. Swallowing difficulties were common across this population. TBI, infection, and hypoxic brain injuries had the highest rates of dysphagia at admission. Children with injuries affecting both sides of the brain were much more likely to experience dysphagia than those with injury on one side only. Importantly, all children with unilateral (one-sided) injuries regained oral feeding by discharge from hospital. In contrast, children with bilateral injuries, especially those involving both cortical and subcortical brain regions, were more likely to have ongoing swallowing difficulties. In our study, brainstem involvement was not found to be significantly associated with dysphagia at admission or discharge.