嬰幼兒吞嚥機轉(Pediatric Swallowing Anatomy & Physiology)

Pediatric Dysphagia   
(source from: American Speech-Language-Hearing Association (ASHA))

include difficulty with any step of the feeding process (mouth àstomach and intestines ). atypical eating and drinking behaviors, such as not accepting age-appropriate liquids or foods, being unable to use age-appropriate feeding devices and utensils, or being unable to self-feed.

Dysphagia can occur in any phase of the swallow(Logemann, 1998):

Oral preparation stage : (口腔準備期)
preparing the food or liquid in the oral cavity to form a bolus-including sucking liquids, manipulating soft boluses, and chewing solid food.

Oral transit phase:(口腔期)
moving or propelling the bolus posteriorly through the oral cavity.

Pharyngeal phase: (咽部期)
initiating the swallow; moving the bolus through the pharynx.

Esophageal phase: (食道期)
moving the bolus through the cervical and thoracic esophagus and into the stomach via esophageal peristalsis

◎ Infant’ s swallow anatomy:

Picture source: http://spiritedspeechpathology.blogspot.tw/

 
 資料整理來源: (2004)。吞嚥障礙評估與治療。 J.A. Logemann著；盛華總校閱；葉麗莉等譯。

Tongue 舌頭	Tongue fills the oral cavity; tongue rests between lips and sits against palate 舌頭占滿整個口腔，相對於口腔舌頭的尺寸較大; 舌頭靜止位於雙唇和顎間
Cheeks 臉頰	Sucking pads in the cheeks which provide stability during sucking. 臉頰有吸允墊(sucking pads)，兩頰內部的脂肪較厚，口腔側邊窄，同時能穩定舌頭在口腔的位置，能容易吸允。
Velum/ soft palate 懸雍垂	The soft palate and epiglottis are in contact at rest, providing a valve at the back of the oral cavity, than swallowing the food. 懸壅垂位置較低，靠近會厭軟骨(epiglottis)，在會厭谷( vallecula )形成一個口袋，此時食物可慢慢累積，然後再吞下。
Epiglottis 會厭	The epiglottis is more bending than adult. 會厭(epiglottis)的形狀較成人彎曲
Hyoid bone & Larynx 舌骨&喉部	The larynx and hyoid cartilage are higher in the neck and closer to the base of the epiglottis. The height as cervical vertebrae 3th-4th as the same, to protect the airway. 舌骨位置較高與下頷的位置同高，喉部位置也較高、接近舌根(tongue base)和會厭 (epiglottis)，位於頸椎第三至第四節處(C3-C4)，以保護呼吸道。 吞嚥動作時其喉部上抬的程度較成人少，且喉部的大小約為成人喉部的1/3。
Arytenoid 杓狀軟骨	The vocal process of arytenoid are longer, so the vocal folds close easier. 杓狀軟骨( Arytenoid)結構中的聲帶突(vocal process)較長，讓聲帶(vocal folds)較容易閉合。
pharynx 咽部	The pharynx shorter and narrower, so the foods into the esophagus are easier. 咽部(pharynx)較短且窄，讓食物更容易進入食道。
Post pharynx wall 後咽壁	Post pharynx wall more elastic, forward, and the foods into esophagus smoothly. 後咽壁( PPW)較具彈性，比較容易前傾，讓食物能更順利下降至食道

  

  

＊吞嚥機轉特徵: 

   -藉由壓縮(compression)及吸允(sucking)液體進食，且口腔內的溝(sulci)對吸允(sucking)是重

  要的影響

  -生理構造更能自然保護呼吸道

  -吸允和呼吸同時並存 
  -未明確界定口咽腔(no definite oropharynx)

＊孩子更成熟時:

  (1)下頦(jaw)向下及向前增長(the jaw grows down and forward)

  (2)舌頭往下移動 (the tongue moves down.)

  (3)舌頭與硬顎(palate)間的空間增加(the space between the tongue and the palate increases)

  (4)喉部、舌骨下降，咽腔延長並擴大

      (the larynx and the hyoid bone lower, elongating and enlarging the pharynx)'

＊當嬰幼兒開始吃泥狀食物(purees food)，口腔期及咽部期與成人相似。