Sucking and swallowing difficulties in infancy: diagnostic problem of dysphagia.

The purpose of this paper is to review the world literature about dysphagia in infancy, and to provide a simple classification, illustrated here by a brief resume of 19 personally observed cases. Finally, there is a short section on diagnosis and prognosis. There is a lack of a good discussion of the whole problem of dysphagia in a textbook, whether paediatric, neurological, dental, or otorhinolaryngological. Indeed, many of the textbooks devoted to these subjects do not include the word dysphagia (or suitable synonym) in the index. Part of the difficulty may lie in the fact that affected children may be referred to any of a variety of specialistspaediatricians, otorhinolaryngologists, maxillofacial surgeons, plastic surgeons, and, later, speech therapists, so that few have adequate experience of the problem. Accordingly I decided to review the literature, and apart from consulting all available textbooks devoted to the subjects of paediatrics, neurology, and otorhinolaryngology, I looked personally through 203 volumes of indices of the world literature-the Current List of Medical Literature, the Quarterly Cumulative Index Medicus, the Cumulative Index Medicus, and the Index Medicus, from volume 1 (1879) to December 1968, referring to all the papers quoted except two foreign articles (Bluhm, 1927; Dalloz, 1963) which I was unable to obtain. Most of the papers to which reference was made in these indices were under the heading of 'Deglutition, Disorders of'. I have interpreted the word dysphagia broadly, to include rumination and difficulties with sucking. For the purposes of this review, I propose to divide the references into two groups, those referring to gross structural abnormalities, and those referring to neuromuscular problems. There is a small amount of overlap between them. Gross Structural Abnormalities