Dr. Haguki's Field Guide ① 🟢 'Can we support eating while using nasal high flow?' Endoscopic evaluation of swallowing, food texture adjustment, oral care... Let's take a peek at the field of pediatric home dental care
*The scenes and individuals appearing in this article have been reconstructed based on actual clinical practice with consideration for privacy.
🌱 The Field This Time
We visited the home of a one-year-old child with congenital heart disease, accompanied by a dentist, a dental hygienist, and a registered dietitian. This visit was requested by the child's neonatologist.
The home was equipped with various devices to support home medical care, where the living space and the medical space naturally overlapped. Delivering 'eating support' to the home through the collaboration of dentistry and nutrition—that is one form of pediatric home dental care.
🔵 What is Nasal High Flow?
A tube for a device called nasal high flow is connected to this child's nose.
Nasal high flow is a respiratory support device that continuously delivers warmed oxygen through the nose at a constant flow rate. Because it can deliver oxygen more stably and at a higher flow rate than standard oxygen inhalation, it is sometimes used for children with unstable respiratory conditions.
'Just because they are using a device doesn't mean eating support is still far off.' While carefully checking their condition, we can proceed with an approach to 'eating' at the child's own pace.
🔵 The Connection Between Congenital Heart Disease and 'Eating'
For children with congenital heart disease, the state of their heart and breathing can affect 'eating.' There may be a need to consider fluid intake, or they may have difficulty coordinating breathing and swallowing, which can lead to swallowing challenges.
If the respiratory condition is not stable, it can be difficult to start an approach to eating, and anxiety about 'what risks might be involved if we try to start' can grow. Being there for that anxiety and thinking together about what can be done for this child right now is the starting point for home-based eating support.
🔵 Organizing the Current Situation in Three Phases
When supporting 'eating,' we organize the current situation from the perspective of 'three phases' (Knowledge Note ①).
How is the sensation and function at the entrance of the mouth (Phase 1), how is the processing of food inside the mouth (Phase 2), and are there any challenges with the swallowing function (Phase 3)—we look at which stage the child is currently in while keeping this flow in mind.
In this child's case, we started with Phase 1—addressing challenges with the sensation at the entrance of the mouth—during our previous involvement (Knowledge Note ②). Now that the mouth has developed a little, we judged that 'the time has come to check the swallowing state,' which led to this visit.
🟢 Endoscopic Evaluation of Swallowing—'Seeing' the Swallowing
During this visit, we performed an endoscopic evaluation of swallowing. This is an examination where a thin endoscopic camera is inserted through the nose to observe the movement of the throat in real-time while the child actually eats (Knowledge Note ⑤).
By visually confirming whether the food has entered the airway (aspiration) or if it remains in the throat (pharyngeal residue), we can judge with evidence 'what food texture is safe for this child right now.'
This examination can be performed even while using nasal high flow.
🟢 Together with the Registered Dietitian—Talking About Thickening and Food Texture
Based on the test results, the registered dietitian explained to the family how to adjust the thickness of the food.
They carefully explained the types of thickening agents, how to add them to liquids, and the approximate amounts, using diagrams. When heart disease is present, managing fluid intake is also an important perspective. While increasing swallowing safety with thickening agents, we think together with the family about how to ensure necessary hydration and nutrition—combining perspectives from dentistry and nutrition.
Home-based eating support is something the family will continue in their daily lives. We value finding 'methods that can be sustained' together.
🟢 Oral care is also an important step toward 'eating'
When approaching eating by mouth, the importance of oral care increases even further.
Children who require medical care may have mouths that dry out easily or environments where bacteria can easily multiply. Keeping the inside of the mouth clean also leads to lowering the risk of aspiration pneumonia.
During this visit, the dental hygienist provided advice to the family on oral care methods. What tools to use, how to clean the inside of the mouth—we check these together so that the family can continue daily care without strain.
🌱 Conclusion—Eating support that reaches your home
What was accomplished during this visit:
Evaluation of swallowing via endoscopic examination (Dentist)
Proposals and advice on safe food textures and thickening (Registered Dietitian)
Advice on oral care (Dental Hygienist)
In parallel with hospital treatment, there is a system where you can receive this kind of 'eating support' at home. If you are a family member who feels 'this might be necessary for my child,' please first consult your primary care physician or local support staff.
📝 About this article
The scenes and individuals appearing in this article have been reconstructed based on actual medical care with consideration for privacy. Every child's eating and swallowing condition is different. If you have any concerns, please consult your primary care physician or staff specializing in eating and swallowing.