The functional chewing training for chewing dysfunction in children with repaired EA-TEF

J Pediatr Surg. 2020 Apr;55(4):635-638. doi: 10.1016/j.jpedsurg.2019.04.028. Epub 2019 May 7.


Background/purpose: Chewing disorders (CD) may cause restrictions in solid food intake and can be seen in 37% of children with esophageal atresia-tracheoesophageal fistula (EA-TEF). The Functional Chewing Training (FCT) is a holistic approach to improve chewing function (CF) in children. The study aimed to evaluate the effects of FCT on CF in children with EA-TEF.

Methods: Twenty children with CD were included. Patients received 12 weeks FCT including impairment-based and adaptive components. Chewing performance level was scored with Karaduman Chewing Performance Scale (KCPS), and tolerated food texture was determined by the International Dysphagia Diet Standardization Initiative (IDDSI). The baseline and final levels of KCPS and IDDSI were compared to evaluate the effects of FCT on CF.

Results: Forty-five percent of cases were isolated-EA, and 55% were EA-distal TEF with a median age of 31 (min = 25, max = 84) months, of which 65% (n = 13) were male. Baseline evaluation showed that 12 cases were in level-1, 6 cases in level-3 and 2 cases in level-4 according to KCPS. Eight children with CD (40%) had IDDSI level-3 and 12 (60%) had level-7. There was a significant improvement in KCPS scores and IDDSI scores after 12 weeks of training (p < 0.01, p = 0.005,respectively). KCPS scores showed level-0 in 15 cases, and level-1 in 5 cases. All children had IDSSI level-7.

Conclusions: The FCT is an effective method to improve chewing function in children EA-TEF who had CD.

Type of study: Single group treatment study.

Level of evidence: Level 4.

Keywords: Chewing disorders; Chewing exercise; Esophageal atresia; Tracheoesophageal fistula.

MeSH terms

  • Child, Preschool
  • Deglutition Disorders / etiology
  • Deglutition Disorders / rehabilitation*
  • Esophageal Atresia / rehabilitation*
  • Esophageal Atresia / surgery
  • Female
  • Humans
  • Male
  • Mastication*
  • Tracheoesophageal Fistula / rehabilitation*
  • Tracheoesophageal Fistula / surgery

Supplementary concepts

  • Esophageal atresia with or without tracheoesophageal fistula