The Chicago Feeding Group is excited to welcome Hema Desai, MS, CCC-SLP, BCS-S, as she shares her knowledge and insight into how congenital heart defects impact feeding and swallowing development in infants. Ms. Desai’s value for a multidisciplinary approach to care and her awareness of the impact that addressing underlying medical issues can have on feeding outcomes are demonstrated in her participation in research and efforts towards education. Here are a few highlights from her work:  

Neurodevelopmental Considerations in Infants with Congenital Heart Defects 

In the article Neurodevelopmental Intervention Strategies to Improve Oral Feeding Skills in Infants with Congenital Heart Defects (2019), Ms. Desai highlighted the need to address neurobehavioral stability when addressing feeding challenges in infants with congenital heart defects (CHD). The whole feeding experience for infants with CHD is frequently disregarded, with emphasis typically placed on advanced oral motor skills and volume intake instead. The survival rate of children with CHD has increased significantly since 1980 given the advancements of surgical intervention and medicine, resulting in a need for further considerations of neuro developmental outcomes. Within their first week of life, infants with CHD often require procedures which, in addition to the risk of postoperative complications, can negatively impact their neurodevelopmental outcomes. As supported by the synactive theory of development (Als, 1986), a deeper understanding of an infant’s internal and external subsystems will serve as an indicator for their capacity to establish higher level feeding readiness skills. When clinicians are able to also identify signs of stress as an infant transitions to the oral feeding process as well as have an awareness of postsurgical considerations, feeding therapists and other appropriate strategies can be referred to as needed.  

Addressing Risks in High Flow Oxygen Therapy for Infant Feeding 

In the paper, High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness (2020), Desai and Raminick address the potential risk involved with the use of high flow oxygen therapy (HFOT) in infants with acute respiratory illness. While the use of HFOT has become more common for treating infants with respiratory illness to improve respiration, the effects that the added pharyngeal pressure has on swallow function is a growing concern. Existing literature is limited in addressing safety guidelines when it comes to oral feedings. To address the risk of potential adverse effects that HFOT has on swallowing, Desai and Raminick provide safer oral feeding recommendations for infants receiving this form of respiratory treatment. As a whole, both medical and therapy teams would benefit from having a standardized protocol in place to evaluate the readiness for oral feeds and the risk of aspiration.  

The Chicago Feeding Group is looking forward to Ms. Desai joining us to present her insights during the course titled “The Impact of Congenital Heart Defects on Feeding/Swallowing Development in Infants and Children.” 

Written by Nora Lewis,

Occupational Therapy Doctoral Student, Midwestern University

Als, H. (1986). A synactive model of neonatal behavioral organization: Physical & Occupational Therapy In Pediatrics, 6(3–4), 3–53. https://doi.org/10.1080/j006v06n03_02  

Desai, H., & Lim, A. N. (2019). Neurodevelopmental intervention strategies to improve oral feeding skills in infants with congenital heart defects. Perspectives of the ASHA Special Interest Groups, 4(6), 1492–1497. https://doi.org/10.1044/2019_pers-sig13-2019-0017  

Raminick, J., & Desai, H. (2020). High flow oxygen therapy and the pressure to feed infants with acute respiratory illness. Perspectives of the ASHA Special Interest Groups, 5(4), 1006–1010. https://doi.org/10.1044/2020_persp-19-00158