# Electrical Stimulation May Improve the Feeding and Nutritional Status of Children with Dysphagia
## 1 Introduction  
Food intake depends on swallowing. It is a complex process that involves the actions of many muscles and nerves [1]. However, most children are born with this skill. Infants typically receive hydration and nutrition from the breast or bottle. Safe feeding requires precise coordination of swallowing and breathing [2, 3]. Newborns normally master this coordination within 20-30 min of their first feed after birth [4]. Nonetheless, feeding disorder due to difficulty swallowing may arise in children born prematurely, with malformations, neurological issues, or medical complications [5, 6, 7]. The term 'dysphagia' refers to difficulty swallowing, which can be caused by various underlying conditions [8]. The exception is the occasional occurrence of difficulty in swallowing certain foods or liquids, such as when taking too large a bite of food. Dysphagia in pediatric patients is a kind of pediatric feeding disorder (PFD). According to the World Health Organization (WHO), PFD is defined as impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. Various causes of PFD are emphasized, such as medical, oromotor, or behavioral difficulties [9]. Any approach to feeding issues emphasizes that PFD or dysphagia is a complex and multifaceted issue that necessitates the involvement of numerous specialists from diverse fields [10, 11, 12]. Dysphagia concerns various activities associated with eating, including difficulties in oral intake of food, or liquids, forming a bolus (a bowl-like food bite), or swallowing (Figure 1) [12; 13]. It may manifest as a singular symptom or as one of a collection. Some kinds of feeding problems occur in about 25-45% of children, and in children with developmental delays, this percentage reaches as much as 80% [14; 15]. This mainly affects children with neurological disorders of the functioning of the muscles responsible for swallowing. Dysphagia is also common in children with anatomical abnormalities, such as cleft palate, laryngeal deformities, or esophageal atresia, or genetic conditions such as Down syndrome [8; 11; 12; 16]. Another case is that of neurological problems, e.g., disorders of the function of the orofacial muscles involved in, among others, the oral-facial complex taking part in feeding and its transfer to the esophagus, as well as cerebral palsy or brain injuries [7; 17]. Dysphagia may also be attributed to disorders of the digestive system, such as gastroesophageal reflux, and may also be associated with posture and movement control issues [2; 3; 18]. Children with dysphagia resulting from neurological disorders exhibit an elevated frequency of upper respiratory tract infections, thereby increasing the likelihood of recurrent pneumonia [8; 19]. Figure 1: Overview of dysphagia in children. Malnutrition, growth retardation, cognitive impairment, emotional dysfunction, weakened immunity, and increased susceptibility to disease are some of the health consequences of chronic feeding difficulties caused by dysphagia [16; 17; 18]. Moreover, aspiration to the respiratory tract and pneumonia are common respiratory complications [2; 16]. In extreme cases, they can even lead to death [16; 20]. Malnutrition as a result of dysphagia is particularly dangerous in newborns [2; 21]. In this situation, the child may lose weight quickly and develop energy and protein deficiencies, as well as dehydration. If this continues, it may lead to death [1]. To prevent the negative consequences of dysphagia, a multidisciplinary approach is necessary, including ensuring children's safe feeding, and improving nutritional status, anthropometric indicators, and quality of life [8; 22; 23]. Dysphagia can occur in newborns, but a considerable number of infants overcome dysphagia within the initial few weeks of life. The age of 3-4 months is the next time when dysphagia can become apparent. At three months of age, the sucking reflex begins to diminish, and solid foods are introduced to the diet.