Turkiye Klinikleri Journal of Pediatrics

.: REVIEW
Çocuklarda Çiğneme Bozukluklarına Yaklaşım
Approach to Chewing Disorders in Children
Selen SEREL ARSLANa
aHacettepe Üniversitesi Fizik Tedavi ve Rehabilitasyon Fakültesi, Ankara, TÜRKİYE
Turkiye Klinikleri J Pediatr. 2020;29(3):168-74
doi: 10.5336/pediatr.2020-77155
Article Language: TR
Full Text
ÖZET
 Çiğneme fonksiyonu, katı yiyecekleri öğütmek ve yumuşatmak için gerekli ritmik oral motor aktivitelerin bütünüdür. Katı yiyecekleri, yumuşak ve yapışkan bir lokma hâline dönüştürmede yaşanan zorluklar, çiğneme bozukluğu olarak tanımlanmaktadır. Çocuklarda çiğneme bozukluğu yeterli besin alımını zorlaştırmakta, büyüme ve genel sağlığı olumsuz yönde etkilemektedir. Çiğneme bozukluğu, aile bireylerini de etkilemektedir. Özellikle birincil bakım veren kişiler, besinleri çocuğa uygun hâle getirmek için daha fazla zaman harcamakta, öğün süreleri uzamakta, beslenme yorucu hâle gelmekte, çocuk ile bakım veren arasındaki etkileşim olumsuz yönde etkilenmekte ve hem çocuk, hem de ailenin yaşam kalitesi azalmaktadır. Bu nedenle çocuklarda, çiğneme bozuklukları erken dönemde tespit edilmeli ve uygun müdahale programı belirlenmelidir. Bu derlemenin amacı, çocuklarda çiğneme bozukluklarına yaklaşım basamaklarını tanımlamak ve yol gösterici bir kaynak sunmaktır. Çocuklarda çiğneme bozukluklarında, bireye özel ve uygun yaklaşımın belirlenmesi için klinik karar verme süreci sürdürülmektedir. Değerlendirme, klinik karar verme sürecinin ilk basamağıdır. Çiğneme bozukluklarının değerlendirilmesi; öykü alımı, baş, boyun ve gövde kontrolünün değerlendirilmesi, tonus ve beslenme pozisyonlarının değerlendirilmesi, çiğnemede görevli yapıların fiziksel değerlendirilmesi ve çiğneme fonksiyonunun gözlemsel ve aletsel teknikler ile değerlendirilmesini içermektedir. Değerlendirme sonucunda, çiğneme bozukluğunun nedenleri saptanmakta ve bu nedenlere yönelik, hastaya özel rehabilitasyon programı oluşturulmaktadır. Çiğneme bozukluğunun rehabilitasyonunda amacımız; uygun dudak, dil ve yanak koordinasyonunu sağlamak, öğütme işlevinin etkinliğini geliştirmek ve besini lokma hâline getirmeyi sağlamaktır. Rehabilitasyon sürecinde gerçekçi hedeflerin belirlenmesi, olumsuz deneyimlerin azaltılması ve olumlu davranışların pekiştirilmesi de oldukça önemlidir.

Anahtar Kelimeler: Çocuk; çiğneme; çiğneme bozukluğu; çiğneme eğitimi
ABSTRACT
 Chewing function is the rhythmic oral motor activity required to grind and soften solid foods. Difficulties in transforming solid foods into a soft and cohesive bolus are defined as chewing disorders. Chewing disorders complicate adequate food intake, negatively affect growth and overall health. It also affects family members. In particular, primary caregivers spend more time for preparing foods suitable for child, meal times are prolonged, feeding becomes tiring, interaction between child and caregivers is negatively affected, and quality of life for both child and family is decreasing. Thus, chewing disorders in children should be detected in early period and appropriate intervention program should be determined. The purpose of this review is to describe the steps of approach to chewing disorders in children and provide a guiding reference. A clinical decision-making process is maintained to determine an individual and appropriate approach in children. Evaluation is the first step of the clinical decision making process. Evaluation of chewing disorders include history taken, evaluation of head, neck and trunk control, evaluation of tonus and feeding positions, physical assessment of structures involved in chewing function, and evaluation of chewing function by observational and instrumental techniques. As a result of evaluation, the causes of chewing disorders are determined and a patient-specific rehabilitation program is established. The goal in rehabilitation of chewing disorders is to ensure proper lip, tongue and cheek coordination, improve the effectiveness of grinding function and transform food into bolus. It is also very important to set realistic goals in rehabilitation process, reduce negative experiences and reinforce positive behaviors.

Keywords: Child; mastication; chewing disorders; chewing training
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