Down症児の粗大運動発達が摂食嚥下機能の発達に与える影響

Influence of the development of gross motor skills on the feeding development in children with Down syndrome

　Down症(以下，DS)児の摂食嚥下機能と粗大運動の発達の関連に関する検討は少ない．本研究では，DS児の摂食機能について粗大運動の観点から横断的に検討し，発達的変化とその関連について明らかにすることを目的とした．38名のDS児を対象に食事場面を動画記録し，舌挺出の割合や押しつぶしの有無を評価した．また，粗大運動発達を併せて評価し，摂食嚥下機能と粗大運動発達の関連を検討した．その結果，粗大運動の発達に伴い舌挺出が減少し，独歩を獲得する頃にはDS児の多くは押しつぶしを獲得していることが明らかになった．押しつぶしを獲得すると処理時の舌挺出は減少していたが，嚥下時の舌挺出は残存していた．これらのことから，摂食嚥下機能が粗大運動と発達的に関連していると考えられ，離乳などの摂食指導において，粗大運動発達を指標とすることの有用性が示唆された．

　The relation between the development of feeding and gross motor skills in children with Down syndrome (DS) has not been closely investigated. The purpose of this study was to conduct a cross-sectional investigation of the oral motor skills and gross motor skills of children with DS to record any developmental change and see if, and how, the two skills are related. The subjects were 38 children with DS. Their meal scenes were video recorded and the ratio of how often they thrust their tongue and whether they were able to mash food with their tongue was evaluated. In addition, their gross motor development was also evaluated and its relation to oral motor development was investigated. As a result, it was found that most children with DS were able to mash food with their tongue when they acquired the ability to walk. Tongue thrusting was less frequent when they were able to mash food in the oral cavity but was still observed during swallowing. These findings indicated that oral motor skills are related to gross motor development, and it was useful to use gross motor milestones as an indicator of feeding instruction.