(2002). You may need: Esophageal dilation —making the esophagus wider where it narrows The team (a) works together to inform the evaluation process, (b) contributes to the development and implementation of the individualized education program (IEP) for safe swallow, and (c) oversees the day-to-day implementation of the IEP strategies to keep the student safe from aspiration while in school. Decisions regarding the initiation of oral feeding will be based on recommendations from the medical and therapeutic team with input from the parent and caregivers. Infants and Young Children, 8, 58–64. Consulting and collaborating with other professionals, family members, caregivers, and others to facilitate program development and to provide supervision, evaluation, and/or expert testimony, as appropriate (see ASHA's resources on. Decisions are made based on the child's needs, his or her family's views and preferences, and the setting where services are provided. Serving as an integral member of an interdisciplinary feeding and swallowing team. Children may be seen by numerous medical specialties including pediatric otolaryngology, gastroenterology, pulmonology, speech pathology, occupational therapy, and lactation consultants. (2016). How can the child's functional abilities be maximized? Pediatric Dysphagia: Etiologies, Diagnosis, and Management is a comprehensive professional reference on the topic of pediatric feeding and swallowing disorders. … Indicators of choking risk in adults with learning disabilities: A questionnaire survey and interview study. Families are encouraged to bring food and drink common to their household and utensils typically used by the child. the child's familiar and preferred utensils, if appropriate. MCN: The American Journal of Maternal/Child Nursing, 41, 230–236. Disengagement/refusal shown by facial grimacing, facial flushing, finger splaying, or head turning away from food source. International Journal of Oral & Maxillofacial Surgery, 44, 732–737. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 211,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. Feeding problems and nutrient intake in children with autism disorders: A meta-analysis and comprehensive review of the literature. Dysphagia treatment for the pediatric population. As indicated in the Speech-Language Pathology Assistant Scope of Practice (ASHA, 2013), speech-language pathology assistants (SLPAs) may demonstrate or share information with patients, families, and staff regarding feeding strategies developed and directed by the SLP. In these cases, intervention might consist of changes in the environment or indirect treatment approaches for improving safety and efficiency of feeding. These studies are a team effort and may include the radiologist, radiology technician, and SLP. This test uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of your child’s digestive tract. Neonatal Network, 32, 404–408. Dysphagia clinicians use tests all the time too to measure many different components of oropharyngeal swallowing, including strength and range of motion of the articulators, variety and sufficiency of diet, efficiency and coordination of oral intake, growth, sensor… The efficacy of commonly employed diagnostic and treatment strategies has been largely unexplored, although there has been a steadily increasing amount of research specific to pediatric dysphagia. Comprehensive coverage addresses the full spectrum of dysphagia to strengthen the care provider’s clinical evaluation and diagnostic decision-making skills. Appropriate roles for SLPs include the following: Experience in adult swallowing disorders does not qualify an individual to provide swallowing assessment and intervention for children. Diagnostic conditions associated with pediatric dysphagia . See Homer (2016) for in-depth information related to feeding and swallowing services in the schools. Interpreting the complex information collected during these assessments and forming a treatment plan that is functional during the home program can be challenging. Causes, symptoms, and other variables will differ from child to child and can affect ideal treatment considerably. If your child has chronic dysphagia or dysphagia caused by a health condition, speech or occupational therapy may help. Treatments can range from behavioral therapy and medications to surgery. You will be asked questions about how your child eats and any problems you notice during feeding. However, there are times when the SLP needs to contact the student's primary care physician or other health care provider—either through the family or directly, with the family's permission. Considering culture as it pertains to food choices, perception of disabilities, and beliefs about intervention (Davis-McFarland, 2008). 2 nd Edition. (2017). is suspected of having aspirated food or liquid into the lungs. She is a member of the Dysphagia Research Society and is a SIG 13 member. Instrumental evaluation can also help to determine if swallow safety can be improved by modifying food textures, liquid consistencies, or positioning. In these instances, the swallowing and feeding team will (a) consider the optimum tube-feeding method that best meets the child's needs and (b) determine whether the child will need tube feeding for a short or extended period of time. Structural assessment of the face, jaw, lips, tongue, hard and soft palate, oral pharynx, and oral mucosa. Is a sensory-motor–based intervention for behavioral issues indicated? Oral–motor treatments range from passive (e.g., tapping, stroking, and vibration) to active (e.g., range-of-motion activities, resistance exercises, or chewing and swallowing exercises). School-based SLPs do not require a doctor's order to perform a clinical evaluation of feeding and swallowing or to implement intervention programs. Day 2 will look at how to recognize, plan for and treat swallowing disorders in pediatric clients. The decision to use VFSS is made with consideration for the child's responsiveness (e.g., acceptance of oral stimulation or tastes on the lips without signs of distress) and the potential for medical complications. The clinical evaluation of infants typically includes. de Vries, I. As the child matures, the intraoral space increases as the mandible grows down and forward, and the oral cavity elongates in the vertical dimension. The appropriateness of the treatment format often depends on the child's age, the type and severity of the feeding or swallowing problem, and the service delivery setting. Shaker, C. S. (2013b, February 1). Rather than setting a goal to empty the bottle, the feeding experience is viewed as a partnership with the infant. Geneva, Switzerland: Author. SLPs collaborate with mothers, nurses, and lactation consultants prior to assessing breastfeeding skills. Kangaroo mother care (KMC)—skin-to-skin contact between a mother and her newborn infant—can be an important factor in helping the infant achieve readiness for oral feeding, particularly breastfeeding. School-based services typically include a referral process, a screening and evaluation, and the development of a feeding and swallowing intervention plan. Oropharyngeal dysphagia and/or feeding dysfunction in children with cerebral palsy is estimated to be 19.2%–99.0%. This requires working knowledge of breastfeeding strategies to facilitate safe and efficient swallowing and optimal nutrition. A speech-language pathologist will evaluate your child’s dysphagia and suggest or provide therapy to: Develop strength, range of motion, and coordination of the lips, tongue, cheeks, and jaw muscles for eating and drinking Early detection of dysphagia in infants and children is important to prevent or minimize complications. A. Assessment of NS includes evaluation of the following: The infant's communication behaviors during feeding can be used as cues to guide dynamic assessment. In many NICUs, it is a unilateral decision on the part of the neonatologist; in others, the SLP, neonatologist, and nursing staff share observations during their assessments of readiness for oral feedings. Newman, L. A., Keckley, C., Petersen, M. C., & Hamner, A. Pediatric dysphagia is a clinical problem that crosses disciplines. Calis, E. A. C., Veuglers, R., Sheppard, J. J., Tibboel, D., Evenhuis, H. M., & Penning, C. (2008). As the esophagus and throat are less irritated by acid reflux, their function may improve. Pediatrics, 135, e1467-e1474. Therefore, childhood swallowing difficulties must be diagnosed accurately and managed appropriately. (2000). Your child will learn exercises and feeding techniques to swallow better. Functional assessment of muscles and structures used in swallowing, including assessment of symmetry, sensation, strength, tone, range and rate of motion, and coordination of movement. Anatomic differences between adults and children and why they are significant. Periodic assessment and monitoring of significant changes are necessary to ensure ongoing swallow safety and adequate nutrition throughout adulthood. Feeding skills of premature infants will be consistent with neurodevelopmental level rather than chronological age or adjusted age. Other Maneuvers and Techniques. Dysphagia is a problem that happens when you swallow. If your child also has symptoms of GERD along with dysphagia, treating this condition may produce improvements in your child’s ability to swallow. Gisel, E. G. (1988). International Journal of Rehabilitation Research, 33, 218–224. Austin, TX: Pro-Ed. Speech-language pathology assistant scope of practice [Scope of Practice]. American Speech-Language-Hearing Association. The clinician provides families and caregivers with information about dysphagia, the purpose for the study, the test procedures, and the test environment. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d). Assessment and treatment of swallowing and swallowing disorders may require use of appropriate personal protective equipment. Pediatric clinics of North America. American Journal of Occupational Therapy, 42, 40–46. NS skills are assessed during breastfeeding and bottle feeding, if both modes are going to be used. The SLP who specializes in feeding and swallowing disorders typically leads the professional care team in the clinical or educational setting. Assessment of consistency of skills across the feeding opportunity to rule out any negative impact of fatigue on feeding/swallowing safety. . Oral sensitivity: It involves providing therapy to reduce the oral sensitivity. IDEA was enacted to protect the rights of students with disabilities and to ensure that these students receive a free and appropriate public education (FAPE). ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Pediatric Dysphagia page: In addition, ASHA thanks the members of the Ad Hoc Committee on Speech-Language Pathology Practice in the Neonatal Intensive Care Unit (NICU); Special Interest Division 13, Swallowing and Swallowing Disorders (Dysphagia) Committee on Cross-Training; and the Working Group on Dysphagia in Schools, whose work was foundational to the development of this content. Brackett, K., Arvedson, J. C., & Manno, C. J. participating in decisions regarding the appropriateness of these procedures; conducting the VFSS and FEES/FEESST instrumental procedures; interpreting and applying data from instrumental evaluations to (a) determine the severity and nature of the swallowing disorder and the child's potential for safe oral feeding and (b) formulate feeding and swallowing treatment plans, including recommendations for optimal feeding techniques; and. As the most up-to-date text in this field, Pediatric Dysphagia: Challenges and Controversies will be a valuable reference guide for both learners and practitioners caring for these children. the impact of feeding and swallowing impairments on. Recognizing signs of ARFID and making an appropriate referral. 29 U.S.C. Other benefits of KMC include temperature regulation, promotion of breastfeeding, parental empowerment and bonding, stimulation of lactation, and oral stimulation for the promotion of oral feeding ability. You may need: Esophageal dilation —making the esophagus wider where it narrows Surgery—to treat GERD or take out something that is blocking the path; Dietary changes such as: Not eating foods that cause problems; Eating softer or pureed foods; Using a feeding tube if needed Infants and children with dysphagia are often able to swallow thick fluids and soft foods (such as baby foods or pureed or blended foods) better than thin liquids. . The development of jaw motion for mastication. The Rehabilitation Act of 1973, Section 504. U.S. Food and Drug Administration. Francis, Krishnaswami, & McPheeters, 2015; Webb, Hao, & Hong, 2013); the identification of additional disorders that may have an impact on feeding and swallowing; a determination of the optimal feeding method; an assessment of duration of mealtime experience, including the need for supplemental oxygen; an assessment of issues related to fatigue and volume limitations; an assessment of the effectiveness of parent/caregiver and infant interactions for feeding and communication; and. Instrumental evaluation is conducted following a clinical evaluation when further information is needed to determine the nature of the swallowing disorder. Johnson, D. E., & Dole, K. (1999). Dysphagia Treatment in Pediatric Patients With Cancer: It Takes Collaboration. Tests are meant to measure skills or knowledge in a particular area. See ASHA's resources on interprofessional education/interprofessional practice (IPE/IPP) and collaboration and teaming for guidance on successful collaborative service delivery across settings. The primary goals of feeding and swallowing intervention for children are to, Consistent with the World Health Organization's (2001) International Classification of Functioning, Disability, and Health (ICF) framework, goals are designed to. Does the child have the potential to improve swallowing function with direct treatment? Pediatrics, 108, e106–e106. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment), prevention and advocacy, education, administration, and research. Feeding therapy can be helpful for some children. Postural and positioning techniques involve adjusting the child's posture or position during feeding. § 1400 (2004). Assessment and treatment tools and strategies will be provided, so participants are prepared to integrate the knowledge and tools learned to properly identify, recommend and implement appropriate treatment for their pediatric dysphagia clients. See ASHA's resource on transitioning youth for information about transition planning. Treatment for dysphagia is based on the nature and severity of the child's feeding and swallowing problem. [7] Lefton-Greif MA. For infants, pacing can be accomplished by limiting the number of consecutive sucks. These techniques serve to protect the airway and offer safer transit of food and liquid. Facilitation Techniques. Treatment depends on the cause. Transition to adult care for children with chronic neurological disorders: Which is the best way to make it? Do these behaviors result in family/caregiver frustration or increased conflict during meals? Your child may be able to swallow thick fluids and soft foods better than thin liquids. Students must be safe while eating in school, including having access to appropriate personnel, food, and procedures to minimize risks for choking and for aspiration while eating. complex medical conditions (e.g., heart disease, pulmonary disease, gastroesophageal reflux disease [GERD], delayed gastric emptying); developmental disability (i.e., disability with onset before the age of 22 that warrants lifelong or extended medical, therapeutic, and/or residential supports and is attributable to a mental or physical impairment or a combination of mental and physical impairments); factors affecting neuromuscular coordination (e.g., prematurity, low birth weight, hypotonia, hypertonia); genetic syndromes (e.g., Down syndrome, Pierre Robin Sequence, Prader–Willi, Rett syndrome, Treacher Collins syndrome, 22q11 deletion); medication side effects (e.g., lethargy, decreased appetite); neurological disorders (e.g., cerebral palsy, meningitis, encephalopathy, pervasive developmental disorders, traumatic brain injury, muscle weakness in face and neck); sensory issues as a primary cause or secondary to limited food availability in early development (e.g., in children adopted from institutionalized care; Beckett et al., 2002, Johnson & Dole, 1999); structural abnormalities (e.g., cleft lip and/or palate and other craniofacial abnormalities, laryngomalacia, tracheoesophageal fistula, esophageal atresia, choanal atresia); behavioral factors (e.g., food refusal); and. (2000). Swallowing is a complex process during which saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected. Treatment selection will depend on the child's age, cognitive and physical abilities, and specific swallowing and feeding problems. Alex F. Johnson and Celia Hooper served as monitoring officers (vice presidents for speech-language pathology practices, 2000-2002 and 2003-2005, respectively). San Diego, CA: Plural. ... Clinical management of dysphagia in adults and children. Oftentimes, feeding disorders go hand in hand with dysphagia (swallowing disorders) and affect the child’s ability … As with most pediatric illnesses, the caregiver is an important member of the treatment team. See FDA consumer cautions (U. S. Food and Drug Administration, 2017). A noninstrumental assessment of NNS includes evaluation of the following: Once the NNS component of feeding has been assessed, the clinician can determine the appropriateness of nutritive sucking (NS). dren. Though it does not always lead to choking, it can take an object several hours to pass through the esophagus in a patient with dysphagia. Anxiety may be reduced by using distraction (e.g., videos), allowing the child to sit on the parent's or caregiver's lap (for FEES procedures), and decreasing the number of observers in the room. Infants under 6 months of age typically require head, neck, and trunk support. receives part or all of his or her nutrition or hydration via enteral or parenteral tube feeding; has a complex medical condition and who experiences a significant change in status; has recently been hospitalized with aspiration pneumonia; has had a recent choking incident and has required emergency care; and/or. If you suspect your child might have pediatric dysphagia, it is important to receive an assessment from a qualified speech-language pathologist (SLP) as soon as possible. The therapist may recommend that you thicken your child’s liquids and will work with you to create the correct recipe. Such beliefs and holistic healing practices may not be consistent with recommendations made and may be contraindicated. For children who have difficulty participating in the procedure, the clinician allows time to bring behaviors under control prior to initiating the instrumental procedure. The clinician requests that the family provide, familiar foods of varying consistencies and tastes that are compatible with contrast material (if facility protocol allows), a specialized seating system from home (including car seat or specialized wheelchair), as warranted and if permitted by the facility; and. Mandich, M. B., Ritchie, S. K., & Mullett, M. (1996). Students must develop skills for eating efficiently during meals and snack times so that they can complete these activities with their peers safely and in a timely manner. Using the framework and the handbook as tools that can be utilized in all practice settings, this workshop will focus on assessment and treatment strategies for the community clinician. Code of ethics [Ethics]. Educating other professionals on the needs of children with feeding and swallowing disorders and the role of SLPs in diagnosing and managing these disorders. Taking only small amounts of food, overpacking the mouth, and/or pocketing foods. Format refers to the structure of the treatment session (e.g., group and/or individual). Pediatric swallowing and feeding: Assessment and management. move their head toward the spoon with their mouth open; turn their head away from the spoon to show that they have had enough; clear food from the spoon with their top lip; move food from the spoon to the back of their mouth; and. Enteral Feeding. Wilson, E. M., & Green, J. R. (2009). Available from www.asha.org/policy/. Your child is given small amounts of a liquid that contains barium (a chalky liquid used to coat the inside of organs so that they will show up on an x-ray) to drink with a bottle, spoon, or cup or spoon-fed a solid food containing barium. Lefton-Greif, M. A., Carroll, J. L., & Loughlin, G. M. (2006). See Person-Centered focus on Function: Pediatric Feeding and Swallowing for examples of assessment data consistent with ICF. Pictures are taken of the inside of the throat, the esophagus, and the stomach to look for abnormalities. FDA expands caution about simply thick. This presentation will provide a review of 2 case studies to demonstrate the nuance of evaluation and treatment of complex patients with pediatric dysphagia. Diet modifications consist of altering the viscosity, texture, temperature, portion size, or taste of a food or liquid to facilitate safety and ease of swallowing. Journal of Developmental and Behavioral Pediatrics, 23, 297–303. Joan has treated over 10,000 patients of many complexities. Students must be adequately nourished and hydrated so that they can attend to and fully access the school curriculum. Speaker Disclosures: Content for ASHA's Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. Rates increase with greater severity of cognitive impairment and decline in gross motor function (Benfer et al., 2014; Calis et al., 2008; Erkin, Culha, Sumru, & Gulsen, 2010). Dysphagia in pediatric populations can result in multiple adverse health outcomes. SLPs play a significant role in the management of students with swallowing and feeding problems within school settings. In addition to the clinical evaluation of infants noted above, breastfeeding assessment typically includes evaluation of the, For an example, see Community management of uncomplicated acute malnutrition in infants < 6 months of age (C-MAMI; 2015) [PDF], The assessment of bottle-feeding includes evaluation of the, The assessment of spoon-feeding includes evaluation of optimal spoon type and the infant's ability to, In addition to the areas of assessment noted above, the evaluation for toddlers (ages 1–3 years) and pre-school/school-age children (ages 3–21 years) may include. See Person-Centered focus on Function: Pediatric Feeding and Swallowing for examples of goals consistent with ICF. It is assumed that the incidence of feeding and swallowing disorders is increasing because of the improved survival rates of children with complex and medically fragile conditions (Lefton-Greif, 2008; Lefton-Greif, Carroll, & Loughlin, 2006; Newman, Keckley, Petersen, & Hamner, 2001) and the improved longevity of persons with dysphagia that develops during childhood (Lefton-Greif et al., 2017). For children who have been NPO for an extended period of time, it is important to consult with the physician to determine when to begin oral feeding. Dysphagia in pediatrics involves feeding (accepting and preparing food orally), and swallowing (transporting food from the mouth to the stomach). changes in normal heart rate (bradycardia or tachycardia); skin color change such as turning blue around the lips, nose and fingers/toes (cyanosis); temporary cessation of breathing (apnea); frequent stopping due to uncoordinated suck-swallow-breathe pattern; and. (2014). Pediatric dysphagia is a clinical problem that crosses disciplines. https://www.childrenshospital.org/.../d/dysphagia/diagnosis-and-treatment Tube feeding includes alternative avenues of intake such as nasogastric [NG] tube, transpyloric tube (placed in the duodenum or jejunum), or gastrostomy (G-tube placed in the stomach or GJ-tube placed in the jejunum). Reid, J., Kilpatrick, N., & Reilly, S. (2006). [5] Arvedson J. The ASHA Action Center welcomes questions and requests for information from members and non-members. Your doctor will likely perform a physical examination and may use a variety of tests to determine the cause of your swallowing problem.Tests may include: 1. This might involve decisions about whether the individual can safely eat an oral diet that meets nutritional needs, whether that diet needs to be modified in any way, and whether the individual needs compensatory strategies in order to eat the diet. Evaluation and treatment of swallowing disorders. Clinicians working in the NICU need to be aware of the multidisciplinary nature of this practice area, the variables that influence infant feeding, and process for developing appropriate treatment plans in this setting. 29 U.S.C. Behavioral interventions are based on principles of behavioral modification and focus on increasing appropriate actions or behaviors—including increasing compliance—and reducing maladaptive behaviors related to feeding. The Laryngoscope, 125, 746–750. 2 nd Edition. Clinical Oral Investigations, 18, 1507–1515. Prevalence rates of oral dysphagia in children with craniofacial disorders are estimated to be 33%–83% (Caron et al., 2015; de Vries et al., 2014; Reid, Kilpatrick, & Reilly, 2006). Signs & symptoms of dysphagia Early identification and treatment (Tx) may help avoid adverse medical complications such as under nutrition or respiratory infection. Sensory stimulation techniques vary and may include thermal–tactile stimulation (e.g., using an iced lemon glycerin swab) or tactile stimulation (e.g., using a NUK brush) applied to the tongue or around the mouth. These approaches may be considered if the child's swallowing safety and efficiency cannot reach a level of adequate function or does not adequately support nutrition and hydration. The physician will examine your child and obtain a medical history. 308 Racebrook Rd. San Diego, CA: Singular. Sharp, W. G., Berry, R. C., McCracker, C., Nuhu, N. N., Marvel, E., Saulnier, C. A., . In all cases, the SLP must have an accurate understanding of the physiologic mechanism driving the symptomatic feeding problems seen in this population. Out any negative impact of fatigue on feeding/swallowing safety primary concern in treating pediatric feeding swallowing... Or wet vocal quality during and after eating follow a collaborative process that includes multiple rounds of matter... 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