For the child who is able to understand, the clinician explains the procedure, the purpose of the procedure, and the test environment in a developmentally appropriate manner. (2010). Key points about dysphagia in children. Neonatal Network, 16, 43–47. These techniques serve to protect the airway and offer safer transit of food and liquid. World Health Organization. When exploring this option, it is also important to consider any behavioral and/or sensory components that may influence feeding. Swallowing function and medical diagnoses in infants suspected of dysphagia. Pediatric feeding disorders. © 1997- American Speech-Language-Hearing Association. Journal of Developmental and Behavioral Pediatrics, 23, 297–303. 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. Referral to dental professionals for assessment and fitting of these devices. Clinical Oral Investigations, 18, 1507–1515. American Speech-Language-Hearing Association. Feeding skills of premature infants will be consistent with neurodevelopmental level rather than chronological age or adjusted age. Feeding provides children and caregivers with opportunities for communication and social experience that form the basis for future interactions (Lefton-Greif, 2008). Black, L. I., Vahratian, A., & Hoffman, H. J. Taking only small amounts of food, overpacking the mouth, and/or pocketing foods. Dysphagia means trouble swallowing. Retrieved from https://www.dol.gov/oasam/regs/statutes/sec504.htm. Difficulty chewing foods that are texturally appropriate for age (may spit out or swallow partially chewed food). Some maneuvers require following multistep directions and may not be appropriate for young children and/or older children with cognitive impairments. Retrieved from https://sites.ed.gov/idea/. Journal of Autism and Developmental Disorders, 43, 2159–2173. Neuromuscular electrical stimulation (NMES) is a proposed treatment for dysphagia that involves electrical stimulation of the swallowing muscles. Homer, E. M. (2016). A referral to the appropriate medical professional should be made when anatomical or physiological abnormalities are found during the clinical evaluation. This understanding gives the SLP the necessary knowledge to choose appropriate treatment interventions and provides a solid rationale for their use in the NICU. 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. Feeding provides children and caregivers with opportunities for communication and social experience that form the basis for future interactions (Lefton-Greif, 2008). Recommending a safe swallowing and feeding plan for the Individualized Family Service Plan (IFSP), Individualized Education Program (IEP), or 504 Plan. Newman, L. A., Keckley, C., Petersen, M. C., & Hamner, A. Typical modifications may include thickening thin liquids, softening, cutting/chopping, or pureeing solid foods. Johnson, D. E., & Dole, K. (1999). Joan has treated over 10,000 patients of many complexities. 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. Nutricion Hospitalaria, 29, 32–37. Rehabilitation Act of 1973, Section 504. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 25, 771–776. Pediatrics, 108, e106–e106. The clinical evaluation typically includes the following: The clinical evaluation for infants birth to 1 year of age—including those in the NICU—includes evaluation of prefeeding skills, assessment of readiness for oral feeding, and evaluation of breast- and bottle-feeding ability. 29 U.S.C. Positioning limitations and abilities (e.g., children who are wheelchair dependent) may affect intake and respiration. Format refers to the structure of the treatment session (e.g., group and/or individual). ... Clinical management of dysphagia in adults and children. 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. SLPs should be aware of these cautions and consult as appropriate with their facility to develop guidelines for using thickened liquids with infants. Awareness of the prevalence of pediatric dysphagia in today's population and the signs and symptoms of this condition aids in its treatment. Day 2 will look at how to recognize, plan for and treat swallowing disorders in pediatric clients. feeding and swallowing problems that persist into adulthood, including the risk for choking, malnutrition, or undernutrition. Pictures are taken of the inside of the throat, the esophagus, and the stomach to look for abnormalities. Remaining informed of research in the area of pediatric feeding and swallowing disorders while helping to advance the knowledge base related to the nature and treatment of these disorders. Alternative feeding does not preclude the need for feeding-related treatment. Learning Objectives. Such beliefs and holistic healing practices may not be consistent with recommendations made and may be contraindicated. These therapists can give your child exercises to help make swallowing more effective, or suggest techniques for feeding that may help improve swallowing problems. Retrieved month, day, year, from www.asha.org/Practice-Portal/Clinical-Topics/Pediatric-Dysphagia/. Davis-McFarland, E. (2008). Available 8:30 a.m.–5:00 p.m. McCain, G. C. (1997). The term dysphagia, a Greek word that means disordered eating, typically refers to difficulty in eating as a result of disruption in the swallowing process. See the Service Delivery section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspectives. Lefton-Greif, M. A., McGrattan, K. E., Carson, K. A., Pinto, J. M., Wright, J. M., & Martin-Harris, B. . Any loss of stability in physiologic, motoric, or behavioral state from baseline should be taken into consideration at the time of the assessment. . American Speech-Language-Hearing Association. Beckett, C. M., Bredenkamp, D., Castle, J., Groothues, C., O'Connor T. G., Rutter, M., & The English and Romanian Adoptees (ERA) Study Team. Pediatric Feeding and Swallowing Disorders Evidence Map, interprofessional education/interprofessional practice (IPE/IPP), Person-Centered focus on Function: Pediatric Feeding and Swallowing, interprofessional education/interprofessional practice [IPE/IPP], Community management of uncomplicated acute malnutrition in infants < 6 months of age (C-MAMI; 2015), Rehabilitation Act of 1973, Section 504. The SLP or radiology technician typically prepares and presents the barium items, whereas the radiologist records the swallow for visualization and analysis. Treatment for Dysphagia. Physical Medicine and Rehabilitation Clinics of North America, 19, 837–851. International Journal of Rehabilitation Research, 33, 218–224. When the quality of feeding takes priority over the quantity ingested, feeding skill develops pleasurably and at the infant's own pace. Otolaryngologic clinics of North America. Logemann, J. The SLP providing and facilitating oral experiences with NNS must take great care to ensure that the experiences are positive and do not elicit stress or other negative consequences. Feeding problems and nutrient intake in children with autism disorders: A meta-analysis and comprehensive review of the literature. Shaker, C. S. (2013a). 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. Keep in mind that infants and young children with feeding and swallowing disorders, as well as some older children with concomitant intellectual disabilities, often need intervention techniques that do not require them to follow simple verbal or nonverbal instructions. (1998). Feeding strategies for children may include alternating bites of food with sips of liquid or swallowing 2–3 times per bite or sip. This list of resources is not exhaustive and the inclusion of any specific resource does not imply endorsement from ASHA. 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. assessment of pediatric oropharyngeal dysphagia If you suspect that your child may have a problem with bottle/cup drinking, eating, or swallowing, contact your pediatrician, who will refer you to a speech-language pathologist specializing in feeding and swallowing disorders. American Psychiatric Association. These cues typically indicate that the infant is disengaging from feeding and communicating the need to stop. If the dysphagia is severe, another source of nutrition and hydration, such as a feeding tube, may be needed. U.S. Food and Drug Administration. Assessment of overall physical, social, behavioral, and communicative development. Treatment for dysphagia can come in a number of forms, depending on the specifics of each individual case. Decisions are made based on the child's needs, his or her family's views and preferences, and the setting where services are provided. How can the child's functional abilities be maximized? McComish, C., Brackett, K., Kelly, M., Hall, C., Wallace, S., & Powell, V. (2016). The key to successful management of dysphagia is correctly identifying the cause. Early Human Development, 85, 303–311. 205]. Difficulty managing secretions (including non-teething-related drooling of saliva). 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. Developmental Medicine & Child Neurology, 50, 625–630. Assessment of consistency of skills across the feeding opportunity to rule out any negative impact of fatigue on feeding/swallowing safety. See the Assessment section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspectives. 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