pediatric dysphagia treatment

A risk assessment for choking and an assessment of nutritional status should be considered as part of a routine examination for adults with disabilities, particularly those with a history of feeding and swallowing problems. 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. The physician will examine your child and obtain a medical history. Characteristics of avoidant/restrictive food intake disorder in children and adolescents: A “new disorder” in DSM-5. A referral to the appropriate medical professional should be made when anatomical or physiological abnormalities are found during the clinical evaluation. Precautions, accommodations, and adaptations must be considered and implemented as students transition to post-secondary settings. Our Pediatric Dysphagia treatment service manage children with speech and language delays, Speech Apraxia, Swallowing problems, Poor Oro-motor skills, Stutter/Stammer etc. Because a variety of medical specialists can be involved in the care of the patient with dysphagia, all must However, they may not perform diagnostic evaluations of feeding and swallowing, including swallowing screenings/checklists; tabulate or interpret results and observations of feeding and swallowing evaluations performed by SLPs; or perform oral pharyngeal swallow therapy with bolus material. The infant's ability to maintain physiological state during NNS. Similar to treatment for infants in the NICU, treatment for toddlers and older children takes a number of factors into consideration, including the following: Management of students with feeding and swallowing disorders in the schools addresses the impact of the disorder on the student's educational performance and promotes the student's safe swallow in order to avoid choking and/or aspiration pneumonia. This list of resources is not exhaustive and the inclusion of any specific resource does not imply endorsement from ASHA. Therapy techniques that are used to assist with bolus management can be developed to help children be more successful eaters. Developmental Medicine & Child Neurology, 50, 625–630. The hyoid bone and larynx are positioned higher than in adults, and the larynx elevates less than in adults during the pharyngeal phase of the swallow. Family and cultural issues in a school swallowing and feeding program. See the Pediatric Feeding and Swallowing Disorders Evidence Map for summaries of the available research on this topic. Nutricion Hospitalaria, 29, 32–37. SLPs treating preterm and medically fragile infants must be well versed in typical infant behavior and development so that they can recognize and interpret changes in behavior that provide cues that signal well-being or stress during feeding. They are seated upright or in the position that you feed them in at home. Feeding strategies for children may include alternating bites of food with sips of liquid or swallowing 2–3 times per bite or sip. § 701 (1973), Individuals with Disabilities Education Improvement Act (IDEA, 2004), videofluoroscopic swallowing study (VFSS), fiberoptic endoscopic evaluation of swallowing without sensory testing (FEES) or with sensory testing (FEEST), Dysphagia Management for School Children: Dealing With Ethical Dilemmas, Feeding and Swallowing Disorders in Children, International Dysphagia Diet Standardisation Initiative (IDDSI), Interprofessional Education/Interprofessional Practice [IPE/IPP], User's Guide to Pediatric Clinical Feeding Assessment Templates, Pediatric Clinical Assessment Template (Liquids only), Pediatric Clinical Assessment Template (Liquids, semi-solid and solid foods), Videofluoroscopic Swallowing Exam (infants consuming liquids only), Videofluoroscopic Swallowing Exam (children consuming purees through table foods), Pick the Right Code for Pediatric Dysphagia, Fiberoptic Endoscopic Evaluation of Swallowing: Without Sensory testing (FEES) or With Sensory Testing (FEESST), International Commission on Radiological Protection (ICRP), National Foundation of Swallowing Disorders, RadiologyInfo.org: Video Fluoroscopic Swallowing Exam (VFSE), https://www.cdc.gov/nchs/data/nhds/8newsborns/2010new8_numbersick.pdf, https://www.dol.gov/oasam/regs/statutes/sec504.htm, www.asha.org/Practice-Portal/Clinical-Topics/Pediatric-Dysphagia/, Connect with your colleagues in the ASHA Community, Avoiding or restricting one's food intake (avoidance/restrictive food intake disorder [ARFID]; American Psychiatric Association, 2016), Refusing age-appropriate or developmentally appropriate foods or liquids, Accepting a restricted variety or quantity of foods or liquids, Displaying disruptive or inappropriate mealtime behaviors for developmental level, Failing to master self-feeding skills expected for developmental levels, Failing to use developmentally appropriate feeding devices and utensils, Experiencing less than optimal growth (Arvedson, 2008). This course includes video examples, case studies, lab practice, and application activities. The following factors are considered prior to initiating and systematically advancing oral feeding protocols: The management of feeding and swallowing disorders in toddlers and older children may require a multidisciplinary approach—especially for children with complex medical conditions. Chronic dysphagia may be caused by an underlying health problem. Diagnosing pediatric oral and pharyngeal swallowing disorders (dysphagia). If a natural feeding process (e.g., position, caregiver involvement, and use of familiar foods) cannot be achieved, the results may not represent typical swallow function, and the study may need to be terminated, with results interpreted with caution. Davis-McFarland, E. (2008). Learning Objectives. Recommending a safe swallowing and feeding plan for the Individualized Family Service Plan (IFSP), Individualized Education Program (IEP), or 504 Plan. Treatment. Dysphagia means trouble swallowing. 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. Causes, symptoms, and other variables will differ from child to child and can affect ideal treatment considerably. Dysphagia in Children Dysphagia is a term that means “difficulty swallowing.” It is the inability of food or liquids to pass easily from your child’s mouth, into the throat, and through the esophagus to the stomach during the process of swallowing. Key criteria to determine readiness for oral feeding include. 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. American Speech-Language-Hearing Association. An understanding of adult anatomy and physiology of the swallow may provide a good basis for understanding dysphagia in children; however, additional knowledge and skills specific to pediatric populations are needed. Dysphagia in pediatric populations can result in multiple adverse health outcomes. 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. § 1400 (2004). Arvedson, J. C., & Lefton-Greif, M. A. 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 Apnea is strongly correlated with longer transition time to full oral feeding (Mandich, Ritchie, & Mullett, 1996). Surgery for Chronic Aspiration. SLPs play a significant role in the management of students with swallowing and feeding problems within school settings. Treatment for Dysphagia. Oropharyngeal dysphagia in preschool children with cerebral palsy: Oral phase impairments. Assessment of pediatric dysphagia and feeding disorders: Clinical and instrumental approaches. . 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. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d). Does the child have the potential to improve swallowing function with direct treatment? [7] Lefton-Greif MA. 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. See for example, Dodrill (2017) and Manikam and Perman (2000). A clinical evaluation of swallowing and feeding is the first step in determining the presence or absence of a swallowing disorder. 205]. Gisel, E. G. (1988). Pediatrics, 108, e106–e106. These therapists can give your child exercises to help make swallowing more effective, or suggest techniques for feeding that may help improve swallowing problems. Swallowing is a complex process during which saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected. 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. Assessment of developmentally appropriate secretion management, which might include frequency and adequacy of spontaneous dry swallowing and ability to swallow voluntarily. These studies are a team effort and may include the radiologist, radiology technician, and SLP. A child who struggles to prepare (chew) food or liquid in their mouth and swallow it may have a feeding disorder. This requires working knowledge of breastfeeding strategies to facilitate safe and efficient swallowing and optimal nutrition. Communication disorders and use of intervention services among children aged 3-17 years: United States, 2012 [NHS Data Brief No. Sharp, W. G., Berry, R. C., McCracker, C., Nuhu, N. N., Marvel, E., Saulnier, C. A., . Neonatal Network, 32, 404–408. Key points about dysphagia in children. Decisions are made based on the child's needs, his or her family's views and preferences, and the setting where services are provided. 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. School-based SLPs need to be informed about these effective treatment techniques and the background of pediatric dysphagia to accurately diagnosis and treat this special population. consideration of the infant's ability to obtain sufficient nutrition/hydration across settings (e.g., hospital, home, daycare setting). The infant's oral structures and functions, including palatal integrity, jaw movement, and tongue movements for cupping and compression. Some infants who had trouble swallowing formula will do better when they are old enough to eat baby foods. (2001). Oropharyngeal dysphagia and/or feeding dysfunction in children with cerebral palsy is estimated to be 19.2%–99.0%. See Person-Centered focus on Function: Pediatric Feeding and Swallowing for examples of assessment data consistent with ICF. Infants cannot verbally describe their symptoms, and children with reduced communication skills may not be able to adequately do so—clinicians must rely on a thorough case history; data from monitoring devices (e.g., in the neonatal intensive care unit (NICU); and nonverbal forms of communication (e.g., behavioral cues signaling feeding or swallowing problems). When conducting an instrumental evaluation, consider the following: Procedures take place in a child-friendly environment with toys, visual distracters, rewards, and a familiar caregiver, if possible and when appropriate. Clinical Oral Investigations, 18, 1507–1515. 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. SLPs need to be sensitive to family values and beliefs regarding bottle feeding and breastfeeding; they consult with parents and collaborate with nurses, lactation consultants, and other medical professionals to help identify parent preferences. Our specialization and expertise provides complete dysphagia evaluation and treatment, from mild feeding issues to medically complex problems. Feeding problems and nutrient intake in children with autism disorders: A meta-analysis and comprehensive review of the literature. Hyattsville, MD: National Center for Health Statistics. Dysphagia treatment for the pediatric population. Positioning limitations and abilities (e.g., children who are wheelchair dependent) may affect intake and respiration. 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. Coughing and/or choking during or after swallowing. When assessing feeding and swallowing disorders in the pediatric population, clinicians consider the following factors: As infants and children grow and develop, the absolute and relative size and shape of oral and pharyngeal structures change. Instrumental evaluation can also help to determine if swallow safety can be improved by modifying food textures, liquid consistencies, or positioning. They will be lying down on their back for this test. They may include the following: Underlying etiologies associated with pediatric feeding and swallowing disorders include. Description: The incidence of dysphagia in pediatrics is increasing, creating a greater need for evidence-based assessments and interventions. Feeding and Swallowing. promote a meaningful and functional mealtime experience for children and families. 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. Gaithersburg, MD: Aspen. International adoptions: Implications for early intervention. Cricopharyngeal Myotomy. Some maneuvers require following multistep directions and may not be appropriate for young children and/or older children with cognitive impairments. Mandich, M. B., Ritchie, S. K., & Mullett, M. (1996). 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. It’s that time of year again- back to school and back to frequent testing for school age children. Dosage depends on individual factors, including the child's medical status, nutritional needs, and readiness for oral intake. (1998). Children are positioned as they are typically fed at home and in a manner that avoids spontaneous or reflex movements that could interfere with the safety of the examination. Treatment of Pediatric Swallowing Disorders ***** DISCLAIMER The information in these notes were developed from the three primary sources cited below. Consideration for interventions and referrals (e.g., medical or surgical specialists, nutritionist, psychologist or social worker, occupational therapist, physical therapist). ... Orange Pediatric Therapy. Lefton-Greif, M. A., Carroll, J. L., & Loughlin, G. M. (2006). You do not have JavaScript Enabled on this browser. Beckett, C. M., Bredenkamp, D., Castle, J., Groothues, C., O'Connor T. G., Rutter, M., & The English and Romanian Adoptees (ERA) Study Team. Oftentimes, feeding disorders go hand in hand with dysphagia (swallowing disorders) and affect the child’s ability … Dysphagia, 33, 76–82. infant's response to attempted interventions (e.g., different nipple for flow control, external pacing, different bottle to control air intake, different positions such as side feeding). Families may have strong beliefs about the medicinal value of some foods or liquids. Treatment for dysphagia is based on the nature and severity of the child's feeding and swallowing problem. Students must be healthy (e.g., free from aspiration pneumonia or other illnesses related to malnutrition or dehydration) to maximize their attendance at school. Clinicians will discuss this with the medical team in order to determine options, including temporary removal of the feeding tube and/or use of another means of swallowing assessment. Feeding strategies include pacing and cue-based feeding. Members of the Swallowing and Swallowing Disorders (Dysphagia) Committee on Cross-Training included Caryn Easterling, Maureen Lefton-Greif, Paula Sullivan, Nancy Swigert, and Janet Brown (ASHA staff liaison). 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. Cue-based feeding in the NICU: Using the infant's communication as a guide. Do these behaviors result in family/caregiver frustration or increased conflict during meals? 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