SLPs provide assessment and treatment to the student as well as education to parents, teachers, and other professionals who work with the student daily. Such beliefs and holistic healing practices may not be consistent with recommendations made. MCN: The American Journal of Maternal/Child Nursing, 41(4), 230236. The prevalence of pediatric voice and swallowing problems in the United States. The prevalence of swallowing dysfunction in children with laryngomalacia: A systematic review. an assessment of oral structures and function during intake; an assessment to determine the developmental level of feeding skills; an assessment of issues related to fatigue and access to nutrition and hydration during school; a determination of duration of mealtime experiences, including the ability to eat within the schools mealtime schedule; an assessment of response to intake, including the ability to manipulate and propel the bolus, coughing, choking, or pocketing foods; an assessment of adaptive equipment for eating and positioning by an OT and a PT; and. Referrals may be made to dental professionals for assessment and fitting of these devices. The participants in the experimental group underwent five consecutive sessions of tactile-thermal stimulation for 30 minutes each time. https://doi.org/10.1080/09638280701461625, U.S. Department of Agriculture. The process of identifying the feeding and swallowing needs of students includes a review of the referral, interviews with the family/caregiver and teacher, and an observation of students during snack time or mealtime. Pro-Ed. American Psychiatric Association. (2001). Prevalence of feeding problems in young children with and without autism spectrum disorder: A chart review study. An estimated 116,000 newborn infants are discharged from short-stay hospitals with a diagnosis of feeding problems, according to the. Experience in adult swallowing disorders does not qualify an individual to provide swallowing assessment and intervention for children. If certain practices are contraindicated, the clinician can work with the family to determine alternatives that allow the child to safely participate as fully as possible. Pediatric feeding and swallowing disorders: General assessment and intervention. Treatment selection will depend on the childs age, cognitive and physical abilities, and specific swallowing and feeding problems. Feeding readiness in NICUs may be a unilateral decision on the part of the neonatologist or a collaborative process involving the SLP, neonatologist, and nursing staff. an evaluation of dependence on nutritional supplements to meet dietary needs, an evaluation of independence and the need for supervision and assistance, and. Best practice indicates establishing open lines of communication with the students physician or other health care providereither through the family or directlywith the familys permission. Sensory stimulation techniques vary and may include thermaltactile 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. https://doi.org/10.1002/eat.22350, Erkin, G., Culha, C., Ozel, S., & Kirbiyik, E. G. (2010). https://doi.org/10.1044/0161-1461(2008/018). See figures below. observations of the caregivers behaviors and ability to read the childs cues as they feed the child. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research. https://doi.org/10.1016/j.ijporl.2013.03.008, Wilson, E. M., & Green, J. R. (2009). The NICU is considered an advanced practice area, and inexperienced SLPs should be aware that additional training and competencies may be necessary. Use: The Swallowing Activator is used for Tactile-Thermal Stimulation (TTS) to enhance bilateral cortical and brainstem activation of the swallow. https://doi.org/10.1177/1053815118789396, Shaker, C. S. (2013a). identify any parental or student concerns or stress regarding mealtimes. The team may consider the tube-feeding schedule, type of pump, rate, calories, and so forth. 0000001861 00000 n Consider the childs pulmonary status, nutritional status, overall medical condition, mobility, swallowing abilities, and cognition, in addition to the childs swallowing function and how these factors affect feeding efficiency and safety. The school SLP (or case manager) contacts the family to obtain consent for an evaluation if further evaluation is deemed necessary. Decisions regarding the initiation of oral feeding are based on recommendations from the medical and therapeutic team, with input from the parent and caregivers. Scope of practice in speech-language pathology [Scope of practice]. A. determine whether the child will need tube feeding for a short or an extended period of time. safety while eating in school, including having access to appropriate personnel, food, and procedures to minimize risks of choking and aspiration while eating; adequate nourishment and hydration so that students can attend to and fully access the school curriculum; student health and well-being (e.g., free from aspiration pneumonia or other illnesses related to malnutrition or dehydration) to maximize their attendance and academic ability/achievement at school; and. J Rehabil Med 2009; 41: 174-178 Correspondence address: Kil-Byung Lim, Department of Reha- https://doi.org/10.1044/0161-1461.3101.50, Mandich, M. B., Ritchie, S. K., & Mullett, M. (1996). Oralmotor treatments include stimulation toor actions ofthe lips, jaw, tongue, soft palate, pharynx, larynx, and respiratory muscles. Anxiety may be reduced by using distractions (e.g., videos), allowing the child to sit on the parents or the caregivers lap (for FEES procedures), and decreasing the number of observers in the room. Results There were eight participants, six women and. Responsive feedingLike cue-based feeding, responsive feeding focuses on the caregiver-and-child dynamic. Instrumental evaluation is completed in a medical setting. The development of jaw motion for mastication. 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 et al., 2006; Newman et al., 2001) and the improved longevity of persons with dysphagia that develops during childhood (Lefton-Greif et al., 2017). Intraoral prosthetics (e.g., palatal obturator, palatal lift prosthesis) can be used to normalize the intraoral cavity by providing compensation or physical support for children with congenital abnormalities (e.g., cleft palate) or damage to the oropharyngeal mechanism. Children who demonstrate aversive responses to stimulation may need approaches that reduce the level of sensory input initially, with incremental increases as the child demonstrates tolerance. Feeding and eating disorders: DSM-5 Selections. https://doi.org/10.1016/j.pmr.2008.05.007, Lefton-Greif, M. A., Carroll, J. L., & Loughlin, G. M. (2006). Consumers should use caution regarding the use of commercial, gum-based thickeners for infants of any age (Beal et al., 2012; U.S. Food and Drug Administration, 2017). ASHA does not endorse any products, procedures, or programs, and therefore does not have an official position on the use of electrical stimulation or specific workshops or products associated with electrical stimulation. However, there are times when a prescription, referral, or medical clearance from the students primary care physician or other health care provider is indicated, such as when the student. Swallowing is a complex process during which saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected. The VFSS may be appropriate for a child who is currently NPO or has never eaten by mouth to determine whether the child has a functional swallow and which types of food they can manage. Disruptions in swallowing may occur in any or all phases of swallowing. In turn, the caregiver can use these cues to optimize feeding by responding to the infants needs in a dynamic fashion at any given moment (Shaker, 2013b). The clinical evaluation for infants from birth to 1 year of ageincluding those in the NICUincludes an evaluation of prefeeding skills, an assessment of readiness for oral feeding, an evaluation of breastfeeding and bottle-feeding ability, and observations of caregivers feeding the child. Thermal tactile stimulation also, known as thermal application is one type of therapy used for the treatment of swallowing disorders. Alex F. Johnson and Celia Hooper served as monitoring officers (vice presidents for speech-language pathology practices, 20002002 and 20032005, respectively). Communication disorders and use of intervention services among children aged 317 years: United States, 2012 [NCHS Data Brief No. Dosage depends on individual factors, including the childs medical status, nutritional needs, and readiness for oral intake. Modifications to positioning are made as needed and are documented as part of the assessment findings. data from monitoring devices (e.g., for patients in the neonatal intensive care unit [NICU]); nonverbal forms of communication (e.g., behavioral cues signaling feeding or swallowing problems); and. Journal of Adolescent Health, 55(1), 4952. Pediatric videofluoroscopic swallow studies: A professional manual with caregiver guidelines. Introduction | EBRSR - Evidence-Based Review of Stroke Rehabilitation consider the optimum tube-feeding method that best meets the childs needs and. The electrical stimulation protocol was performed using a modified hand- held battery powered electrical stimulator (vital stim) that consists of a symmetric . A written referral or order from the treating physician is required for instrumental evaluations such as VFSS or FEES. effect of neuromuscular and thermal tactile stimulation on its rehabilitation. Recent clinical practice survey data have supported the fact that clinicians continue to use thermo-tactile stimulation (TTS) as a strategy to stimulate key nerve pathways and evoke a swallow reflex for patients with a delayed or absent swallow reflex. SLPs do not diagnose or treat eating disorders such as bulimia, anorexia, and avoidant/restrictive food intake disorder; in the cases where these disorders are suspected, the SLP should refer to the appropriate behavioral health professional. Group I received neuromuscular electric stimulation sessions on the neck one hour daily for 12 weeks. Further investigative research to clarify NMES protocols and patient population is needed to optimize results. Consistent with the World Health Organizations (WHO) International Classification of Functioning, Disability and Health framework (ASHA, 2016a; WHO, 2001), a comprehensive assessment is conducted to identify and describe. Diet modifications incorporate individual and family preferences, to the extent feasible. It is used as a treatment option to encourage eventual oral intake. They were divided into two equal groups according to the rehabilitation programs they received. For children who have difficulty participating in the procedure, the clinician should allow time to control problem behaviors prior to initiating the instrumental procedure. Pacingmoderating the rate of intake by controlling or titrating the rate of presentation of food or liquid and the time between bites or swallows. 0000063213 00000 n Developmental Medicine & Child Neurology, 50(8), 625630. Apnea is strongly correlated with longer transition time to full oral feeding (Mandich et al., 1996). Arvedson, J. C., & Brodsky, L. (2002). Children with sufficient cognitive skills can be taught to interpret this visual information and make physiological changes during the swallowing process. Please visit ASHAs Pediatric Feeding and Swallowing Evidence Map for further information. 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 students educational performance and promotes the students safe swallow in order to avoid choking and/or aspiration pneumonia. 0000088800 00000 n https://www.fns.usda.gov/cn/2017-edition-accommodating-children-disabilities-school-meal-programs, U.S. Food and Drug Administration. The appropriateness of the treatment format often depends on the childs age, the type and severity of the feeding or swallowing problem, and the service delivery setting. Adaptive equipment and utensils may be used with children who have feeding problems to foster independence with eating and increase swallow safety by controlling bolus size or achieving the optimal flow rate of liquids. Little is known about the possible mechanisms by which this interventional therapy may work. Assessment and treatment of swallowing and swallowing disorders may require the use of appropriate personal protective equipment and universal precautions. Oropharyngeal dysphagia in preschool children with cerebral palsy: Oral phase impairments. 0000018013 00000 n Anatomical and physiological differences include the following: Chewing matures as the child develops (see, e.g., Gisel, 1988; Le Rvrend et al., 2014; Wilson & Green, 2009). The referral can be initiated by families/caregivers or school personnel. Various items are available in the room to facilitate success and replicate a typical mealtime experience, including preferred foods, familiar food containers, utensil options, and seating options. Speech-language pathologists (SLPs) play a central role in the assessment, diagnosis, and treatment of infants and children with swallowing and feeding disorders. Johnson, D. E., & Dole, K. (1999). 0000089259 00000 n No single posture will provide improvement to all individuals. Administration of small amounts of maternal milk into the oral cavity of enteral tubedependent infants improves breastfeeding rates, growth, and immune-protective factors and reduces sepsis (Pados & Fuller, 2020). B. NS skills are assessed during breastfeeding and bottle-feeding if both modes are going to be used. Geyer, L. A., McGowan, J. S. (1995). For more information, see also Accommodating Children With Disabilities in the School Meal Programs: Guidance for School Food Service Professionals [PDF] (U.S. Department of Agriculture, 2017). With this support, swallowing efficiency and function may be improved. https://doi.org/10.1891/0730-0832.32.6.404, Shaker, C. S. (2013b, February 1). Clinicians may consider the following factors when assessing feeding and swallowing disorders in the pediatric population: As infants and children grow and develop, the absolute and relative size and shape of oral and pharyngeal structures change. See ASHAs resources on interprofessional education/interprofessional practice (IPE/IPP), and person- and family-centered care. As a result, intake is improved (Shaker, 2013a). Singular. Journal of Clinical Gastroenterology, 30(1), 3446. Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: a. Feeding and gastrointestinal problems in children with cerebral palsy. participating in decisions regarding the appropriateness of these procedures; conducting the VFSS and FEES instrumental procedures; interpreting and applying data from instrumental evaluations to, determine the severity and nature of the swallowing disorder and the childs potential for safe oral feeding; and. According to IDEA, students with disabilities may receive school health and nursing as related services to address safe mealtimes regardless of their special education classification. Postural and positioning techniques involve adjusting the childs posture or position to establish central alignment and stability for safe feeding. National Center for Health Statistics. Families may have strong beliefs about the medicinal value of some foods or liquids. Responsive feeding emphasizes communication rather than volume and may be used with infants, toddlers, and older children, unlike cue-based feeding that focuses on infants. Members of the dysphagia team may vary across settings. (2017). International Journal of Rehabilitation Research, 33(3), 218224. https://wayback.archive-it.org/7993/20170722060115/https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm256250.htm, Velayutham, P., Irace, A. L., Kawai, K., Dodrill, P., Perez, J., Londahl, M., Mundy, L., Dombrowski, N. D., & Rahbar, R. (2018). Furthermore, as stimulation of the rapidly-adapting skin mechanoreceptors during dynamic touch has been shown to be critical for other previously described intra- and inter-sensory interactions (e.g. Chewing cycles in 2- to 8-year-old normal children: A developmental profile. Prevalence refers to the number of children who are living with feeding and swallowing problems in a given time period. SLPs work with oral and pharyngeal implications of adaptive equipment. Clinicians working in the NICU should be aware of the multidisciplinary nature of this practice area, the variables that influence infant feeding, and the process for developing appropriate treatment plans in this setting. Lateral views of infant head, toddler head, and older child head showing structures involved in swallowing. Logemann, J. Deep Pharyngeal Neuromuscular Stimulation (DPNS) is a therapeutic program that restores muscle strength and reflexes within the pharynx for better swallowing. Treatment of ankyloglossia and breastfeeding outcomes: A systematic review. The SLP frequently serves as coordinator for the team management of dysphagia. Diet modifications should consider the nutritional needs of the child to avoid undernutrition and malnutrition. The effects of TTS on swallowing have not yet been investigated in IPD. Early introduction of oral feeding in preterm infants. appropriate positioning of the student for a safe swallow; specialized equipment indicated for positioning, as needed; environmental modifications to minimize distractions; adapted utensils for mealtimes (e.g., low flow cup, curved spoon/fork); recommended diet consistency, including food and liquid preparation/modification; sensory modifications, including temperature, taste, or texture; food presentation techniques, including wait time and amount; the level of assistance required for eating and drinking; and/or, Maureen A. Lefton-Greif, MA, PhD, CCC-SLP, Panayiota A. Senekkis-Florent, PhD, CCC-SLP. 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 et al., 2006). The experimental protocol was approved by the research ethics committee of University College London. 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