Please see the Treatment section of ASHAs Practice Portal page on Adult Dysphagia for further information. 0000018888 00000 n These techniques may be used prior to or during the swallow. Instrumental evaluation can also help determine if swallow safety can be improved by modifying food textures, liquid consistencies, and positioning or implementing strategies. Can the child receive adequate nutrition and hydration by mouth alone, given length of time to eat, efficiency, and fatigue factors? facilitate the individuals activities and participation by promoting safe, efficient feeding; capitalize on strengths and address weaknesses related to underlying structures and functions that affect feeding and swallowing; modify contextual factors that serve as barriers and enhance those that facilitate successful feeding and swallowing, including the development and use of appropriate feeding methods and techniques; and. https://doi.org/10.1542/peds.110.3.517, Snyder, R., Herdt, A., Mejias-Cepeda, N., Ladino, J., Crowley, K., & Levy, P. (2017). Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. Concurrent medical issues may affect this timeline. Feeding difficulties in craniofacial microsomia: A systematic review. Postural and positioning techniques involve adjusting the childs posture or position to establish central alignment and stability for safe feeding. Infants & Young Children, 11(4), 3445. Families are encouraged to bring food and drink common to their household and utensils typically used by the child. American Speech-Language-Hearing Association. Oropharyngeal dysphagia in preschool children with cerebral palsy: Oral phase impairments. Members of the Working Group on Dysphagia in Schools included Emily M. Homer (chair), Sheryl C. Amaral, Joan C. Arvedson, Randy M. Kurjan, Cynthia R. O'Donoghue, Justine Joan Sheppard, and Janet E. Brown (ASHA liaison). 0000090522 00000 n 0000063213 00000 n Precautions, accommodations, and adaptations must be considered and implemented as students transition to postsecondary settings. 0000051615 00000 n (2017). 0000017421 00000 n This paper reviews the method's history and selected data, outlines the theoretical underpinnings of sensory stimulation, reminds readers of what is required to bring a treatment from the laboratory to the clinic, and ends with some notions about the importance of belief and data in rehabilitation. Research in Developmental Disabilities, 35(12), 34693481. [Transition to adult care for children with chronic neurological disorders: Which is the best way to make it?]. DPNS has been shown to have a large effect on swallow function, quickly improving reflexive cough and improving vocal quality. NS skills are assessed during breastfeeding and bottle-feeding if both modes are going to be used. The data below reflect this variability. Therapeutic learning is the motor learning process in which target behavior is achieved by utilizing activity-dependent elements and the assistive system. Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants. Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors. For children with complex feeding problems, an interdisciplinary team approach is essential for individualized treatment (McComish et al., 2016). Indicators of choking risk in adults with learning disabilities: A questionnaire survey and interview study. With this support, swallowing efficiency and function may be improved. Oralmotor treatments include stimulation toor actions ofthe lips, jaw, tongue, soft palate, pharynx, larynx, and respiratory muscles. 0000090444 00000 n The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d). The decision to use a VFSS is made with consideration for the childs responsiveness (e.g., acceptance of oral stimulation or tastes on the lips without signs of distress) and the potential for medical complications. The development of jaw motion for mastication. Although thermal tactile oral stimulation is a common method to treat dysphagic patients to improve swallowing movement, little is known about the possible mechanisms. Dysphagia, 33(1), 7682. Once the infant begins eating pureed food, each swallow is discrete (as opposed to sequential swallows in bottle-fed or breastfed infants), and the oral and pharyngeal phases are similar to those of an adult (although with less elevation of the larynx). TTS should be combined with other swallowing exercises or alternated between such exercises. 0000090877 00000 n https://doi.org/10.1111/j.1552-6909.1996.tb01493.x. It may also improve the timing of oral feeding initiation (Simpson et al., 2002), increase rates of majority breastmilk enteral feeds compared to those who receive tube feeding of formula alone (Snyder et al., 2017), and allow for earlier attainment of full enteral feedings (Rodriguez & Caplan, 2015). Johnson, D. E., & Dole, K. (1999). The school SLP (or case manager) contacts the family to obtain consent for an evaluation if further evaluation is deemed necessary. The tactile and thermal sensitivity, and 2-point . Yet, thermal feedback is important for material discrimination and has been used to convey . SLPs develop and typically lead the school-based feeding and swallowing team. McCain, G. C. (1997). The SLP plays a critical role in the neonatal intensive care unit (NICU), supporting and educating parents and other caregivers to understand and respond accordingly to the infants communication during feeding. In the school setting a physicians order or prescription is not required to perform clinical evaluations, modify diets, or to provide intervention. (2008). hb``b````c` B,@. The Laryngoscope, 128(8), 19521957. complex medical conditions (e.g., heart disease, pulmonary disease, allergies, gastroesophageal reflux disease [GERD], delayed gastric emptying); factors affecting neuromuscular coordination (e.g., prematurity, low birth weight, hypotonia, hypertonia); medication side effects (e.g., lethargy, decreased appetite); sensory issues as a primary cause or secondary to limited food availability in early development (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, restrictive tethered oral tissues); educating families of children at risk for pediatric feeding and swallowing disorders; educating other professionals on the needs of children with feeding and swallowing disorders and the role of SLPs in diagnosis and management; conducting a comprehensive assessment, including clinical and instrumental evaluations as appropriate; considering culture as it pertains to food choices/habits, perception of disabilities, and beliefs about intervention (Davis-McFarland, 2008); diagnosing pediatric oral and pharyngeal swallowing disorders (dysphagia); recognizing signs of avoidant/restrictive food intake disorder (ARFID) and making appropriate referrals with collaborative treatment as needed; referring the patient to other professionals as needed to rule out other conditions, determine etiology, and facilitate patient access to comprehensive services; recommending a safe swallowing and feeding plan for the individualized family service plan (IFSP), individualized education program (IEP), or 504 plan; educating children and their families to prevent complications related to feeding and swallowing disorders; serving as an integral member of an interdisciplinary feeding and swallowing team; 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 ASHAs resources on, 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; and. Pediatric feeding and swallowing disorders: General assessment and intervention. In their role as communication specialists, SLPs monitor the infant for stress cues and teach parents and other caregivers to recognize and interpret the infants communication signals. For children who have difficulty participating in the procedure, the clinician should allow time to control problem behaviors prior to initiating the instrumental procedure. Assessment and treatment of swallowing and swallowing disorders may require the use of appropriate personal protective equipment and universal precautions. (n.d.). https://doi.org/10.1017/S0007114513002699, Lefton-Greif, M. A. the presence or absence of apnea. The health and well-being of the child is the primary concern in treating pediatric feeding and swallowing disorders. 0000090091 00000 n [1] Here, we cite the most current, updated version of 7 C.F.R. National Center for Health Statistics. https://doi.org/10.1016/j.ijom.2015.02.014, Centers for Disease Control and Prevention. Those section letters and numbers from 2011 are 210.10(g)(1) and can be found at https://www.govinfo.gov/content/pkg/CFR-2011-title7-vol4/pdf/CFR-2011-title7-vol4-sec210-10.pdf. 0000001702 00000 n 0000023230 00000 n 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. The school-based feeding and swallowing team consists of parents and professionals within the school as well as professionals outside the school (e.g., physicians, dietitians, and psychologists). Format refers to the structure of the treatment session (e.g., group and/or individual). Pediatrics, 108(6), e106. Speech-language pathologists (SLPs) play a central role in the assessment, diagnosis, and treatment of infants and children with swallowing and feeding disorders. screening of willingness to accept liquids and a variety of foods in multiple food groups to determine risk factors for avoidant/restrictive food intake disorder. (2016a). In addition to determining the type of treatment that is optimal for the child with feeding and swallowing problems, SLPs consider other service delivery variables that may affect treatment outcomes, including format, provider, dosage, and setting. 0000075777 00000 n If the child cannot meet nutritional needs by mouth, what recommendations need to be made concerning supplemental non-oral intake and/or the inclusion of orally fed supplements in the childs diet? 0000089259 00000 n Behavioral interventions include such techniques as antecedent manipulation, shaping, prompting, modeling, stimulus fading, and differential reinforcement of alternate behavior, as well as implementation of basic mealtime principles (e.g., scheduled mealtimes in a neutral atmosphere with no food rewards). Logemann, J. Haptic displays aim at artificially creating tactile sensations by applying tactile features to the user's skin. https://doi.org/10.1016/j.ridd.2014.08.029, Benfer, K. A., Weir, K. A., Bell, K. L., Ware, R. S., Davies, P. S. W., & Boyd, R. N. (2017). The team may consider the tube-feeding schedule, type of pump, rate, calories, and so forth. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. . According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed. 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. Pediatric dysphagia. When conducting an instrumental evaluation, SLPs should 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. (2012). Pediatric Pulmonology, 41(11), 10401048. Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Silent aspiration is estimated at 41% of children with laryngeal cleft, 41%49% of children with laryngomalacia, and 54% of children with unilateral vocal fold paralysis (Jaffal et al., 2020; Velayutham et al., 2018). (2001). In these instances, the swallowing and feeding team will. See, for example, Moreno-Villares (2014) and Thacker et al. The two most commonly used instrumental evaluations of swallowing for the pediatric population are. . 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. As a result, intake is improved (Shaker, 2013a). Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. 128 48 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. American Psychiatric Association. https://doi.org/10.1097/NMC.0000000000000252, Meal Requirements for Lunches and Requirements for Afterschool Snacks, 7 C.F.R. Chewing cycles in 2- to 8-year-old normal children: A developmental profile. Deep Pharyngeal Neuromuscular Stimulation (DPNS) is a therapeutic program that restores muscle strength and reflexes within the pharynx for better swallowing. A. Pro-Ed. an evaluation of dependence on nutritional supplements to meet dietary needs, an evaluation of independence and the need for supervision and assistance, and. Benfer, K. A., Weir, K. A., Bell, K. L., Ware, R. S., Davies, P. S. W., & Boyd, R. N. (2014). Please see ASHAs resource on alternative nutrition and hydration in dysphagia care for further information. The pharyngeal muscles are stimulated through neural pathways. https://doi.org/10.1016/j.pmr.2008.05.007, Lefton-Greif, M. A., Carroll, J. L., & Loughlin, G. M. (2006). J Rehabil Med 2009; 41: 174-178 Correspondence address: Kil-Byung Lim, Department of Reha- an assessment of behaviors that relate to the childs response to food. The Cleft PalateCraniofacial Journal, 43(6), 702709. A population of cold-responding fibers with response properties similar to those innervating primate skin were determined to be mediating the thermal evoked response to skin cooling in man. 0000001256 00000 n turn their head away from the spoon to show that they have had enough. Feeding and eating disorders: DSM-5 Selections. (1998). 205]. A non-instrumental assessment of NNS includes an evaluation of the following: The clinician can determine the appropriateness of NS following an NNS assessment. an acceptance of the pacifier, nipple, spoon, and cup; the range and texture of developmentally appropriate foods and liquids tolerated; and, the willingness to participate in mealtime experiences with caregivers, skill maintenance across the feeding opportunity to consider the impact of fatigue on feeding/swallowing safety, impression of airway adequacy and coordination of respiration and swallowing, developmentally appropriate secretion management, which might include frequency and adequacy of spontaneous dry swallowing and the ability to swallow voluntarily, modifications in bolus delivery and/or use of rehabilitative/habilitative or compensatory techniques on the swallow. Code of ethics [Ethics]. https://doi.org/10.1177/1053815118789396, Shaker, C. S. (2013a). Methodology: Fifty patients with dysphagia due to stroke were included. Cue-based feeding in the NICU: Using the infants communication as a guide. The SLP or radiology technician typically prepares and presents the barium items, whereas the radiologist records the swallow for visualization and analysis. The prevalence rises to 14.5% in 11- to 17-year-olds with communication disorders (CDC, 2012). Dysphagia can occur in one or more of the four phases of swallowing and can result in aspirationthe passage of food, liquid, or saliva into the tracheaand retrograde flow of food into the nasal cavity. (2001). https://doi.org/10.1542/peds.2017-0731, Bhattacharyya, N. (2015). Disruptions in swallowing may occur in any or all phases of swallowing. infants current state, including the respiratory rate and heart rate; infants behavior (willingness to accept nipple); caregivers behavior while feeding the infant; nipple type and form of nutrition (breast milk or formula); length of time the infant takes for one feeding; and, infants response to attempted interventions, such as, a different bottle to control air intake, and. https://doi.org/10.1002/eat.22350, Erkin, G., Culha, C., Ozel, S., & Kirbiyik, E. G. (2010). 0000063512 00000 n This question is answered by the childs medical team. Behaviors can include changes in the following: Readiness for oral feeding in the preterm or acutely ill, full-term infant is associated with. The clinician requests that the family provide. Prior to bolus delivery, the SLP may assess the following: A team approach is necessary for appropriately diagnosing and managing pediatric feeding and swallowing disorders, as the severity and complexity of these disorders vary widely in this population (McComish et al., 2016). Key words: swallowing, dysphagia, stroke, neuromuscular elec-trical stimulation. clear food from the spoon with their top lip, move food from the spoon to the back of their mouth, and. Some maneuvers require following multistep directions and may not be appropriate for young children and/or older children with cognitive impairments. skill development for eating and drinking efficiently during meals and snack times so that students can complete these activities with their peers safely and in a timely manner. 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. Consider how long it takes to eat a meal, fear of eating, pleasure obtained from eating, social interactions while eating, and so on (Huckabee & Pelletier, 1999). Pediatrics, 140(6), e20170731. (2017). https://www.cdc.gov/nchs/nhis/index.htm, Davis-McFarland, E. (2008). advocating for families and individuals with feeding and swallowing disorders at the local, state, and national levels. Journal of Adolescent Health, 55(1), 4952. 0000055191 00000 n 0000016477 00000 n From Arvedson, J.C., & Lefton-Greif, M.A. If the child is NPO, the clinician allows time for the child to develop the ability to accept and swallow a bolus. See the Service Delivery section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. The odds of having a feeding problem increase by 25 times in children with autism spectrum disorder compared with children who do not have autism spectrum disorder (Seiverling et al., 2018; Sharp et al., 2013). Prior to the instrumental evaluation, clinicians are encouraged to collaborate with the medical team regarding feeding schedules that will maximize feeding readiness during the evaluation. The infants ability to maintain a stable physiological state (e.g., oxygen saturation, heart rate, respiratory rate) during NNS. effect of neuromuscular and thermal tactile stimulation on its rehabilitation. The plan includes a protocol for response in the event of a student health emergency (Homer, 2008). 0000018013 00000 n thermal stimulation and swallow maneuvers for treatment of the patients with dysphagia. 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 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. The infants ability to turn the head and open the mouth (rooting) when stimulated on the lips or cheeks and to accept a pacifier into the mouth. The NICU is considered an advanced practice area, and inexperienced SLPs should be aware that additional training and competencies may be necessary. receives part or all of their nutrition or hydration via enteral or parenteral tube feeding. Characteristics of avoidant/restrictive food intake disorder in children and adolescents: A new disorder in DSM-5. American Journal of Occupational Therapy, 42(1), 4046. National Center for Health Statistics. (Practice Portal). ARFID is distinct from PFD in that ARFID does not include children whose primary challenge is a skill deficit (e.g., dysphagia) and requires that the severity of the eating difficulty exceeds the severity usually associated with a certain condition (e.g., Down syndrome). Cue-based feedingrelies on cues from the infant, such as lack of active sucking, passivity, pushing the nipple away, or a weak suck. 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. Thermal tactile stimulation on its rehabilitation saturation, heart rate, respiratory rate ) during NNS for discrimination. Characteristics of avoidant/restrictive food intake disorder in children without apparent risk factors for avoidant/restrictive food intake disorder in DSM-5 prepares. Thermal feedback is important for material discrimination and has been shown to have a large effect on swallow,. Infants & Young children, 11 ( 4 ), 702709 thermal feedback is important for material and. According to the user & # x27 ; s skin ( TTOS ) is a therapeutic program restores! Evaluations, modify diets, or to provide intervention lead the school-based feeding and swallowing.. 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