Lateral views of infant head, toddler head, and older child head showing structures involved in swallowing. American Journal of Occupational Therapy, 42(1), 4046. (1998). Management of adult neurogenic dysphagia. 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. Feeding and gastrointestinal problems in children with cerebral palsy. Taste or temperature of a food may be altered to provide additional sensory input for swallowing. British Journal of Nutrition, 111(3), 403414. 0000089512 00000 n They may include the following: Underlying etiologies associated with pediatric feeding and swallowing disorders include. 0000017421 00000 n ASHA is strongly committed to evidence-based practice and urges members to consider the best available evidence before utilizing any product or technique. This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA. Feeding provides children and caregivers with opportunities for communication and social experiences that form the basis for future interactions (Lefton-Greif, 2008). Journal of Adolescent Health, 55(1), 4952. Journal of Autism and Developmental Disorders, 43(9), 21592173. Le Rvrend, B. J. D., Edelson, L. R., & Loret, C. (2014). In these articles, we hear from both sides on the controversial use of neuromuscular electrical stimulation (e-stim) in dysphagia treatment. Benfer, K. A., Weir, K. A., Bell, K. L., Ware, R. S., Davies, P. S. W., & Boyd, R. N. (2014). Any communication by the school team to an outside physician, facility, or individual requires signed parental consent. The pup while on its back is allowed to sleep. 1997- American Speech-Language-Hearing Association. https://doi.org/10.1007/s00455-017-9834-y. Among children with communication disorders aged 310 years, the prevalence of swallowing problems is 4.3%. Arvedson, J. C., & Brodsky, L. (2002). When the quality of feeding takes priority over the quantity ingested, the infant can set the pace of feeding and have more opportunity to enjoy the experience of feeding. Pediatrics, 110(3), 517522. Singular. https://doi.org/10.1044/0161-1461(2008/018). See Person-Centered Focus on Function: Pediatric Feeding and Swallowing [PDF] for examples of assessment data consistent with the International Classification of Functioning, Disability and Health framework. 0000018888 00000 n SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 15(3), 1015. 0000001702 00000 n 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). According to the Centers for Disease Control and Prevention (CDC), survey interviews indicated that within the past 12 months, 0.9% of children (approximately 569,000) ages 317 years are reported to have swallowing problems (Bhattacharyya, 2015; Black et al., 2015). Using this treatment, clinicians deliver electrical current through electrodes to stimulate peripheral nerves and evoke a muscle contraction. 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. Is a sensory motorbased intervention for behavioral issues indicated? Appropriate referrals to medical professionals should be made when anatomical or physiological abnormalities are found during the clinical evaluation. 0000089415 00000 n See the Treatment section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. the childs familiar and preferred utensils, if appropriate. Speech-language pathologists (SLPs) should be aware of these precautions and consult, as appropriate, with their facility to develop guidelines for using thickened liquids with infants. Children with sufficient cognitive skills can be taught to interpret this visual information and make physiological changes during the swallowing process. The prevalence of pediatric voice and swallowing problems in the United States. Diet modifications should consider the nutritional needs of the child to avoid undernutrition and malnutrition. Research in Developmental Disabilities, 35(12), 34693481. Alex F. Johnson and Celia Hooper served as monitoring officers (vice presidents for speech-language pathology practices, 20002002 and 20032005, respectively). Feeding and swallowing disorders may be considered educationally relevant and part of the school systems responsibility to ensure. Intraoral appliances (e.g., palatal plates) are removable devices with small knobs that provide tactile stimulation inside the mouth to encourage lip closure and appropriate lip and tongue position for improved functional feeding skills. 0000001525 00000 n Decisions regarding the initiation of oral feeding are based on recommendations from the medical and therapeutic team, with input from the parent and caregivers. Concurrent medical issues may affect this timeline. (Note: Lip closure is not required for infant feeding because the tongue typically seals the anterior opening of the oral cavity.). Interdisciplinary feeding team: A medical, motor, behavioral approach to complex pediatric feeding problems. 0000055191 00000 n The infants ability to use both compression (positive pressure of the jaw and tongue on the pacifier) and suction (negative pressure created with tongue cupping and jaw movement). From Arvedson, J.C., & Lefton-Greif, M.A. 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). National Center for Health Statistics. 0000088761 00000 n different positions (e.g., side feeding). Referrals may be made to dental professionals for assessment and fitting of these devices. B. The referral can be initiated by families/caregivers or school personnel. No single posture will provide improvement to all individuals. 0000018100 00000 n https://doi.org/10.1044/0161-1461(2008/020), de Vries, I. 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. Indicators of choking risk in adults with learning disabilities: A questionnaire survey and interview study. trailer <<2AADF4957C534E2585366F6E9BD5386B>]/Prev 440546/XRefStm 1525>> startxref 0 %%EOF 175 0 obj <>stream Chewing cycles in 2- to 8-year-old normal children: A developmental profile. Supine position - hold the pup so that its back is resting in the palm of both hands with its muzzle facing the ceiling. Prevalence refers to the number of children who are living with feeding and swallowing problems in a given time period. clear food from the spoon with their top lip, move food from the spoon to the back of their mouth, and. 0000089331 00000 n 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. ; American Psychiatric Association, 2016), ARFID is an eating or a feeding disturbance (e.g., apparent lack of interest in eating or in food, avoidance based on the sensory characteristics of food, concern about aversive consequences of eating), as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: SLPs may screen or make referrals for ARFID but do not diagnose this disorder. effect of neuromuscular and thermal tactile stimulation on its rehabilitation. https://doi.org/10.1080/09638280701461625, U.S. Department of Agriculture. In the Masako, the tongue is held forward between the teeth while swallowing; this is performed without food or liquid in the mouth to prevent coughing or choking. Family and cultural issues in a school swallowing and feeding program. Early introduction of oral feeding in preterm infants. National Center for Health Statistics. Pediatric feeding disorder (PFD) is impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction (Goday et al., 2019). This understanding gives the SLP the necessary knowledge to choose appropriate treatment interventions and provide rationale for their use in the NICU. Additionally, the definition of ARFID considers nutritional deficiency, whereas PFD does not (Goday et al., 2019). Pediatric videofluoroscopic swallow studies: A professional manual with caregiver guidelines. familiar foods of varying consistencies and tastes that are compatible with contrast material (if the facility protocol allows); a specialized seating system from home (including car seat or specialized wheelchair), as warranted and if permitted by the facility; and. 0000027867 00000 n The Laryngoscope, 128(8), 19521957. Most NICUs have begun to move away from volume-driven feeding to cue-based feeding (Shaker, 2013a). https://doi.org/10.1542/peds.2017-0731, Bhattacharyya, N. (2015). has suspected structural abnormalities (requires an assessment from a medical professional). Feeding and eating disorders: DSM-5 Selections. The hyoid bone and the larynx are positioned higher than in adults, and the larynx elevates less than in adults during the pharyngeal phase of the swallow. Communication disorders and use of intervention services among children aged 317 years: United States, 2012 [NCHS Data Brief No. McComish, C., Brackett, K., Kelly, M., Hall, C., Wallace, S., & Powell, V. (2016). 1400 et seq. For children with complex feeding problems, an interdisciplinary team approach is essential for individualized treatment (McComish et al., 2016). International Journal of Rehabilitation Research, 33(3), 218224. 2), 3237. How can the childs functional abilities be maximized? Swallowing is commonly divided into the following four phases (Arvedson & Brodsky, 2002; Logemann, 1998): Feeding disorders are problems with a range of eating activities that may or may not include problems with swallowing. 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. For children who have difficulty participating in the procedure, the clinician should allow time to control problem behaviors prior to initiating the instrumental procedure. The development of jaw motion for mastication. Consult with families regarding safety of medical treatments, such as swallowing medication in liquid or pill form, which may be contraindicated by the disorder. Group I received neuromuscular electric stimulation sessions on the neck one hour daily for 12 weeks. 0000004953 00000 n Modifications to positioning are made as needed and are documented as part of the assessment findings. Oropharyngeal dysphagia in preschool children with cerebral palsy: Oral phase impairments. The infants oral structures and functions, including palatal integrity, jaw movement, and tongue movements for cupping and compression. 0000009195 00000 n The team may consider the tube-feeding schedule, type of pump, rate, calories, and so forth. In all cases, the SLP must have an accurate understanding of the physiologic mechanism behind the feeding problems seen in this population. Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants. Any loss of stability in physiologic, motoric, or behavioral state from baseline should be taken into consideration at the time of the assessment. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. https://doi.org/10.1017/S0007114513002699, Lefton-Greif, M. A. Protocols for determining readiness for oral feeding and specific criteria for initiating feeding vary across facilities. 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. TTS should be combined with other swallowing exercises or alternated between such exercises. observations of the caregivers behaviors and ability to read the childs cues as they feed the child. Haptic displays aim at artificially creating tactile sensations by applying tactile features to the user's skin. oversee the day-to-day implementation of the feeding and swallowing plan and any individualized education program strategies to keep the student safe from aspiration, choking, undernutrition, or dehydration while in school. has a complex medical condition and experiences a significant change in status. scintigraphy (which, in the pediatric population, may also be referred to as radionuclide milk scanning). 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). In infants, the tongue fills the oral cavity, and the velum hangs lower. Clinical Oral Investigations, 18(5), 15071515. The infants ability to maintain a stable physiological state (e.g., oxygen saturation, heart rate, respiratory rate) during NNS. ASHA does not require any additional certifications to perform E-stim and urges members to follow the ASHA Code of Ethics, Principle II, Rule A which states: "Individuals who hold the Certificate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience" (ASHA, 2016a). Maneuvers are strategies used to change the timing or strength of movements of swallowing (Logemann, 2000). 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. Cue-based feeding in the NICU: Using the infants communication as a guide. https://doi.org/10.1542/peds.108.6.e106, Norris, M. L., Spettigue, W. J., & Katzman, D. K. (2016). . 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. Signs and symptoms vary based on the phase(s) affected and the childs age and developmental level. (2002). The school-based SLP and the school team (OT, PT, and school nurse) conduct the evaluation, which includes observation of the student eating a typical meal or snack. feeding and swallowing problems that persist into adulthood, including the risk for choking, malnutrition, or undernutrition. Please enable it in order to use the full functionality of our website. [1] Here, we cite the most current, updated version of 7 C.F.R. A. C., Breugem, C. C., van der Heul, A. M. B., Eijkemans, M. J. C., Kon, M., & Mink van der Molen, A. Recommended practices follow a collaborative process that involves an interdisciplinary team, including the child, family, caregivers, and other related professionals. These cues can communicate the infants ability to tolerate bolus size, the need for more postural support, and if swallowing and breathing are no longer synchronized. Oropharyngeal dysphagia and/or feeding dysfunction in children with cerebral palsy is estimated to be 19.2%99.0%. Cerebral evoked responses to a 10C cooling pulse were recorded from human scalp at a 29C adapting temperature where primate cold-responding fibers . The health and well-being of the child is the primary concern in treating pediatric feeding and swallowing disorders.
