This article provides a review of symptoms, etiologies, and resources available regarding management of this condition to help the primary care physician and the families … 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. Structural assessment of the face, jaw, lips, tongue, hard and soft palate, oral pharynx, and oral mucosa. The health and well-being of the child is the primary concern in treating pediatric feeding and swallowing disorders. Children with sufficient cognitive skills can be taught to interpret this visual information and make physiological changes during the swallowing process. the impact of feeding and swallowing impairments on. Precautions, accommodations, and adaptations must be considered and implemented as students transition to post-secondary settings. This condition can be long-term or it can come on suddenly. See, for example, Moreno Villares (2014) and Thacker, Abdelnoor, Anderson, White, & Hollins, (2008). Feeding problems and nutrient intake in children with autism disorders: A meta-analysis and comprehensive review of the literature. 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. Pediatrics, 108, e106–e106. Dysphagia in pediatric populations can result in multiple adverse health outcomes. Infants and children with dysphagia are often able to swallow thick fluids and soft foods (such as baby foods or pureed or blended foods) better than thin liquids. SLPs conduct assessments in a manner that is sensitive and responsive to the family's cultural background, beliefs, and preferences for treatment. The ASHA Leader, 18, 42–47. International adoptions: Implications for early intervention. Your speech-language pathologist (SLP) will work with you and other specialists to determine the treatment plan that is right for your child. 29 U.S.C. Interpreting the complex information collected during these assessments and forming a treatment plan that is functional during the home program can be challenging. 2 nd Edition. 2. There is little data on the effectiveness and safety of NMES for treatment of dysphagia in infants with neurological impairment to … The efficacy of commonly employed diagnostic and treatment strategies has been largely unexplored, although there has been a steadily increasing amount of research specific to pediatric dysphagia. Feeding is the process involving any aspect of eating or drinking, including gathering and preparing food and liquid for intake, sucking or chewing, and swallowing (Arvedson & Brodsky, 2002). Reid, J., Kilpatrick, N., & Reilly, S. (2006). 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 skills of premature infants will be consistent with neurodevelopmental level rather than chronological age or adjusted age. Available from www.asha.org/policy/. Enteral Feeding. Webb, A. N., Hao, W., & Hong, P. (2013). How can the child's quality of life be preserved and/or enhanced? Wilson, E. M., & Green, J. R. (2009). Oropharyngeal dysphagia in preschool children with cerebral palsy: Oral phase impairments. SLPs collaborate with mothers, nurses, and lactation consultants prior to assessing breastfeeding skills. Erkin, G., Culha, C., Sumru, K., & Gulsen, E. (2010). Cricopharyngeal Myotomy. Consistent with the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) framework (ASHA, 2016a; WHO, 2001), comprehensive assessment is conducted to identify and describe. Multiple radiographic studies are used to diagnose aspiration and dysphagia in children. Pediatric videofluoroscopic swallow studies: A professional manual with caregiver guidelines. 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. Therapy techniques that are used to assist with bolus management can be developed to help children be more successful eaters. Practice Gaps. (. Number of all-listed diagnoses for sick newborn infants by sex and selected diagnostic categories [Data File]. Students must be safe while eating in school, including having access to appropriate personnel, food, and procedures to minimize risks for choking and for aspiration while eating. Counseling children and their families to provide education to prevent complications related to feeding and swallowing disorders. This article provides an overview of dysphagia in children, as well as common causes of childhood swallowing difficulties, populations at risk for pediatric dysphagia, techniques used to assess swallowing in pediatric patients, and the current treatment options available for infants and children with dysphagia. . San Diego, CA: Singular. In all cases, the SLP must have an accurate understanding of the physiologic mechanism driving the symptomatic feeding problems seen in this population. Treatment Efficacy Summary on Pediatric Feeding and Swallowing Disorders. British Journal of Nutrition, 111, 403–414. See ASHA's resources on dysphagia teams, interprofessional education/interprofessional practice [IPE/IPP], and person- and family-centered care. Provider refers to the person providing treatment (e.g., SLP, occupational therapist, or other feeding specialist). FDA expands caution about simply thick. Rather than setting a goal to empty the bottle, the feeding experience is viewed as a partnership with the infant. Dave, what are we talking about today? Some maneuvers require following multistep directions and may not be appropriate for young children and/or older children with cognitive impairments. The physician will examine your child and obtain a medical history. A. Description: The incidence of dysphagia in pediatrics is increasing, creating a greater need for evidence-based assessments and interventions.In spite of this, there is limited evidence to support treatment in this population. An estimated 116,000 newborn infants are discharged from short-stay hospitals with a diagnosis of feeding problems, according to the. Does the child have the potential to improve swallowing function with direct treatment? 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. Key points about dysphagia in children. The clinician provides families and caregivers with information about dysphagia, the purpose for the study, the test procedures, and the test environment. 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 3–17 years are reported to have swallowing problems (Bhattacharyya, 2015; Black, Vahratian, & Hoffman, 2015). Therefore, childhood swallowing difficulties must be diagnosed accurately and managed appropriately. It is important to study children with dysphagia to determine what treatment techniques are effective in reducing the prevalence of dysphagia in the school system. Following are some of the common treatment of pediatric dysphagia: Oral motor treatment: It involves coordination of lips, tongue, cheek and jaw muscles for optimal eating. Some infants who had trouble swallowing formula will do better when they are old enough to eat baby foods. (2006). Chewing cycles in 2- to 8-year-old normal children: A developmental profile. Therefore, childhood swallowing difficulties must be diagnosed accurately and … move their head toward the spoon with their mouth open; turn their head away from the spoon to show that they have had enough; clear food from the spoon with their top lip; move food from the spoon to the back of their mouth; and. When treatment incorporates accommodations, modifications, and supports in everyday settings, SLPs often provide training and education in how to use strategies to facilitate safe swallowing. First steps towards development of an instrument for the reproducible quantification of oropharyngeal swallow physiology in bottle-fed children. Pediatric Dysphagia Pediatric Dysphagia Overview; Symptoms and Diagnosis; Treatments; Definition. 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. Families are encouraged to bring food and drink common to their household and utensils typically used by the child. The physician can watch what happens as your child swallows the fluid, and note any problems that may occur in the throat, esophagus or stomach. . The goal of a system-supported process is to develop procedures that are consistent throughout a school district. Educating other professionals on the needs of children with feeding and swallowing disorders and the role of SLPs in diagnosing and managing these disorders. Following are some of the common treatment of pediatric dysphagia: Oral motor treatment: It involves coordination of lips, tongue, cheek and jaw muscles for optimal eating. School-based SLPs do not require a doctor's order to perform a clinical evaluation of feeding and swallowing or to implement intervention programs. 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. [6] Arvedson JC. Retrieved from https://www.dol.gov/oasam/regs/statutes/sec504.htm. See the Assessment section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspectives. ARFID rates are estimated to be 1.5%–13.8% in children between the ages of 8 and 18 years with suspected gastrointestinal problems or eating disorders (Eddy et al., 2015; Fisher et al., 2014). Homer, E. M. (2016). (2000). 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. This course includes video examples, case studies, lab practice, and application activities. Day 2 will look at how to recognize, plan for and treat swallowing disorders in pediatric clients. Unfortunately, little is known about the impact of pediatric dysphagia and the efficacy of interventions on the long-term health and quality-of-life outcomes for affected children . International Journal of Rehabilitation Research, 33, 218–224. infant's behavior (willingness to accept nipple); nipple type and form of nutrition (breast milk or formula); length of time infant takes for one feeding; and. Causes of dysphagia may evolve from five broad diagnostic categories: neurologic disorders (eg, immaturity, delays, or defects), anatomic abnormalities involving the aerodigestive tract, genetic conditions, conditions affecting suck/swallow/breathing coordination, and other comorbidities influencing deglutition ( Table 1 ). Pacing—moderating the rate of intake by controlling or titrating the rate of presentation of food or liquid and the time between bites or swallows. See ASHA's resources on dysphagia teams, interprofessional education/interprofessional practice [IPE/IPP], and collaboration and teaming. 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. The effect of tongue-tie division on breastfeeding and speech articulation: A systematic review. International Journal of Pediatric Otorhinolaryngology, 77, 635-646. The scope of this page is feeding and swallowing disorders in infants, pre-school children, and school-age children up to 21 years of age. 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. Management of adult neurogenic dysphagia. Imaging tests may also be done to evaluate your child’s mouth, throat and esophagus. Underlying disease state(s), chronological and developmental age of the child, social and environmental factors, and psychological and behavioral factors also affect treatment recommendations. If the team determines that medical assessment is advisable prior to initiating a school-based feeding and swallowing program or during the course of a program, the team can recommend that the family seek medical consultation (e.g., for a videofluoroscopic swallowing study [VFSS] referral and/or other medical assessments). Pediatric Dysphagia: Etiologies, Diagnosis, and Management is a comprehensive professional reference on the topic of pediatric feeding and swallowing disorders. In infants, the tongue fills the oral cavity and the velum hangs lower. Learning Objectives. Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., . You will be asked questions about how your child eats and any problems you notice during feeding. Sharp, W. G., Berry, R. C., McCracker, C., Nuhu, N. N., Marvel, E., Saulnier, C. A., . Taking only small amounts of food, overpacking the mouth, and/or pocketing foods. American Speech-Language-Hearing Association. A. The long-term consequences of feeding and swallowing disorders can include. Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors. 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 Dysphagia — difficulty swallowing — can turn an enjoyable meal or evening into a painful situation. Instrumental evaluation is conducted following a clinical evaluation when further information is needed to determine the nature of the swallowing disorder. Frequent congestion, particularly after meals. aspiration pneumonia and/or compromised pulmonary status; gastrointestinal complications such as motility disorders, constipation, and diarrhea; poor weight gain velocity and/or undernutrition; rumination disorder (unintentional and reflexive regurgitation of undigested food that may involve re-chewing and re-swallowing of the food); ongoing need for enteral (gastrointestinal) or parenteral (intravenous) nutrition; psychosocial effects on the child and his or her family; and. In addition, an ASHA treatment efficacy report on pediatric feeding and swallowing disorders is available on the ASHA Web site (search “pediatric dysphagia” on the ASHA Web site). She initially became Board Certified in Swallowing and Swallowing Disorders in 2011. Know the conditions predisposing to dysphagia and aspiration in children. Foods given during the assessment should be consistent with the child's current level of chewing skills. Prevalence of feeding disorders in children with cleft palate only: A retrospective study. Compensatory Techniques. Her writings have been published in professional and industry journals. Treatment of your child’s GERD may include: #1 Ranked Children's Hospital by U. S. News & World Report, remaining upright for at least an hour after eating, medications to decrease stomach acid production, medications to help food move through the digestive tract faster, an operation to help keep food and acid in the stomach (fundoplication). Arvedson, J. C., & Brodsky, L. (2002). San Diego, CA: Plural. Treatment for dysphagia is based on the nature and severity of … (2000). 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). These studies are a team effort and may include the radiologist, radiology technician, and SLP. Congenital abnormalities and/or chronic conditions can affect feeding and swallowing function. Providing prevention information to families of children at risk for pediatric feeding and swallowing disorders as well as to individuals working with those at risk. changes in normal heart rate (bradycardia or tachycardia); skin color change such as turning blue around the lips, nose and fingers/toes (cyanosis); temporary cessation of breathing (apnea); frequent stopping due to uncoordinated suck-swallow-breathe pattern; and. When exploring this option, it is also important to consider any behavioral and/or sensory components that may influence feeding. § 1400 (2004). © 1997- 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. Apnea is strongly correlated with longer transition time to full oral feeding (Mandich, Ritchie, & Mullett, 1996). Journal of Developmental and Behavioral Pediatrics, 23, 297–303. Feeding therapy can be helpful for some children. She consults to organizations worldwide to create and train for treatment. ... Effect of nutrition staging on treatment delays and outcome in stage IV neuroblastoma. Because a variety of medical specialists can be involved in the care of the patient with dysphagia, all must Students must be healthy (e.g., free from aspiration pneumonia or other illnesses related to malnutrition or dehydration) to maximize their attendance at school. As indicated in the Code of Ethics (ASHA, 2016a), SLPs who serve this population should be educated and appropriately trained to do so. Disability and Rehabilitation, 30, 1131–1138. Infants are obligate nasal breathers, and compromised breathing may result from the placement of a fiberoptic endoscope in one nostril when a nasogastric tube is in place in the other nostril. In addition to an IEP or 504 Plan, other documentation may be required, including the following: Feeding and swallowing challenges can persist well into adolescence and adulthood. They typically develop and lead the team to address the needs of student with feeding and swallowing issues. Assessment of developmentally appropriate secretion management, which might include frequency and adequacy of spontaneous dry swallowing and ability to swallow voluntarily. 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. A referral to the appropriate medical professional should be made when anatomical or physiological abnormalities are found during the clinical evaluation. Typical modifications may include thickening thin liquids, softening, cutting/chopping, or pureeing solid foods. (1998). You may need: Esophageal dilation —making the esophagus wider where it narrows Maneuvers are strategies used to change the timing or strength of movements of swallowing (Logemann, 2000). Feeding is the process involving any aspect of eating or drinking, including gathering and preparing food and liquid for intake, sucking or chewing, and swallowing (Arvedson & Brodsky, 2002). Early detection of dysphagia in infants and children is important to prevent or minimize complications. Consideration for interventions and referrals (e.g., medical or surgical specialists, nutritionist, psychologist or social worker, occupational therapist, physical therapist). Dysphagia Treatment in Pediatric Patients With Cancer: It Takes Collaboration. During an instrumental assessment of swallowing, the clinician may use information from cardiac, respiratory, and oxygen-saturation monitors to monitor any changes to physiologic or behavioral condition. Do these behaviors result in family/caregiver frustration or increased conflict during meals? Multiple radiographic studies are used to diagnose aspiration and dysphagia in children. Feeding and Swallowing. They will be able to determine not only if your child is having difficulty with swallowing but also how to treat him/her in order for them to receive the proper amount of nutrition for survival. Brian B. Shulman, vice president for professional practices in speech-language pathology, served as the monitoring officer. Assessment of NS includes evaluation of the following: The infant's communication behaviors during feeding can be used as cues to guide dynamic assessment. SLPs play a significant role in the management of students with swallowing and feeding problems within school settings. 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. International Journal of Eating Disorders, 48, 464–470. Most NICUs have begun to move away from volume-driven feeding to cue-based feeding. § 701 (1973) and the Individuals with Disabilities Education Improvement Act (IDEA, 2004) mandate services for health-related disorders that affect the ability of the student to access educational programs and participate fully. Treatment includes rewarding positive behaviors and decreasing the negative behaviors We want to increase acceptance of foods Aversive behaviors that should be addressed include: food stuffing or holding, spitting food out, food selectivity or refusal, tantrums or crying, refusal of the high chair, blocking, grimacing, and intentional The ASHA Action Center welcomes questions and requests for information from members and non-members. 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. Language, Speech, and Hearing Services in Schools, 31, 50–55. Functional assessment of muscles and structures used in swallowing, including assessment of symmetry, sensation, strength, tone, range and rate of motion, and coordination of movement. World Health Organization. ET Monday–Friday, Site Help | A–Z Topic Index | Privacy Statement | Terms of Use Neuromuscular electrical stimulation (NMES) is a proposed treatment for dysphagia that involves electrical stimulation of the swallowing muscles. The clinician allows time for the child to acclimate to the room, the equipment, and the professionals who will be present for the procedure. It is used as a treatment option to encourage eventual oral intake. C, Breugem, C. C., van der Heul, A. M. B., Eijkemans, M. J. C., Kon, M., & Mink van der Molen, A. The infant's strength of compression and suction. She developed the successful STEP program for evaluation and treatment of pediatric dysphagia used by many practices. 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, Carroll, & Loughlin, 2006; Newman, Keckley, Petersen, & Hamner, 2001) and the improved longevity of persons with dysphagia that develops during childhood (Lefton-Greif et al., 2017). 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, Kilpatrick, & Reilly, 2006). Calis, E. A. C., Veuglers, R., Sheppard, J. J., Tibboel, D., Evenhuis, H. M., & Penning, C. (2008). It’s that time of year again- back to school and back to frequent testing for school age children. Some of these interventions can also incorporate sensory stimulation. Earn an Advanced Certificate in Pediatric Dysphagia online at New York Medical College. Code of ethics [Ethics]. 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. The clinician requests that the family provide, familiar foods of varying consistencies and tastes that are compatible with contrast material (if facility protocol allows), a specialized seating system from home (including car seat or specialized wheelchair), as warranted and if permitted by the facility; and. Transition to adult care for children with chronic neurological disorders: Which is the best way to make it? Johnson, D. E., & Dole, K. (1999). Typical feeding practices are used during assessment (e.g., if the child is typically fed sitting on a parent's lap, then this is observed during the assessment).