X-ray with a contrast material (barium X-ray). Children may be seen by numerous medical specialties including pediatric otolaryngology, gastroenterology, pulmonology, speech pathology, occupational therapy, and lactation consultants. Taking only small amounts of food, overpacking the mouth, and/or pocketing foods. Foods given during the assessment should be consistent with the child's current level of chewing skills. Assessment and treatment tools and strategies will be provided, so participants are prepared to integrate the knowledge and tools learned to properly identify, recommend and implement appropriate treatment for their pediatric dysphagia clients. Pediatric feeding assessments and interventions. See ASHA's Scope of Practice in Speech-Language Pathology (ASHA, 2016b). You drink a barium solution that coats your esophagus, allowing it to show up better on X-rays. Atypical eating and drinking behaviors can develop in association with dysphagia, aspiration, or a choking event. Thacker, A., Abdelnoor, A., Anderson, C., White, S., & Hollins, S. (2008). 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. Barium swallow/upper GI series. A prospective, longitudinal study of feeding skills in a cohort of babies with cleft conditions. Treatment depends on the cause. Francis D. O., Krishnaswami S., & McPheeters M. (2015). IDEA was enacted to protect the rights of students with disabilities and to ensure that these students receive a free and appropriate public education (FAPE). Know when and to what subspecialist(s) to refer the patient who has dysphagia and chronic aspiration. Earn an Advanced Certificate in Pediatric Dysphagia online at New York Medical College. This report can be used as an educational tool as well as a document supporting payment. Gisel, E. G. (1988). (Practice Portal). A. As indicated in the Code of Ethics (ASHA, 2016a), SLPs who serve this population should be educated and appropriately trained to do so. 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. Can the child receive adequate nutrition and hydration by mouth alone, given length of time to eat, efficiency, and fatigue factors? Dysphagia — difficulty swallowing — can turn an enjoyable meal or evening into a painful situation. 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. Reading the feeding. How can the child's functional abilities be maximized? Dysphagia in pediatric populations can result in multiple adverse health outcomes. Gisel, E. G., Applegate-Ferrante, T., Benson, J., & Bosma, J. F. (1996). Arlington, VA: Author. 2. Using the framework and the handbook as tools that can be utilized in all practice settings, this workshop will focus on assessment and treatment strategies for the community clinician. review of any past diagnostic test results; review of current programs and treatments; assessment of current skills and limitations at home and in other day settings; assessment of willingness to accept liquids and a variety of foods in multiple food groups; consideration of ARFID concerns, such as dependence on diet supplements to meet nutrition needs; evaluation of independence and need for supervision and assistance; and. Instrumental evaluation is conducted following a clinical evaluation when further information is needed to determine the nature of the swallowing disorder. Swallowing function and medical diagnoses in infants suspected of 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. Dysphagia Treatment in Pediatric Patients With Cancer: It Takes Collaboration. Treatment Efficacy Summary on Pediatric Feeding and Swallowing Disorders. 205]. © 1997- American Speech-Language-Hearing Association. The ASHA Action Center welcomes questions and requests for information from members and non-members. The health and well-being of the child is the primary concern in treating pediatric feeding and swallowing disorders. Dysphagia and the accompanying pulmonary aspiration are frequently unrecognized by pediatricians and caregivers as a cause of chronic respiratory symptoms such as recurrent wheezing, recurrent pneumonias, chronic cough, stridor, and brief resolved unexplained events (formerly known as acute life-threatening events). Part IV includes an introduction to the concept of evidence-based practice and the application of evidence-based strategies in the management of dysphagia. Pediatric dysphagia. 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. https://www.childrenshospital.org/.../d/dysphagia/diagnosis-and-treatment Setting refers to the location of treatment and varies across the continuum of care (e.g., NICU, intensive care unit, inpatient acute care, outpatient clinic, home, or school). Referring the patient to other professionals as needed to rule out other conditions, determine etiology, and facilitate patient access to comprehensive services. Rehabilitation Act of 1973, Section 504. Your child’s speech or occupational therapist may be able to recommend other commercial products that help thicken liquids and make them easier to swallow. Clinical Oral Investigations, 18, 1507–1515. Lefton-Greif, M. (2008). They may also change the type of cup or bottle your child is eating or drinking from. For children with complex feeding problems, an interdisciplinary team approach is essential for individualized treatment (McComish et al., 2016). 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 ASHA's resources on. No single posture will provide improvement to all individuals, and, in fact, postural changes differ between infants and older children. In addition to the clinical evaluation of infants noted above, breastfeeding assessment typically includes evaluation of the, For an example, see Community management of uncomplicated acute malnutrition in infants < 6 months of age (C-MAMI; 2015) [PDF], The assessment of bottle-feeding includes evaluation of the, The assessment of spoon-feeding includes evaluation of optimal spoon type and the infant's ability to, In addition to the areas of assessment noted above, the evaluation for toddlers (ages 1–3 years) and pre-school/school-age children (ages 3–21 years) may include. • Its chronic course and frequent progression to subepithelial fibrosis leading to strictures and narrow-caliber esophagus indicate the need for treatment. Treatment. 2002; 49(1): 97-112, vi. Management of pediatric dysphagia. Feeding disorders can be characterized by one or more of the following behaviors: Swallowing disorders (dysphagia) can occur in one or more of the four phases of swallowing and can result in aspiration—the passage of food, liquid, or saliva into the trachea—and retrograde flow of food into the nasal cavity. Estimated reports of the incidence and prevalence of pediatric feeding and swallowing disorders vary widely due to factors including variations in the conditions and populations sampled, how feeding disorders and/or swallowing impairment are defined, and the choice of assessment methods and measures (Arvedson, 2008; Lefton-Greif, 2008). Shaker, C. S. (2013a). 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. Logemann, J. 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. ... Orange Pediatric Therapy. 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. See ASHA's resources on interprofessional education/interprofessional practice (IPE/IPP) and collaboration and teaming for guidance on successful collaborative service delivery across settings. These studies are a team effort and may include the radiologist, radiology technician, and SLP. infant's current state, including respiratory rate and heart rate; infant's behavior (e.g., positive rooting, willingness to suckle at breast); infant's position (e.g., well supported, tucked against mother's body); infant's ability to latch onto the breast; efficiency and coordination of infant's suck/swallow/breathe pattern; mother's behavior (e.g., comfort with breastfeeding, confidence handling infant, awareness of infant's cues during feeding). Medical, surgical, and nutritional considerations are important components in treatment planning. Positioning limitations and abilities (e.g., children who are wheelchair dependent) may affect intake and respiration. This requires working knowledge of breastfeeding strategies to facilitate safe and efficient swallowing and optimal nutrition. These therapists can give your child exercises to help make swallowing more effective, or suggest techniques for feeding that may help improve swallowing problems. These techniques serve to protect the airway and offer safer transit of food and liquid. The SLP who specializes in feeding and swallowing disorders typically leads the professional care team in the clinical or educational setting. (2016). Our specialization and expertise provides complete dysphagia evaluation and treatment, from mild feeding issues to medically complex problems. 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. Number of all-listed diagnoses for sick newborn infants by sex and selected diagnostic categories [Data File]. Therefore, childhood swallowing difficulties must be diagnosed accurately and managed appropriately. Other signs to monitor include color changes, nasal flaring, and suck/swallow/breathe patterns. 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. Available from www.asha.org/policy/. Pediatric Dysphagia Pediatric Dysphagia Overview; Symptoms and Diagnosis; Treatments; Definition. Core members of the team include the SLP, family/caregiver, classroom teacher, nurse, occupational therapist, physical therapist, and school administrator. 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. The infant's oral structures and functions, including palatal integrity, jaw movement, and tongue movements for cupping and compression.