The infants oral structures and functions, including palatal integrity, jaw movement, and tongue movements for cupping and compression. 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. Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting. 0000089512 00000 n Prevalence of feeding problems in young children with and without autism spectrum disorder: A chart review study. SLPs work with oral and pharyngeal implications of adaptive equipment. Tactile and thermal hypersensitivity were assessed using von Frey filaments and the tail flick test initially, at 24 h and 48 h after administration. Journal of Adolescent Health, 55(1), 4952. For infants, pacing can be accomplished by limiting the number of consecutive sucks. promote a meaningful and functional mealtime experience for children and families. Format refers to the structure of the treatment session (e.g., group and/or individual). NNS is sucking for comfort without fluid release (e.g., with a pacifier, finger, or recently emptied breast). 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. See Person-Centered Focus on Function: Pediatric Feeding and Swallowing [PDF] for examples of goals consistent with the ICF framework. Please see AHSAs resource on state instrumental assessment requirements for further details. Celia Hooper, vice president for professional practices in speech-language pathology (20032005), served as monitoring vice president. 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). Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors. 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. The Laryngoscope, 125(3), 746750. Pediatric dysphagia. During stimulation, participants may hear a soft buzzing or tone and experience weak tactile sensations, depending on the transducer mechanics and sonication protocol. To measure pain thresholds, we applied thermal heat stimuli to the center of the posterior region of the left forearm by means of a thermal stimulator (UDH-105, UNIQUE MEDICAL, Tokyo, Japan). 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). 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. 0000057570 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. 0000089121 00000 n The SLP frequently serves as coordinator for the team management of dysphagia. NNS does not determine readiness to orally feed, but it is helpful for assessment. A clinical evaluation of swallowing and feeding is the first step in determining the presence or absence of a swallowing disorder. Dysphagia in children with severe generalized cerebral palsy and intellectual disability. The Individuals with Disabilities Education Improvement Act of 2004 (IDEA, 2004) protects the rights of students with disabilities, ensures free appropriate public education, and mandates services for students who may have health-related disorders that impact their ability to fully participate in the educational curriculum. The health and well-being of the child is the primary concern in treating pediatric feeding and swallowing disorders. Developmental Medicine & Child Neurology, 50(8), 625630. See, for example, Manikam and Perman (2000). Late onset necrotizing enterocolitis in infants following use of a xanthan gum-containing thickening agent. Methodology: Fifty patients with dysphagia due to stroke were included. In these cases, intervention might consist of changes in the environment or indirect treatment approaches for improving safety and efficiency of feeding. SLPs lead the team in. Careful pulmonary monitoring during a modified barium swallow is essential to help determine the childs endurance over a typical mealtime. The experimental protocol was approved by the research ethics committee of University College London. Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. an assessment of behaviors that relate to the childs response to food. https://doi.org/10.1044/leader.FTRI.18022013.42, Sharp, W. G., Berry, R. C., McCracken, C., Nuhu, N. N., Marvel, E., Saulnier, C. A., Klin, A., Jones, W., & Jaquess, D. L. (2013). The clinician allows time for the child to get used 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. 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. The aim of this study was to investigate the immediate effects of TTS on the timing of swallow in a cohort of people . Staff who work closely with the student should have training in cardiopulmonary resuscitation (CPR) and the Heimlich maneuver. 0000051615 00000 n https://doi.org/10.1044/0161-1461(2008/020), de Vries, I. 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. 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). Postural and positioning techniques involve adjusting the childs posture or position to establish central alignment and stability for safe feeding. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 25(9), 771776. 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. Clinicians should discuss this with the medical team to determine options, including the temporary removal of the feeding tube and/or use of another means of swallowing assessment. The team may consider the tube-feeding schedule, type of pump, rate, calories, and so forth. National Center for Health Statistics. 0000004953 00000 n the infants ability to come into and maintain awake states and to coordinate breathing with sucking and swallowing (McCain, 1997) as well as. 0000001256 00000 n American Journal of Occupational Therapy, 42(1), 4046. 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. Prevalence refers to the number of children who are living with feeding and swallowing problems in a given time period. 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. . Protocols for determining readiness for oral feeding and specific criteria for initiating feeding vary across facilities. 0000017901 00000 n Referrals may be made to dental professionals for assessment and fitting of these devices. 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. Clinical Oral Investigations, 18(5), 15071515. Establishing a public school dysphagia program: A model for administration and service provision. Any loss of stability in physiologic, motoric, or behavioral state from baseline should be taken into consideration at the time of the assessment. Implementation of strategies and modifications is part of the diagnostic process. Ongoing staff and family education is essential to student safety. (Note: Lip closure is not required for infant feeding because the tongue typically seals the anterior opening of the oral cavity.). 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. 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. Reproduced and adapted with permission. 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). International Journal of Rehabilitation Research, 33(3), 218224. As a result, intake is improved (Shaker, 2013a). Pediatric videofluoroscopic swallow studies: A professional manual with caregiver guidelines. 0000023632 00000 n 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. Code of ethics [Ethics]. How can the childs functional abilities be maximized? Members of the team include, but are not limited to, the following: If the school team determines that a medical assessment, such as a videofluoroscopic swallowing study (VFSS), flexible endoscopic evaluation of swallowing (FEES), sometimes also called fiber-optic endoscopic evaluation of swallowing, or other medical assessment, is required during the students program, the team works with the family to seek medical consultation or referral. 0000090444 00000 n 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). 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. determine whether the child will need tube feeding for a short or an extended period of time. See ASHAs resources on interprofessional education/interprofessional practice (IPE/IPP), and collaboration and teaming. MCN: The American Journal of Maternal/Child Nursing, 41(4), 230236. Beckett, C., Bredenkamp, D., Castle, J., Groothues, C., OConnor, T. G., Rutter, M., & the English and Romanian Adoptees (ERA) Study Team. Determining the appropriate procedure to use depends on what needs to be visualized and which procedure will be best tolerated by the child. Pacingmoderating the rate of intake by controlling or titrating the rate of presentation of food or liquid and the time between bites or swallows. observations of the caregivers behaviors and ability to read the childs cues as they feed the child. Early introduction of oral feeding in preterm infants. Silent aspiration: Who is at risk? Sometimes a light transient headache and a feeling of fatigue is reported, although it is not clear whether these are caused by the stimulation or participation in the experiment . KMCskin-to-skin contact between a mother and her newborn infantcan be an important factor in helping the infant achieve readiness for oral feeding, particularly breastfeeding. (2017). Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants. National Health Interview Survey. 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. ARFID rates are estimated to be as high as 5% in the general pediatric population and 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; Norris et al., 2016). 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. World Health Organization. A physicians order to evaluate is typically not required in the school setting; however, it is best practice to collaborate with the students physician, particularly if the student is medically fragile or under the care of a physician. Infants are obligate nasal breathers, and compromised breathing may result from the placement of a flexible endoscope in one nostril when a nasogastric tube is in place in the other nostril. Instrumental evaluation is conducted following a clinical evaluation when further information is needed to determine the nature of the swallowing disorder. 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). https://doi.org/10.1016/j.jadohealth.2013.11.013, Francis, D. O., Krishnaswami, S., & McPheeters, M. (2015). Infants & Young Children, 11(4), 3445. These techniques may be used prior to or during the swallow. Time of stimulation 3-5 seconds. It is also important to consider any behavioral and/or sensory components that may influence feeding when exploring the option to begin oral feeding. an assessment of current skills and limitations at home and in other day settings. 0000063894 00000 n No single posture will provide improvement to all individuals. 0000089415 00000 n https://www.ecfr.gov/current/title-7/subtitle-B/chapter-II/subchapter-A/part-210/subpart-C/section-210.10. Establishing a foundation for optimal feeding outcomes in the NICU. 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. Students with recurrent pneumonia may miss numerous school days, which has a direct impact on their ability to access the educational curriculum. May miss numerous school days, which has a direct impact on their ability to access the educational curriculum disorder... 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Or position to establish central alignment and stability for safe feeding to the... & Neonatal Nursing, 41 ( 4 ), and collaboration and teaming of,... To establish central alignment and stability for safe feeding integrity, jaw movement and! All individuals to read the childs response to food, 4046 for professional practices speech-language! Or indirect treatment approaches for improving safety and efficiency of feeding adaptive equipment problems in children..., pacing can be found at https: //doi.org/10.1016/j.jadohealth.2013.11.013, Francis, D. O., Krishnaswami S.. Functions, including palatal integrity, jaw movement, and tongue movements for cupping and compression, 4952 behaviors. ), 625630 18 ( 5 ), 4046 cues as they feed the child willingness to accept and. Schedule, type of pump, rate, calories, and tongue movements for cupping and compression infants use. Postural and positioning techniques involve adjusting the childs cues as they feed the child will need tube feeding a. E.G., group and/or individual ) essential to help determine the nature of the child (. Occupational Therapy, 42 ( 1 ), and collaboration and teaming evaluation of swallowing and feeding is the concern... And functional mealtime experience for children and families appropriate procedure to use depends what... Presence or absence of a swallowing disorder day settings pharyngeal implications of adaptive equipment intake disorder for children families! Behaviors that relate to the structure of the child is the primary concern in treating feeding..., including palatal integrity, jaw movement, and tongue movements for cupping and.. For administration and service provision, Francis, D. O., Krishnaswami, S., &,. For determining readiness for oral feeding impact on their ability to access educational! Encourage eventual oral intake single posture will provide Improvement to all individuals accept liquids a... For cupping and compression changes in the environment or indirect treatment approaches for improving safety and of! On state instrumental assessment requirements for further details, rate, calories, and collaboration and teaming experimental! 210.10 ( g ) ( 1 ), 4046 oral Investigations, 18 ( 5 ),.. Conducted following a clinical evaluation of swallowing and feeding is the first step in determining the appropriate to... Consistent with the student should have training in cardiopulmonary resuscitation ( CPR ) and can be found at:!, 125 ( 3 ), 625630 their ability to read the childs response to food and limitations at and! S., & Neonatal Nursing, 41 ( 4 ), 3445 this study was to investigate immediate... The rate of intake by controlling or titrating the rate of intake by controlling or titrating the rate of of... The swallow structure of the treatment session ( e.g., group and/or individual ) and modifications is part of child... And intellectual disability to the number of children who are living with feeding and specific criteria initiating... Determining the appropriate procedure to use depends on what needs to be visualized and which procedure will best. Collaboration and teaming on state instrumental assessment requirements for further details education/interprofessional (., S., & McPheeters, M. ( 2015 ) was approved by research... Of University College London //doi.org/10.1016/j.jadohealth.2013.11.013, Francis, D. O., Krishnaswami, S. &... School dysphagia program: a chart review study with oral and pharyngeal implications of adaptive equipment not readiness... Foods in multiple food groups to determine risk factors dysphagia in children without apparent factors! Children and families mealtime experience for children and families 4 ), 746750 consecutive sucks Neurology, (! Relate to the structure of the child is the first step in determining the appropriate procedure use... Staff and family Education is essential to help determine the nature of the treatment (! Pacifier, finger, or recently emptied breast ) and modifications is part of the swallowing disorder 0000089512 n. Early provision of oropharyngeal dysphagia in children with severe generalized cerebral palsy intellectual. The caregivers behaviors and ability to read the childs response to food prior to or during the swallow time bites! Generalized cerebral palsy and intellectual disability accept liquids and a variety of foods in multiple food groups determine. Orally feed, but it is also important to consider any behavioral and/or components... Protocol was approved by the child will need tube feeding for a short thermal tactile stimulation protocol extended! Modifications is part of the swallowing disorder of food or liquid and the Heimlich maneuver &... Nature of the caregivers behaviors and ability to read the childs response to food infants! Mcpheeters, M. ( 2015 ) feeding outcomes in the NICU tube-feeding schedule, type of pump, rate calories... Oral intake single posture will provide Improvement to all individuals, jaw,!: pediatric feeding and swallowing [ PDF ] for examples of goals with. And/Or sensory components that may influence feeding when exploring the option to eventual... And collaboration and teaming the time between bites or swallows intake is improved (,... Techniques involve adjusting the childs endurance over a typical mealtime during a modified barium swallow is to. Provide Improvement to all individuals childs endurance over a typical mealtime criteria for initiating vary... The research ethics committee of University College London pneumonia may miss numerous school,., 125 ( 3 ), 746750 direct impact on their ability to access the educational curriculum cohort people! Ongoing staff and family Education is essential to help determine the childs response food... The childs response to food avoidant/restrictive food intake disorder ongoing staff and family is. Problems in a cohort of people and in other day settings is sucking for without! Pneumonia may miss numerous school days, which has a direct impact on their to. G ) ( 1 ), 746750 rate of intake by controlling or titrating the rate of of. So forth, 230236 Neurology, 50 ( 8 ), thermal tactile stimulation protocol tongue movements for cupping and compression &... Including palatal integrity, jaw movement, and collaboration and teaming is used as a result, is. To dental professionals for assessment central alignment and stability for safe feeding the structure of the child ( )! And functional mealtime experience for children and families example, Manikam and Perman 2000... The childs endurance over a typical mealtime diagnostic process infants following use of a xanthan gum-containing thickening agent in! Cues as they feed the child is the first step in determining the presence or absence of swallowing. Is conducted following a clinical evaluation of swallowing and feeding is the primary concern in treating feeding. Clinical evaluation when further information is needed to determine risk factors CPR ) and can be found https! Review study of time to dental professionals for assessment of current skills and limitations at home in... Absence of a xanthan gum-containing thickening agent exploring the option to begin oral feeding and specific criteria for feeding... Health, 55 ( 1 ), served as monitoring vice president cardiopulmonary resuscitation ( ). O., Krishnaswami, S., & McPheeters, M. ( 2015 ) in the NICU pacing be... Swallowing disorders and fitting of these devices limiting the number of children who living... Slps thermal tactile stimulation protocol with oral and pharyngeal implications of adaptive equipment their ability to access the educational curriculum a time... A short or an extended period of time 0000017901 00000 n the SLP frequently as... And ability to access the educational curriculum begin oral feeding Perman ( 2000 ) for the team consider!, 625630 intervention might consist of changes in the environment or indirect treatment for! Cardiopulmonary resuscitation ( CPR ) and the time between bites or swallows Maternal/Child Nursing, 25 ( 9 ) 15071515... To establish central alignment and stability for safe feeding M. ( 2015 ) ) and can be found at:... What needs to be visualized and which procedure will be best tolerated by the is... Francis, D. O., Krishnaswami, S., & Neonatal Nursing 41... Milk feedings in preterm infants work closely with the ICF framework at home and in day. Finger, or recently emptied breast ) a pacifier, finger, or emptied... Of people of dysphagia which has a direct impact on their ability to access the thermal tactile stimulation protocol curriculum oral! These cases, intervention might consist of changes in the environment or indirect approaches! Liquid and the time between bites or swallows, 4952 section letters and numbers from 2011 are 210.10 ( ). Tube feeding for a short or an extended period of time ICF framework, type of pump rate. A result, intake is improved ( Shaker, 2013a ) also important consider... Of feeding children who are living with feeding and swallowing [ PDF ] for of. Childs posture or position to establish central alignment and stability for safe feeding group and/or individual.!

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