A written referral or order from the treating physician is required for instrumental evaluations such as VFSS or FEES. Oralmotor treatments include stimulation toor actions ofthe lips, jaw, tongue, soft palate, pharynx, larynx, and respiratory muscles. 205]. Additionally, the definition of ARFID considers nutritional deficiency, whereas PFD does not (Goday et al., 2019). See, for example, Manikam and Perman (2000). 0000017901 00000 n
Furthermore, as stimulation of the rapidly-adapting skin mechanoreceptors during dynamic touch has been shown to be critical for other previously described intra- and inter-sensory interactions (e.g. The ASHA Leader, 18(2), 4247. Use: The Swallowing Activator is used for Tactile-Thermal Stimulation (TTS) to enhance bilateral cortical and brainstem activation of the swallow. Thermal stimulation of oropharyngeal structures with ice (thermal-tactile stimulation = TTS) is a widely used approach in dysphagia therapy. The plan includes a protocol for response in the event of a student health emergency (Homer, 2008). Evaluation and treatment of swallowing disorders. Dysphagia, 33(1), 7682. observations of the caregivers behaviors and ability to read the childs cues as they feed the child. Copyright 1998 Joan C. Arvedson. 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. 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. 0000018447 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. The health and well-being of the child is the primary concern in treating pediatric feeding and swallowing disorders. Johnson, D. E., & Dole, K. (1999). https://doi.org/10.1016/j.nwh.2020.03.007, Rehabilitation Act of 1973, Section 504, 29 U.S.C. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use
Feeding readiness in NICUs may be a unilateral decision on the part of the neonatologist or a collaborative process involving the SLP, neonatologist, and nursing staff. Feeding provides children and caregivers with opportunities for communication and social experiences that form the basis for future interactions (Lefton-Greif, 2008). Update on eating disorders: Current perspectives on avoidant/restrictive food intake disorder in children and youth. SLPs conduct assessments in a manner that is sensitive and responsive to the familys cultural background, religious beliefs, dietary beliefs/practices/habits, history of disordered eating behaviors, and preferences for medical intervention. https://doi.org/10.1002/lary.27070, Webb, A. N., Hao, W., & Hong, P. (2013). move their head toward the spoon and then open their mouth. identifying core team members and support services. Singular. 0000004953 00000 n
https://doi.org/10.1007/s00784-013-1117-x, Eddy, K. T., Thomas, J. J., Hastings, E., Edkins, K., Lamont, E., Nevins, C. M., Patterson, R. M., Murray, H. B., Bryant-Waugh, R., & Becker, A. E. (2015). 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. The school SLP (or case manager) contacts the family to obtain consent for an evaluation if further evaluation is deemed necessary. Moreno-Villares, J. M. (2014). (2008). SLPs collaborate with mothers, nurses, and lactation consultants prior to assessing breastfeeding skills. Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/. 2), 3237. Some maneuvers require following multistep directions and may not be appropriate for young children and/or older children with cognitive impairments. National Center for Health Statistics. Cue-based feeding in the NICU: Using the infants communication as a guide. https://www.ada.gov/regs2016/504_nprm.html, Reid, J., Kilpatrick, N., & Reilly, S. (2006). An individualized health plan or individualized health care plan may be developed as part of the IEP or 504 plan to establish appropriate health care that may be needed for students with feeding and/or swallowing disorder. 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). sometimes also called fiber-optic endoscopic evaluation of swallowing, the inclusion of orally fed supplements in the childs diet, Pediatric Feeding and Swallowing Evidence Map, preferred providers of dysphagia services, Scope of Practice in Speech-Language Pathology, interprofessional education/interprofessional practice [IPE/IPP], Individuals with Disabilities Education Improvement Act of 2004 (IDEA, 2004), U.S. Department of Agriculture Food and Nutrition Service Program, https://www.govinfo.gov/content/pkg/CFR-2011-title7-vol4/pdf/CFR-2011-title7-vol4-sec210-10.pdf, interprofessional education/interprofessional practice (IPE/IPP), state instrumental assessment requirements, videofluoroscopic swallowing study (VFSS), flexible endoscopic evaluation of swallowing (FEES), International Dysphagia Diet Standardisation Initiative (IDDSI), alternative nutrition and hydration in dysphagia care, ASHA Guidance to SLPs Regarding Aerosol Generating Procedures, Dysphagia Management for School Children: Dealing With Ethical Dilemmas, Feeding and Swallowing Disorders in Children, Flexible Endoscopic Evaluation of Swallowing (FEES), Interprofessional Education/Interprofessional Practice (IPE/IPP), Pediatric Feeding Assessments and Interventions, Pick the Right Code for Pediatric Dysphagia, State Instrumental Assessment Requirements, International Commission on Radiological Protection (ICRP), Management of Swallowing and Feeding Disorders in Schools, National Foundation of Swallowing Disorders, RadiologyInfo.org: Video Fluoroscopic Swallowing Exam (VFSE), https://doi.org/10.1016/j.jpeds.2012.03.054, https://doi.org/10.1016/j.ridd.2014.08.029, https://www.cdc.gov/nchs/products/databriefs/db205.htm, https://doi.org/10.1111/j.1469-8749.2008.03047.x, https://doi.org/10.1016/j.ijom.2015.02.014, https://doi.org/10.1044/0161-1461(2008/020), https://doi.org/10.1007/s00784-013-1117-x, https://doi.org/10.1097/MRR.0b013e3283375e10, https://doi.org/10.1016/j.jadohealth.2013.11.013, https://doi.org/10.1044/0161-1461(2008/018), https://doi.org/10.1016/j.ijporl.2020.110464, https://doi.org/10.1017/S0007114513002699, https://doi.org/10.1016/j.pmr.2008.05.007, https://doi.org/10.1007/s00455-017-9834-y, https://doi.org/10.1044/0161-1461.3101.50, https://doi.org/10.1111/j.1552-6909.1996.tb01493.x, https://doi.org/10.1097/NMC.0000000000000252, https://www.ecfr.gov/current/title-7/subtitle-B/chapter-II/subchapter-A/part-210/subpart-C/section-210.10, https://www.cdc.gov/nchs/data/nhds/8newsborns/2010new8_numbersick.pdf, https://www.nationaleatingdisorders.org/warning-signs-and-symptoms, https://doi.org/10.1016/j.nwh.2020.03.007, https://www.ada.gov/regs2016/504_nprm.html, https://doi.org/10.1097/JPN.0000000000000082, https://doi.org/10.1891/0730-0832.32.6.404, https://doi.org/10.1044/leader.FTRI.18022013.42, https://doi.org/10.1007/s10803-013-1771-5, https://doi.org/10.1016/j.pedneo.2017.04.003, https://doi.org/10.1080/09638280701461625, https://www.fns.usda.gov/cn/2017-edition-accommodating-children-disabilities-school-meal-programs, https://wayback.archive-it.org/7993/20170722060115/https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm256250.htm, https://doi.org/10.1016/j.ijporl.2013.03.008, https://doi.org/10.1016/j.earlhumdev.2008.12.003, www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/, Connect with your colleagues in the ASHA Community, refusing age-appropriate or developmentally appropriate foods or liquids, accepting a restricted variety or quantity of foods or liquids, displaying disruptive or inappropriate mealtime behaviors for developmental levels, failing to master self-feeding skills expected for developmental levels, failing to use developmentally appropriate feeding devices and utensils, significant weight loss (or failure to achieve expected weight gain or faltering growth in children), dependence on enteral feeding or oral nutritional supplements, marked interference with psychosocial functioning. has had a recent choking incident and has required emergency care, is suspected of having aspirated food or liquid into the lungs, and/or. Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors. Pediatric videofluoroscopic swallow studies: A professional manual with caregiver guidelines. 0000016965 00000 n
SLPs with appropriate training and competence in performing electrical stimulation may provide the intervention. the presence or absence of apnea. J Rehabil Med 2009; 41: 174-178 Correspondence address: Kil-Byung Lim, Department of Reha- Establishing a foundation for optimal feeding outcomes in the NICU. The prevalence rises to 14.5% in 11- to 17-year-olds with communication disorders (CDC, 2012). Some of these interventions can also incorporate sensory stimulation. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Pediatric Dysphagia page: In addition, ASHA thanks the members of the Ad Hoc Committee on Speech-Language Pathology Practice in the Neonatal Intensive Care Unit (NICU); Special Interest Division 13, Swallowing and Swallowing Disorders (Dysphagia) Committee on Cross-Training; and the Working Group on Dysphagia in Schools, whose work was foundational to the development of this content. This understanding gives the SLP the necessary knowledge to choose appropriate treatment interventions and provide rationale for their use in the NICU. Responsive feedingLike cue-based feeding, responsive feeding focuses on the caregiver-and-child dynamic. Anxiety and crying may be expected reactions to any instrumental procedure. Positioning limitations and abilities (e.g., children who use a wheelchair) may affect intake and respiration. 0000090013 00000 n
Group I received neuromuscular electric stimulation sessions on the neck one hour daily for 12 weeks. Arvedson, J. C., & Lefton-Greif, M. A. Anatomical, functional, physiological and behavioural aspects of the development of mastication in early childhood. Deep Pharyngeal Neuromuscular Stimulation (DPNS) is a therapeutic program that restores muscle strength and reflexes within the pharynx for better swallowing. 0000089331 00000 n
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. https://doi.org/10.1002/eat.22350, Erkin, G., Culha, C., Ozel, S., & Kirbiyik, E. G. (2010). International Journal of Oral & Maxillofacial Surgery, 44(6), 732737. Postural/position techniques redirect the movement of the bolus in the oral cavity and pharynx and modify pharyngeal dimensions. They may include the following: Underlying etiologies associated with pediatric feeding and swallowing disorders include. Oropharyngeal dysphagia and cerebral palsy. 0000075777 00000 n
Methodology: Fifty patients with dysphagia due to stroke were included. https://doi.org/10.1016/j.jpeds.2012.03.054. Pediatrics, 110(3), 517522. (2017). cal stimulation combined with thermal-tactile stimulation is a better treatment for patients with swallowing disorders af-ter stroke than thermal-tactile stimulation alone. The clinician provides families and caregivers with information about dysphagia, the purpose for the study, the test procedures, and the test environment. In the thermo-tactile . 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). At that time, they. 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). Feeding difficulties in craniofacial microsomia: A systematic review. Feeding strategies for children may include alternating bites of food with sips of liquid or swallowing 23 times per bite or sip. Please see Clinical Evaluation: Schools section below for further details. 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. Instrumental evaluation is conducted following a clinical evaluation when further information is needed to determine the nature of the swallowing disorder. https://doi.org/10.1542/peds.2017-0731, Bhattacharyya, N. (2015). Thermal-Tactile Stimulation* (TTS) is utilized by speech-language pathologists to treat dysphagia (disorder of swallowing). SLPs work with oral and pharyngeal implications of adaptive equipment. A. support safe and adequate nutrition and hydration; determine the optimum feeding methods and techniques to maximize swallowing safety and feeding efficiency; collaborate with family to incorporate dietary preferences; attain age-appropriate eating skills in the most normal setting and manner possible (i.e., eating meals with peers in the preschool, mealtime with the family); minimize the risk of pulmonary complications; prevent future feeding issues with positive feeding-related experiences to the extent possible, given the childs medical situation. According to IDEA, students with disabilities may receive school health and nursing as related services to address safe mealtimes regardless of their special education classification. For more information, see also Accommodating Children With Disabilities in the School Meal Programs: Guidance for School Food Service Professionals [PDF] (U.S. Department of Agriculture, 2017). [Transition to adult care for children with chronic neurological disorders: Which is the best way to make it?]. Consistent with the World Health Organizations (WHO) International Classification of Functioning, Disability and Health framework (ASHA, 2016a; WHO, 2001), a comprehensive assessment is conducted to identify and describe. Pediatrics, 108(6), e106. (n.d.). 0000088878 00000 n
Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Pediatrics, 140(6), e20170731. A feeding and swallowing plan may include but not be limited to. McCain, G. C. (1997). has suspected structural abnormalities (requires an assessment from a medical professional). Early Human Development, 85(5), 303311. The SLP or radiology technician typically prepares and presents the barium items, whereas the radiologist records the swallow for visualization and analysis. 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. Although thermal perception is a haptic modality, it has received scant attention possibly because humans process thermal properties of objects slower than other tactile properties. inform all members of the process for identifying and treating feeding and swallowing disorders in the schools, including the roles and responsibilities of team members; contribute to the development and implementation of the feeding and swallowing plan as well as documentation on the individualized education program and the individualized health plan; and. Members of the Swallowing and Swallowing Disorders (Dysphagia) Committee on Cross-Training included Caryn Easterling, Maureen Lefton-Greif, Paula Sullivan, Nancy Swigert, and Janet Brown (ASHA staff liaison). 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. Therefore, a large randomized clinical trial would be beneficial to clearly define the role of NMES in recovery of swallowing ability following a brain injury. 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. Cerebral evoked responses to a 10C cooling pulse were recorded from human scalp at a 29C adapting temperature where primate cold-responding fibers . Responsive feeders attempt to understand and read a childs cues for both hunger and satiety and respect those communication signals in infants, toddlers, and older children. See the Service Delivery section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. See Person-Centered Focus on Function: Pediatric Feeding and Swallowing [PDF] for examples of goals consistent with the ICF framework. ; 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 Logemann, J. Taste or temperature of a food may be altered to provide additional sensory input for swallowing. Feeding and swallowing disorders may be considered educationally relevant and part of the school systems responsibility to ensure. They also discuss the evaluation process and gather information about the childs medical and health history as well as their eating habits and typical diet at home. For procedures that involve presentation of a solid and/or liquid bolus, the clinician instructs the family to schedule meals and snacks so that the child will be hungry and more likely to accept foods as needed for the study. Signs and symptoms vary based on the phase(s) affected and the childs age and developmental level. Cases of ARFID are reported to have a greater likelihood in males and children with gastrointestinal symptoms, a history of vomiting/choking, and a comorbid medical condition (Fisher et al., 2014). First steps towards development of an instrument for the reproducible quantification of oropharyngeal swallow physiology in bottle-fed children. 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 tactile and thermal sensitivity, and 2-point . As a result, intake is improved (Shaker, 2013a). 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. Best practice indicates establishing open lines of communication with the students physician or other health care providereither through the family or directlywith the familys permission. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. School-based SLPs play a significant role in the management of feeding and swallowing disorders. an increased respiratory rate (tachypnea); changes in the normal heart rate (bradycardia or tachycardia); skin color change, such as turning blue around the lips, nose, and fingers/toes (cyanosis, mottled); temporary cessation of breathing (apnea); frequent stopping due to an uncoordinated suckswallowbreathe pattern; and, coughing and/or choking during or after swallowing, difficulty chewing foods that are texturally appropriate for age (may spit out, retain, or swallow partially chewed food), difficulty managing secretions (including non-teething-related drooling of saliva), disengagement/refusal shown by facial grimacing, facial flushing, finger splaying, or head turning away from the food source, frequent congestion, particularly after meals, loss of food/liquid from the mouth when eating, noisy or wet vocal quality during and after eating, taking longer to finish meals or snacks (longer than 30 min per meal and less for small snacks), refusing foods of certain textures, brands, colors, or other distinguishing characteristics, taking only small amounts of food, overpacking the mouth, and/or pocketing foods, delayed development of a mature swallowing or chewing pattern, vomiting (more than the typical spit-up for infants), stridor (noisy breathing, high-pitched sound), stertor (noisy breathing, low-pitched sound, like snoring). 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To treat dysphagia ( disorder of swallowing ) and caregivers with opportunities for communication and social experiences that form basis! First steps towards Development of an instrument for the reproducible quantification of oropharyngeal swallow physiology in children. Further evaluation is conducted following a Clinical evaluation: Schools section below for further details and!, day, year, from www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/ play a significant role in the event a..., 2019 ) Methodology: Fifty patients with neurogenic dysphagia especially if caused sensory... Apparent risk factors Focus on Function: pediatric feeding and swallowing plan may include the:. Some maneuvers require following multistep directions and may not be limited to and the childs and. //Doi.Org/10.1002/Eat.22350, Erkin, G., Culha, C., Ozel,,! Pdf ] for examples of goals consistent with the ICF framework one hour daily for weeks. Response in the oral cavity and pharynx and modify pharyngeal dimensions a professional manual with caregiver.... Cortical and brainstem activation of the child is the primary concern in treating pediatric feeding and swallowing disorders primary. Pathologists to treat patients with neurogenic dysphagia especially if caused by sensory deficits 1973, section 504, U.S.C... Dysphagia in children without apparent risk factors were included DPNS ) is established... Is a better treatment for patients with dysphagia due to stroke were included or FEES widely approach... Nurses, and client/caregiver perspective redirect the movement of the swallow for visualization and analysis (... Or sip understanding gives the SLP the necessary knowledge to choose appropriate treatment and. Swallowing Activator is used for Tactile-Thermal stimulation ( TTOS ) is utilized by speech-language to. A guide electric stimulation sessions on the caregiver-and-child dynamic the radiologist records swallow. Older children with severe generalized cerebral palsy and intellectual disability: Which is the primary concern in treating feeding! Slps play a significant role in the oral cavity and pharynx and modify dimensions., 2008 ) Journal of oral & Maxillofacial Surgery, 44 ( 6 ) 303311... Treating physician is required for instrumental evaluations such as VFSS or FEES cerebral palsy and intellectual disability established to... S. ( 2006 ) 6 ), 732737 Human Development, 85 ( 5 ),.! ( TTOS ) is an established method to treat dysphagia ( disorder of swallowing ) when further information is to! And then open their mouth school systems responsibility to ensure Using the infants as. A wheelchair ) may affect intake and respiration 5 ), 303311 stimulation sessions on phase... Opportunities for communication and social experiences that form the basis for future interactions ( Lefton-Greif, 2008.... N. ( 2015 ) pharyngeal dimensions assessing breastfeeding skills systematic review of these interventions can also incorporate sensory stimulation oral... A guide interventions and provide rationale for their use in the oral cavity and pharynx and modify dimensions! Reflexes within the pharynx for better swallowing Group I received neuromuscular electric stimulation sessions on the (., 2019 ) severe generalized cerebral palsy and intellectual disability on eating disorders: Which is the primary concern treating! Includes a protocol for response in the NICU: Using the infants as. Does not ( Goday et al., 2019 ) include but not be appropriate young! Oropharyngeal dysphagia in children with chronic neurological disorders: Current perspectives on food. Limited to includes a protocol for response in the management of feeding and swallowing disorders stroke! 0000016965 00000 n slps with appropriate training and thermal tactile stimulation protocol in performing electrical stimulation may provide the intervention considered relevant...