Feeding problems and nutrient intake in children with autism disorders: A meta-analysis and comprehensive review of the literature. formulate feeding and swallowing treatment plans, including recommendations for optimal feeding techniques; being familiar with and using information from diagnostic procedures performed by different medical specialists that yield information about swallowing function, which include. 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. Family and cultural issues in a school swallowing and feeding program. https://doi.org/10.1542/peds.2015-0658. 0000089121 00000 n
Haptic displays aim at artificially creating tactile sensations by applying tactile features to the user's skin. Taste or temperature of a food may be altered to provide additional sensory input for swallowing. The decision to use a VFSS is made with consideration for the childs responsiveness (e.g., acceptance of oral stimulation or tastes on the lips without signs of distress) and the potential for medical complications. Careful pulmonary monitoring during a modified barium swallow is essential to help determine the childs endurance over a typical mealtime. 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. (2015). Little is known about the possible mechanisms by which this interventional therapy may work. The following factors are considered prior to initiating and systematically advancing oral feeding protocols: The management of feeding and swallowing disorders in toddlers and older children may require a multidisciplinary approachespecially for children with complex medical conditions. 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. Pediatrics, 140(6), e20170731. 0000055191 00000 n
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Nursing for Womens Health, 24(3), 202209. 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. an assessment of sucking/swallowing problems and a determination of abnormal anatomy and/or physiology that might be associated with these findings (e.g., Francis et al., 2015; Webb et al., 2013); a determination of oral feeding readiness; an assessment of the infants ability to engage in non-nutritive sucking (NNS); developmentally appropriate clinical assessments of feeding and swallowing behavior (nutritive sucking [NS]), as appropriate; an identification of additional disorders that may have an impact on feeding and swallowing; a determination of the optimal feeding method; an assessment of the duration of mealtime experience, including potential effects on oxygenation (SLP may refer to the medical team, as necessary); an assessment of issues related to fatigue and volume limitations; an assessment of the effectiveness of parent/caregiver and infant interactions for feeding and communication; and. Information from the referral, parent interview/case history, and clinical evaluation of the student is used to develop IEP goals and objectives for improved feeding and swallowing, if appropriate. The prevalence of pediatric voice and swallowing problems in the United States. Is a sensory motorbased intervention for behavioral issues indicated? Results There were eight participants, six women and. https://doi.org/10.1002/ppul.20488, Lefton-Greif, M. A., McGrattan, K. E., Carson, K. A., Pinto, J. M., Wright, J. M., & Martin-Harris, B. Indicators of choking risk in adults with learning disabilities: A questionnaire survey and interview study. Brian B. Shulman, vice president for professional practices in speech-language pathology, served as the monitoring officer. (2002). 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. 0000001702 00000 n
It is used as a treatment option to encourage eventual oral intake. Group I received neuromuscular electric stimulation sessions on the neck one hour daily for 12 weeks. International Journal of Rehabilitation Research, 33(3), 218224. Consult with families regarding safety of medical treatments, such as swallowing medication in liquid or pill form, which may be contraindicated by the disorder. Feeding and gastrointestinal problems in children with cerebral palsy. The pharyngeal muscles are stimulated through neural pathways. In these articles, we hear from both sides on the controversial use of neuromuscular electrical stimulation (e-stim) in dysphagia treatment. Available 8:30 a.m.5:00 p.m. The evaluation process begins with a referral to a team of professionals within the school district who are trained in the identification and treatment of feeding and swallowing disorders. 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. 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. (1999). Feeding difficulties in craniofacial microsomia: A systematic review. Speech-language pathologists (SLPs) play a central role in the assessment, diagnosis, and treatment of infants and children with swallowing and feeding disorders. Determining the appropriate procedure to use depends on what needs to be visualized and which procedure will be best tolerated by the child. A. (2006). Some of these interventions can also incorporate sensory stimulation. In infants, the tongue fills the oral cavity, and the velum hangs lower. In this study, the impact that non-noxious heat had on three features of tactile information processing capacity was evaluated: vibrotactile . Prior to bolus delivery, the SLP may assess the following: A team approach is necessary for appropriately diagnosing and managing pediatric feeding and swallowing disorders, as the severity and complexity of these disorders vary widely in this population (McComish et al., 2016). an assessment of behaviors that relate to the childs response to food. This requires a working knowledge of breastfeeding strategies to facilitate safe and efficient swallowing and optimal nutrition. Late onset necrotizing enterocolitis in infants following use of a xanthan gum-containing thickening agent. Please see AHSAs resource on state instrumental assessment requirements for further details. Johnson, D. E., & Dole, K. (1999). Beckett, C., Bredenkamp, D., Castle, J., Groothues, C., OConnor, T. G., Rutter, M., & the English and Romanian Adoptees (ERA) Study Team. 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. SLPs should be sensitive to family values, beliefs, and access regarding bottle-feeding and breastfeeding and should consult with parents and collaborate with nurses, lactation consultants, and other medical professionals to help identify parent preferences. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. 1 Successful Rehabilitation Strategies Based on Motor Learning in Patients with Swallowing Disorders Motor learning refers to how motor performance is improved and subsequently maintained. https://doi.org/10.1097/JPN.0000000000000082, Seiverling, L., Towle, P., Hendy, H. M., & Pantelides, J. NNS patterns can typically be evaluated with skilled observation and without the use of instrumental assessment. The clinician provides families and caregivers with information about dysphagia, the purpose for the study, the test procedures, and the test environment. Instrumental evaluation can also help determine if swallow safety can be improved by modifying food textures, liquid consistencies, and positioning or implementing strategies. has a complex medical condition and experiences a significant change in status. The team may consider the tube-feeding schedule, type of pump, rate, calories, and so forth. 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. (2018). receives part or all of their nutrition or hydration via enteral or parenteral tube feeding. These changes can provide cues that signal well-being or stress during feeding. In these cases, intervention might consist of changes in the environment or indirect treatment approaches for improving safety and efficiency of feeding. It is primarily used to treat individuals who have an absent or delayed swallow reflex. B. Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/. 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. (Note: Lip closure is not required for infant feeding because the tongue typically seals the anterior opening of the oral cavity.). . If choosing to use electrical stimulation in the pediatric population, the primary focus should be on careful patient selection to ensure that electrical stimulation is being used only in situations where there is no possibility of inducing untoward effects. NS skills are assessed during breastfeeding and bottle-feeding if both modes are going to be used. Therapeutic learning is the motor learning process in which target behavior is achieved by utilizing activity-dependent elements and the assistive system. (2008). The SLP who specializes in feeding and swallowing disorders typically leads the professional care team in the clinical or educational setting. International Classification of Functioning, Disability and Health. 210.10 (from 2021), in which the section letters and numbers are 210.10(m)(1). The original version was codified in 2011and has had many updates since. effect of neuromuscular and thermal tactile stimulation on its rehabilitation. All rights reserved. The data below reflect this variability. International adoptions: Implications for early intervention. TTS is used in patients with neurogenic dysphagia particularly associated with sensory deficits. (1998). Although feeding, swallowing, and dysphagia are not specifically mentioned in IDEA, the U.S. Department of Education acknowledges that chronic health conditions could deem a student eligible for special education and related services under the disability category Other Health Impairment, if the disorder interferes with the students strength, vitality, or alertness and limits the students ability to access the educational curriculum. https://doi.org/10.1002/eat.22350, Erkin, G., Culha, C., Ozel, S., & Kirbiyik, E. G. (2010). Additional medical and rehabilitation specialists may be included, depending on the type of facility, the professional expertise needed, and the specific population being served. Decisions regarding the initiation of oral feeding are based on recommendations from the medical and therapeutic team, with input from the parent and caregivers. Other signs to monitor include color changes, nasal flaring, and suck/swallow/breathe patterns. 0000017901 00000 n
.22 The study protocol had a prior approval by the . https://doi.org/10.1002/lary.24931, Black, L. I., Vahratian, A., & Hoffman, H. J. 0000004839 00000 n
Precautions, accommodations, and adaptations must be considered and implemented as students transition to postsecondary settings. See the Pediatric Feeding and Swallowing Evidence Map for summaries of the available research on this topic. 0000023632 00000 n
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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