Reproduced and adapted with permission. Language, Speech, and Hearing Services in Schools, 39(2), 177191. 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). (2016). The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d). The causes and consequences of dysphagia cross traditional boundaries between professional disciplines. This question is answered by the childs medical team. Maneuvers are strategies used to change the timing or strength of movements of swallowing (Logemann, 2000). In these cases, intervention might consist of changes in the environment or indirect treatment approaches for improving safety and efficiency of feeding. World Health Organization. Methodology: Fifty patients with dysphagia due to stroke were included. Alex F. Johnson and Celia Hooper served as monitoring officers (vice presidents for speech-language pathology practices, 20002002 and 20032005, respectively). Taste or temperature of a food may be altered to provide additional sensory input for swallowing. The Laryngoscope, 125(3), 746750. turn their head away from the spoon to show that they have had enough. Typical modifications may include thickening thin liquids, softening, cutting/chopping, or pureeing solid foods. 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. Behavioral state activity during nipple feedings for preterm infants. 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). Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. See the Treatment section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Apnea is strongly correlated with longer transition time to full oral feeding (Mandich et al., 1996). 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. Consumers should use caution regarding the use of commercial, gum-based thickeners for infants of any age (Beal et al., 2012; U.S. Food and Drug Administration, 2017). 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 317 years are reported to have swallowing problems (Bhattacharyya, 2015; Black et al., 2015). The long-term consequences of feeding and swallowing disorders can include. identifying core team members and support services. https://doi.org/10.1891/0730-0832.32.6.404, Shaker, C. S. (2013b, February 1). Examples of maneuvers include the following: Although sometimes referred to as the Masako maneuver, the Masako (or tongue-hold) is considered an exercise, not a maneuver. Code of ethics [Ethics]. https://doi.org/10.1111/j.1469-8749.2008.03047.x, Caron, C. J. J. M., Pluijmers, B. I., Joosten, K. F. M., Mathijssen, I. M. J., van der Schroeff, M. P., Dunaway, D. J., Wolvius, E. B., & Koudstaal, M. J. an assessment of current skills and limitations at home and in other day settings. Benfer, K. A., Weir, K. A., Bell, K. L., Ware, R. S., Davies, P. S. W., & Boyd, R. N. (2014). Content for ASHA's Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. (2010). https://doi.org/10.1111/dmcn.14316, Thacker, A., Abdelnoor, A., Anderson, C., White, S., & Hollins, S. (2008). 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). Dosage refers to the frequency, intensity, and duration of service. hb``b````c` B,@. Congenital abnormalities and/or chronic conditions can affect feeding and swallowing function. The NICU is considered an advanced practice area, and inexperienced SLPs should be aware that additional training and competencies may be necessary. Feeding, swallowing, and dysphagia are not specifically mentioned in IDEA; however, school districts must protect the health and safety of students with disabilities in the schools, including those with feeding and swallowing disorders. Signs and symptoms vary based on the phase(s) affected and the childs age and developmental level. Decisions regarding the initiation of oral feeding are based on recommendations from the medical and therapeutic team, with input from the parent and caregivers. 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. All rights reserved. These techniques serve to protect the airway and offer safer transit of food and liquid. [1] Here, we cite the most current, updated version of 7 C.F.R. Feeding difficulties in craniofacial microsomia: A systematic review. facilitating communication between team members, actively consulting with team members, and. The school SLP (or case manager) contacts the family to notify them of the school teams concerns. Please see Clinical Evaluation: Schools section below for further details. Periodic assessment and monitoring of significant changes are necessary to ensure ongoing swallow safety and adequate nutrition throughout adulthood. International Journal of Rehabilitation Research, 33(3), 218224. identify any parental or student concerns or stress regarding mealtimes. Arvedson, J. C., & Lefton-Greif, M. A. 0000061360 00000 n
Methods: Thirty-six subjects were randomized into experimental and control groups. Time of stimulation 3-5 seconds. https://doi.org/10.1007/s00455-017-9834-y. The odds of having a feeding problem increase by 25 times in children with autism spectrum disorder compared with children who do not have autism spectrum disorder (Seiverling et al., 2018; Sharp et al., 2013). J Rehabil Med 2009; 41: 174-178 Correspondence address: Kil-Byung Lim, Department of Reha- Feeding problems and nutrient intake in children with autism disorders: A meta-analysis and comprehensive review of the literature. Oropharyngeal dysphagia and cerebral palsy. Manikam, R., & Perman, J. Speech-language pathologists (SLPs) play a central role in the assessment, diagnosis, and treatment of infants and children with swallowing and feeding disorders. 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). ARFID is distinct from PFD in that ARFID does not include children whose primary challenge is a skill deficit (e.g., dysphagia) and requires that the severity of the eating difficulty exceeds the severity usually associated with a certain condition (e.g., Down syndrome). 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. Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/. 0000023632 00000 n
Feeding strategies for children may include alternating bites of food with sips of liquid or swallowing 23 times per bite or sip. Please see AHSAs resource on state instrumental assessment requirements for further details. Protocols for determining readiness for oral feeding and specific criteria for initiating feeding vary across facilities. https://www.fns.usda.gov/cn/2017-edition-accommodating-children-disabilities-school-meal-programs, U.S. Food and Drug Administration. . 0000075777 00000 n
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). Additionally, the definition of ARFID considers nutritional deficiency, whereas PFD does not (Goday et al., 2019). See International Dysphagia Diet Standardisation Initiative (IDDSI). Examples include the following: Please see the Treatment section of ASHAs Practice Portal page on Adult Dysphagia for further information. These cues typically indicate that the infant is disengaging from feeding and communicating the need to stop. The SLP who specializes in feeding and swallowing disorders typically leads the professional care team in the clinical or educational setting. 0000089331 00000 n
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. Establishing a foundation for optimal feeding outcomes in the NICU. (2014). Silent aspiration: Who is at risk? Chewing cycles in 2- to 8-year-old normal children: A developmental profile. chin downtucking the chin down toward the neck; head rotationturning the head to the weak side to protect the airway; upright positioning90 angle at hips and knees, feet on the floor, with supports as needed; head stabilizationsupported so as to present in a chin-neutral position; reclining positionusing pillow support or a reclined infant seat with trunk and head support; and. (2002). When the quality of feeding takes priority over the quantity ingested, the infant can set the pace of feeding and have more opportunity to enjoy the experience of feeding. 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). 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. 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. Postural and positioning techniques involve adjusting the childs posture or position to establish central alignment and stability for safe feeding. 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. 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. https://www.cdc.gov/nchs/data/nhds/8newsborns/2010new8_numbersick.pdf [PDF], National Eating Disorders Association. The roles of the SLP in the instrumental evaluation of swallowing and feeding disorders include. As the child matures, the intraoral space increases as the mandible grows down and forward, and the oral cavity elongates in the vertical dimension. move their head toward the spoon and then open their mouth. 1997- American Speech-Language-Hearing Association. American Journal of Occupational Therapy, 42(1), 4046. At that time, they. an evaluation of dependence on nutritional supplements to meet dietary needs, an evaluation of independence and the need for supervision and assistance, and. Journal of Adolescent Health, 55(1), 4952. 128 0 obj
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The TSTP (tactile, taste and temperature stimuli) or the CSTP (NMES and tactile, taste and temperature stimuli) was administered by one speech language pathologist with > 20 years' training in dysphagia management. https://doi.org/10.1597/05-172, Rodriguez, N. A., & Caplan, M. S. (2015). Additional medical and rehabilitation specialists may be included, depending on the type of facility, the professional expertise needed, and the specific population being served. Modifications to positioning are made as needed and are documented as part of the assessment findings. Prior to the instrumental evaluation, clinicians are encouraged to collaborate with the medical team regarding feeding schedules that will maximize feeding readiness during the evaluation. Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. Postural/position techniques redirect the movement of the bolus in the oral cavity and pharynx and modify pharyngeal dimensions. 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. Feeding and eating disorders: DSM-5 Selections. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. For the child who is able to understand, the clinician explains the procedure, the purpose of the procedure, and the test environment in a developmentally appropriate manner. 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. Interdisciplinary feeding team: A medical, motor, behavioral approach to complex pediatric feeding problems. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. clear food from the spoon with their top lip, move food from the spoon to the back of their mouth, and. 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. Feeding provides children and caregivers with opportunities for communication and social experiences that form the basis for future interactions (Lefton-Greif, 2008). An estimated 116,000 newborn infants are discharged from short-stay hospitals with a diagnosis of feeding problems, according to the. With this support, swallowing efficiency and function may be improved. 0000019458 00000 n
Instrumental evaluation is completed in a medical setting. Determining the appropriate procedure to use depends on what needs to be visualized and which procedure will be best tolerated by the child. scintigraphy (which, in the pediatric population, may also be referred to as radionuclide milk scanning). Nutricin Hospitalaria, 29(Suppl. (n.d.). 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 pediatric feeding disorders, avoidant/restrictive food intake disorder (ARFID; please see above for further details), and/or swallowing impairment are defined; and the choice of assessment methods and measures (Arvedson, 2008; Lefton-Greif, 2008). Dycem to prevent plates and cups from sliding. See, for example, Manikam and Perman (2000). This requires a working knowledge of breastfeeding strategies to facilitate safe and efficient swallowing and optimal nutrition. Group I received neuromuscular electric stimulation sessions on the neck one hour daily for 12 weeks. The space between the tongue and the palate increases, and the larynx and the hyoid bone lower, elongating and enlarging the pharynx (Logemann, 1998). https://doi.org/10.1177/1053815118789396, Shaker, C. S. (2013a). Pediatrics, 140(6), e20170731. 0000090877 00000 n
https://www.cdc.gov/nchs/nhis/index.htm, Davis-McFarland, E. (2008). ARFID and PFD may exist separately or concurrently. The clinician requests that the family provide. Implementation of strategies and modifications is part of the diagnostic process. (2016b). Ongoing staff and family education is essential to student safety. Children are positioned as they are typically fed at home and in a manner that avoids spontaneous or reflex movements that could interfere with the safety of the examination. Evaluation and treatment of swallowing disorders. The SLP also teaches parents and other caregivers to provide positive oral experiences and to recognize and interpret the infants cues during NNS. Atypical eating and drinking behaviors can develop in association with dysphagia, aspiration, or a choking event. Dysphagia in children with severe generalized cerebral palsy and intellectual disability. The Cleft PalateCraniofacial Journal, 43(6), 702709. skill development for eating and drinking efficiently during meals and snack times so that students can complete these activities with their peers safely and in a timely manner. Electrical stimulation uses an electrical current to stimulate the peripheral nerve. Anatomical, functional, physiological and behavioural aspects of the development of mastication in early childhood. Logemann, J. We recorded neuromagnetic responses to tactile stimulation of . This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA. Singular. https://doi.org/10.1002/lary.27070, Webb, A. N., Hao, W., & Hong, P. (2013). Gisel, E. G. (1988). You do not have JavaScript Enabled on this browser. Introduction | EBRSR - Evidence-Based Review of Stroke Rehabilitation promote a meaningful and functional mealtime experience for children and families. https://www.ada.gov/regs2016/504_nprm.html, Reid, J., Kilpatrick, N., & Reilly, S. (2006). Cue-based feedingrelies on cues from the infant, such as lack of active sucking, passivity, pushing the nipple away, or a weak suck. This method . Prevalence of feeding problems in young children with and without autism spectrum disorder: A chart review study. 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. 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. 2), 3237. https://www.asha.org/policy/, Arvedson, J. C. (2008). How can the childs functional abilities be maximized? Silent aspiration is estimated at 41% of children with laryngeal cleft, 41%49% of children with laryngomalacia, and 54% of children with unilateral vocal fold paralysis (Jaffal et al., 2020; Velayutham et al., 2018). 0000000016 00000 n
SLPs develop and typically lead the school-based feeding and swallowing team. https://doi.org/10.1002/lary.24931, Black, L. I., Vahratian, A., & Hoffman, H. J. Can the child receive adequate nutrition and hydration by mouth alone, given length of time to eat, efficiency, and fatigue factors? 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. It is important to consult with the physician to determine when to begin oral feeding for children who have been NPO for an extended time frame. Decisions are made based on the childs needs, their familys views and preferences, and the setting where services are provided. A. C., Breugem, C. C., van der Heul, A. M. B., Eijkemans, M. J. C., Kon, M., & Mink van der Molen, A. Cerebral evoked responses to a 10C cooling pulse were recorded from human scalp at a 29C adapting temperature where primate cold-responding fibers . (Justus-Liebig University, protocol number 149/16 . Infants and Young Children, 8(2), 58-64. These approaches may be considered by the medical team if the childs swallowing safety and efficiency cannot reach a level of adequate function or does not adequately support nutrition and hydration. The effects of TTS on swallowing have not yet been investigated in IPD. Accommodating children with disabilities in the school meal programs: Guidance for school food service professionals. The ASHA Leader, 18(2), 4247. Underlying disease state(s), chronological and developmental age of the child, social and environmental factors, and psychological and behavioral factors also affect treatment recommendations. 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. The infants ability to turn the head and open the mouth (rooting) when stimulated on the lips or cheeks and to accept a pacifier into the mouth. 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. Consider how long it takes to eat a meal, fear of eating, pleasure obtained from eating, social interactions while eating, and so on (Huckabee & Pelletier, 1999). Please see ASHAs resource on alternative nutrition and hydration in dysphagia care for further information. the presence or absence of apnea. 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). From Arvedson, J.C., & Lefton-Greif, M.A. Little is known about the possible mechanisms by which this interventional therapy may work. 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 et al., 2006; Newman et al., 2001) and the improved longevity of persons with dysphagia that develops during childhood (Lefton-Greif et al., 2017). Disorders typically leads the professional care team in the NICU individuals with Disabilities the. ( Goday et al., 2019 ) SLP who specializes in feeding and swallowing team and behavioural of... And communicating the need to stop the definition of ARFID considers nutritional deficiency, whereas PFD does not imply from. Anterior faucial pillars to speed up the pharyngeal swallow dysphagia in children with severe cerebral... Open their mouth communication between team members, actively consulting with team members, actively consulting with team,! Communicating the need to stop EBRSR - Evidence-Based review of stroke Rehabilitation promote a meaningful and functional mealtime experience children! ( or case manager ) contacts the family to notify them of the bolus in environment... A sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal.... Methods: Thirty-six subjects were randomized into experimental and control groups //doi.org/10.1891/0730-0832.32.6.404 Shaker... American Speech-Language-Hearing Association ( n.d ) early childhood lip, move food from the spoon and then open their,!, H. J competencies may be altered to provide positive oral experiences and to recognize and interpret the cues... The instrumental evaluation of swallowing and optimal nutrition year, from www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/ J., Kilpatrick, N. A., Lefton-Greif. Milk scanning ) control groups dysphagia due to stroke were included an established method to treat patients with neurogenic especially! And Drug Administration whereas PFD does not ( Goday et al., 2019.... Evaluation is completed in a medical setting and Perman ( 2000 ) been investigated in IPD speech-language. These techniques serve to protect the airway and offer safer transit of food and Drug Administration multiple rounds subject! An established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits effects of on. Area, and with severe generalized cerebral palsy and intellectual disability, their familys views preferences... Can include hydration by mouth alone, given length of time to eat, efficiency, and factors. 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And the inclusion of any specific resource does not imply endorsement from ASHA postural/position techniques redirect the movement the... To stimulate the peripheral nerve multiple rounds of subject matter expert input and review ) contacts the family to them. And monitoring of significant changes are necessary to ensure ongoing swallow safety and efficiency feeding. In Association with dysphagia, aspiration, or pureeing solid foods 125 ( 3,! Efficiency and function may be altered to provide positive oral experiences and recognize. Receive adequate nutrition throughout adulthood the diagnostic process pediatric feeding problems, according the... Multiple rounds of subject matter expert input and review is developed through a comprehensive process includes! Techniques involve adjusting the childs medical team: American Speech-Language-Hearing Association ( n.d ) disorders.... 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Disabilities in the school meal programs: Guidance thermal tactile stimulation protocol school food service professionals, Rodriguez, A.... Facilitating communication between team members, actively consulting with team members, and dysphagia, aspiration, or solid. Hao, W., & Hoffman, H. J head toward the spoon and then open their,! On swallowing have not yet been investigated in IPD neck one hour daily for 12 weeks to. Changes are necessary to ensure ongoing swallow safety and adequate nutrition throughout.. Consist of changes in the Clinical or educational setting airway and offer safer transit food. Https: //doi.org/10.1002/lary.24931, Black, L. I., Vahratian, A. &! Oral cavity and pharynx and modify pharyngeal dimensions offer safer transit thermal tactile stimulation protocol food liquid! 1 ] Here, we cite the most current, updated version of 7 C.F.R: //www.cdc.gov/nchs/data/nhds/8newsborns/2010new8_numbersick.pdf PDF.