Evaluation and treatment of swallowing disorders. Ongoing staff and family education is essential to student safety. 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). A feeding and swallowing plan may include but not be limited to. Infants under 6 months of age typically require head, neck, and trunk support. 0000075777 00000 n
Dosage refers to the frequency, intensity, and duration of service. Available 8:30 a.m.5:00 p.m. 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. 0000090877 00000 n
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National Center for Health Statistics. The Laryngoscope, 125(3), 746750. https://www.asha.org/policy/, Arvedson, J. C. (2008). (2014). Does the child have the potential to improve swallowing function with direct treatment? National Center for Health Statistics. Pediatric swallowing and feeding: Assessment and management. Johnson, D. E., & Dole, K. (1999). 0000018888 00000 n
(2015). Are there behavioral and sensory motor issues that interfere with feeding and swallowing? Establishing a public school dysphagia program: A model for administration and service provision. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. A. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d). Jennifer Carter of the Carter Swallowing Center, LLC, presents . https://doi.org/10.1097/NMC.0000000000000252, Meal Requirements for Lunches and Requirements for Afterschool Snacks, 7 C.F.R. Instrumental evaluation is completed in a medical setting. All rights reserved. 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). 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. (n.d.). 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. Protocols for determining readiness for oral feeding and specific criteria for initiating feeding vary across facilities. Three groups A, B and C were made, patients were taken through purposive sample technique and groups were . 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. infants current state, including respiratory rate and heart rate; infants behavior (e.g., positive rooting, willingness to suckle at breast); infants position (e.g., well supported, tucked against the mothers body); infants ability to latch onto the breast; efficiency and coordination of the infants suck/swallow/breathe pattern; mothers behavior (e.g., comfort with breastfeeding, confidence in handling the infant, awareness of the infants cues during feeding). They may include the following: Underlying etiologies associated with pediatric feeding and swallowing disorders include. facilitate the individuals activities and participation by promoting safe, efficient feeding; capitalize on strengths and address weaknesses related to underlying structures and functions that affect feeding and swallowing; modify contextual factors that serve as barriers and enhance those that facilitate successful feeding and swallowing, including the development and use of appropriate feeding methods and techniques; and. 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). https://www.asha.org/policy/, American Speech-Language-Hearing Association. . Intraoral prosthetics (e.g., palatal obturator, palatal lift prosthesis) can be used to normalize the intraoral cavity by providing compensation or physical support for children with congenital abnormalities (e.g., cleft palate) or damage to the oropharyngeal mechanism. International Classification of Functioning, Disability and Health. The plan should be reviewed annually along with the IEP goals and objectives or as needed if significant changes occur or if it is found to be ineffective. Positioning infants and children for videofluroscopic swallowing function studies. Experience in adult swallowing disorders does not qualify an individual to provide swallowing assessment and intervention for children. thermal stimulation and swallow maneuvers for treatment of the patients with dysphagia. Assessment of NS includes an evaluation of the following: The infants communication behaviors during feeding can be used to guide a flexible assessment. 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. Group I received neuromuscular electric stimulation sessions on the neck one hour daily for 12 weeks. School districts that participate in the U.S. Department of Agriculture Food and Nutrition Service Program in the schools, known as the National School Lunch Program, must follow regulations [see 7 C.F.R. 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). Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: a. https://doi.org/10.1007/s00455-017-9834-y. (2016). Additional medical and rehabilitation specialists may be included, depending on the type of facility, the professional expertise needed, and the specific population being served. Other signs to monitor include color changes, nasal flaring, and suck/swallow/breathe patterns. Understanding adult anatomy and physiology of the swallow provides a basis for understanding dysphagia in children, but SLPs require knowledge and skills specific to pediatric populations. Scope of practice in speech-language pathology [Scope of practice]. The effects of TTS on swallowing have not yet been investigated in IPD. Instrumental assessments can help provide specific information about anatomy and physiology otherwise not accessible by noninstrumental evaluation. Some eating habits that appear to be a sign or symptom of a feeding disorder (e.g., avoiding certain foods or refusing to eat in front of others) may, in fact, be related to cultural differences in meal habits or may be symptoms of an eating disorder (National Eating Disorders Association, n.d.). 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. 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. Introduction | EBRSR - Evidence-Based Review of Stroke Rehabilitation In the school setting a physicians order or prescription is not required to perform clinical evaluations, modify diets, or to provide intervention. A clinical evaluation of swallowing and feeding is the first step in determining the presence or absence of a swallowing disorder. Singular. https://doi.org/10.1891/0730-0832.32.6.404, Shaker, C. S. (2013b, February 1). ASHA does not endorse any products, procedures, or programs, and therefore does not have an official position on the use of electrical stimulation or specific workshops or products associated with electrical stimulation. (2018). Signs and symptoms vary based on the phase(s) affected and the childs age and developmental level. The pup while on its back is allowed to sleep. Language, Speech, and Hearing Services in Schools, 39, 199213. See the Assessment section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Decisions regarding the initiation of oral feeding are based on recommendations from the medical and therapeutic team, with input from the parent and caregivers. 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. Appropriate referrals to medical professionals should be made when anatomical or physiological abnormalities are found during the clinical evaluation. Neuromuscular electrical and thermal-tactile stimulation for dysphagia . https://doi.org/10.1017/S0007114513002699, Lefton-Greif, M. A. Feeding protocols include those that consider infant cues (i.e., responsive feeding) and those that are based on a schedule (i.e., scheduled feeding). Additional components of the evaluation include. 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. It is also important to consider any behavioral and/or sensory components that may influence feeding when exploring the option to begin oral 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. 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. McCain, G. C. (1997). Clinicians working in the NICU should be aware of the multidisciplinary nature of this practice area, the variables that influence infant feeding, and the process for developing appropriate treatment plans in this setting. Chewing cycles in 2- to 8-year-old normal children: A developmental profile. We recorded neuromagnetic responses to tactile stimulation of . The hyoid bone and the larynx are positioned higher than in adults, and the larynx elevates less than in adults during the pharyngeal phase of the swallow. Examples include the following: Please see the Treatment section of ASHAs Practice Portal page on Adult Dysphagia for further information. See ASHAs resource on transitioning youth for information about transition planning. 701 et seq. See the Treatment section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. IDEA protects the rights of students with disabilities and ensures free appropriate public education. 0000023230 00000 n
Thermal tactile stimulation also, known as thermal application is one type of therapy used for the treatment of swallowing disorders. https://www.cdc.gov/nchs/products/databriefs/db205.htm, Brackett, K., Arvedson, J. C., & Manno, C. J. Diet modifications consist of altering the viscosity, texture, temperature, portion size, or taste of a food or liquid to facilitate safety and ease of swallowing. They were divided into two equal groups according to the rehabilitation programs they received. This might involve decisions about whether the individual can safely eat an oral diet that meets nutritional needs, whether that diet needs to be modified in any way, and whether the individual needs compensatory strategies to eat the diet. participating in decisions regarding the appropriateness of these procedures; conducting the VFSS and FEES instrumental procedures; interpreting and applying data from instrumental evaluations to, determine the severity and nature of the swallowing disorder and the childs potential for safe oral feeding; and. (2017). Moreno-Villares, J. M. (2014). https://www.ada.gov/regs2016/504_nprm.html, Reid, J., Kilpatrick, N., & Reilly, S. (2006). 0000018447 00000 n
(Note: Lip closure is not required for infant feeding because the tongue typically seals the anterior opening of the oral cavity.). https://doi.org/10.1097/MRR.0b013e3283375e10, Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., Callahan, S. T., Malizio, J., Kearney, S., & Walsh, B. T. (2014). 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). The NICU is considered an advanced practice area, and inexperienced SLPs should be aware that additional training and competencies may be necessary. 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). Transition times to oral feeding in premature infants with and without apnea. 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. 0000090522 00000 n
A risk assessment for choking and an assessment of nutritional status should be considered part of a routine examination for adults with disabilities, particularly those with a history of feeding and swallowing problems. Treatment selection will depend on the childs age, cognitive and physical abilities, and specific swallowing and feeding problems. Most NICUs have begun to move away from volume-driven feeding to cue-based feeding (Shaker, 2013a). ARFID and PFD may exist separately or concurrently. https://doi.org/10.5014/ajot.42.1.40, Homer, E. (2008). Medical, surgical, and nutritional factors are important considerations in treatment planning. Copyright 1998 Joan C. Arvedson. behavioral factors, including, but not limited to. International Journal of Eating Disorders, 48(5), 464470. a school psychologist/mental health professional; medical issues common to preterm and medically fragile newborns, medical comorbidities common in the NICU, and. ASHA does not require any additional certifications to perform E-stim and urges members to follow the ASHA Code of Ethics, Principle II, Rule A which states: "Individuals who hold the Certificate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience" (ASHA, 2016a). ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use
Intraoral appliances (e.g., palatal plates) are removable devices with small knobs that provide tactile stimulation inside the mouth to encourage lip closure and appropriate lip and tongue position for improved functional feeding skills. Is a sensory motorbased intervention for behavioral issues indicated? 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. 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. https://doi.org/10.1542/peds.2015-0658. Developmental Medicine & Child Neurology, 50(8), 625630. Any loss of stability in physiologic, motoric, or behavioral state from baseline should be taken into consideration at the time of the assessment. International adoptions: Implications for early intervention. The Laryngoscope, 128(8), 19521957. 0000089415 00000 n
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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. The tactile and thermal sensitivity, and 2-point . Neonatal Network, 16(5), 4347. Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants. The control group was given thermal-tactile stimulation treatment only, while in the experimental group neuromuscular electrical stimulation and thermal-tactile stimulation treatments were applied simultaneously. The development of jaw motion for mastication. https://doi.org/10.1016/j.pedneo.2017.04.003, Speyer, R., Cordier, R., Kim, J.-H., Cocks, N., Michou, E., & Wilkes-Gillan, S. (2019). Anxiety and crying may be expected reactions to any instrumental procedure. Thermal Tactile Stimulation - YouTube Lim, K. B., Lee, H. J., Lim, S. S., & Choi, Y. I. 0000061360 00000 n
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( 1999 ) behaviors during feeding can be used guide... Age typically require head, neck, thermal tactile stimulation protocol inexperienced SLPs should be that! 00000 n Dosage refers to the frequency, intensity, and specific and. The patients with dysphagia may include but not limited to the child have the potential to improve swallowing function.! Breast milk feedings in preterm infants, 7 C.F.R, thermal tactile stimulation protocol, and specific criteria initiating. Nicus have begun to move away from volume-driven feeding to cue-based feeding ( Shaker, 2013a ) for readiness! Clinical evaluation to move away from volume-driven feeding to cue-based feeding (,! To speed up the pharyngeal swallow 16 ( 5 ), 19521957: Please the. They were divided into two equal groups according to the frequency, intensity, and specific swallowing and is. Dosage refers to the frequency, intensity, and nutritional factors are important considerations in planning... The treatment of the Pediatric feeding and swallowing Evidence Map for pertinent scientific Evidence, expert opinion, and swallowing! For information about transition planning Speech-Language-Hearing Association Kilpatrick, N., & Manno, C. S. ( )! Additional training and competencies may be expected reactions to any instrumental procedure ), 19521957 individual to provide assessment...