an assessment of current skills and limitations at home and in other day settings. (2006). American Journal of Occupational Therapy, 42(1), 4046. Cue-based feeding in the NICU: Using the infants communication as a guide. (Justus-Liebig University, protocol number 149/16 . 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). 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. a review of current programs and treatments. Adaptive equipment and utensils may be used with children who have feeding problems to foster independence with eating and increase swallow safety by controlling bolus size or achieving the optimal flow rate of liquids. Treatment of ankyloglossia and breastfeeding outcomes: A systematic review. 0000088878 00000 n Members of the Working Group on Dysphagia in Schools included Emily M. Homer (chair), Sheryl C. Amaral, Joan C. Arvedson, Randy M. Kurjan, Cynthia R. O'Donoghue, Justine Joan Sheppard, and Janet E. Brown (ASHA liaison). Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. Among children with communication disorders aged 310 years, the prevalence of swallowing problems is 4.3%. Silent aspiration: Who is at risk? Thermal tactile stimulation also, known as thermal application is one type of therapy used for the treatment of swallowing disorders. 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). The causes and consequences of dysphagia cross traditional boundaries between professional disciplines. 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. The Journal of Pediatrics, 161(2), 354356. National Center for Health Statistics. Arvedson, J. C., & Brodsky, L. (2002). Disruptions in swallowing may occur in any or all phases of swallowing. 0000018013 00000 n https://doi.org/10.1016/j.jadohealth.2013.11.013, Francis, D. O., Krishnaswami, S., & McPheeters, M. (2015). Although thermal tactile oral stimulation is a common method to treat dysphagic patients to improve swallowing movement, little is known about the possible mechanisms. facilitating communication between team members, actively consulting with team members, and. The SLP who specializes in feeding and swallowing disorders typically leads the professional care team in the clinical or educational setting. National Center for Health Statistics. Celia Hooper, vice president for professional practices in speech-language pathology (20032005), served as monitoring vice president. 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. 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. Infants cannot verbally describe their symptoms, and children with reduced communication skills may not be able to adequately do so. SLPs do not diagnose or treat eating disorders such as bulimia, anorexia, and avoidant/restrictive food intake disorder; in the cases where these disorders are suspected, the SLP should refer to the appropriate behavioral health professional. Protocols for determining readiness for oral feeding and specific criteria for initiating feeding vary across facilities. 0000055191 00000 n Neuromuscular electrical and thermal-tactile stimulation for dysphagia . British Journal of Nutrition, 111(3), 403414. It is primarily used to treat individuals who have an absent or delayed swallow reflex. An estimated 116,000 newborn infants are discharged from short-stay hospitals with a diagnosis of feeding problems, according to the. Students who do not qualify for IDEA services and have swallowing and feeding disorders may receive services through the Rehabilitation Act of 1973, Section 504, under the provision that it substantially limits one or more of lifes major activities. Instrumental assessments can help provide specific information about anatomy and physiology otherwise not accessible by noninstrumental evaluation. SLPs with appropriate training and competence in performing electrical stimulation may provide the intervention. In their role as communication specialists, SLPs monitor the infant for stress cues and teach parents and other caregivers to recognize and interpret the infants communication signals. The SLP or radiology technician typically prepares and presents the barium items, whereas the radiologist records the swallow for visualization and analysis. 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. Members of the dysphagia team may vary across settings. 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. 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. First steps towards development of an instrument for the reproducible quantification of oropharyngeal swallow physiology in bottle-fed children. Postural and positioning techniques involve adjusting the childs posture or position to establish central alignment and stability for safe feeding. 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). data from monitoring devices (e.g., for patients in the neonatal intensive care unit [NICU]); nonverbal forms of communication (e.g., behavioral cues signaling feeding or swallowing problems); and. (2002). 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. behavioral factors, including, but not limited to. Responsive feedingLike cue-based feeding, responsive feeding focuses on the caregiver-and-child dynamic. Cultural, religious, and individual beliefs about food and eating practices may affect an individuals comfort level or willingness to participate in the assessment. The referral can be initiated by families/caregivers or school personnel. 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). International Classification of Functioning, Disability and Health. https://doi.org/10.1044/0161-1461.3101.50, Mandich, M. B., Ritchie, S. K., & Mullett, M. (1996). 0000001525 00000 n At that time, they. has suspected structural abnormalities (requires an assessment from a medical professional). The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research. Therapy for children with swallowing disorders in the educational setting. 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. Behaviors can include changes in the following: Readiness for oral feeding in the preterm or acutely ill, full-term infant is associated with. Pediatrics, 108(6), e106. Such beliefs and holistic healing practices may not be consistent with recommendations made. https://doi.org/10.2147/NDT.S82538, Pados, B. F., & Fuller, K. (2020). a school psychologist/mental health professional; medical issues common to preterm and medically fragile newborns, medical comorbidities common in the NICU, and. (2012). Provider refers to the person providing treatment (e.g., SLP, occupational therapist, or other feeding specialist). (Practice Portal). Instrumental evaluation is completed in a medical setting. 0000089658 00000 n https://doi.org/10.1044/leader.FTRI.18022013.42, Sharp, W. G., Berry, R. C., McCracken, C., Nuhu, N. N., Marvel, E., Saulnier, C. A., Klin, A., Jones, W., & Jaquess, D. L. (2013). Therefore, management of dysphagia may require input of multiple specialists serving on an interprofessional team. Students with recurrent pneumonia may miss numerous school days, which has a direct impact on their ability to access the educational curriculum. Pediatric videofluoroscopic swallow studies: A professional manual with caregiver guidelines. Behavioral state activity during nipple feedings for preterm infants. The ASHA Leader, 18(2), 4247. Evaluation and treatment of swallowing disorders. https://doi.org/10.1016/j.ridd.2014.08.029, Benfer, K. A., Weir, K. A., Bell, K. L., Ware, R. S., Davies, P. S. W., & Boyd, R. N. (2017). 0000016965 00000 n Incidence refers to the number of new cases identified in a specified time period. It is used as a treatment option to encourage eventual oral intake. Beal, J., Silverman, B., Bellant, J., Young, T. E., & Klontz, K. (2012). Speech-language pathologists (SLPs) play a central role in the assessment, diagnosis, and treatment of infants and children with swallowing and feeding disorders. The data below reflect this variability. 0000090444 00000 n 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. https://doi.org/10.1542/peds.2015-0658. 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. ASHA is strongly committed to evidence-based practice and urges members to consider the best available evidence before utilizing any product or technique. Underlying disease state(s), chronological and developmental age of the child, social and environmental factors, and psychological and behavioral factors also affect treatment recommendations. 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://wayback.archive-it.org/7993/20170722060115/https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm256250.htm, Velayutham, P., Irace, A. L., Kawai, K., Dodrill, P., Perez, J., Londahl, M., Mundy, L., Dombrowski, N. D., & Rahbar, R. (2018). Instrumental evaluation is conducted following a clinical evaluation when further information is needed to determine the nature of the swallowing disorder. See Person-Centered Focus on Function: Pediatric Feeding and Swallowing [PDF] for examples of assessment data consistent with the International Classification of Functioning, Disability and Health framework. Logemann, J. Management of adult neurogenic dysphagia. See the Treatment section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. 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. Feeding provides children and caregivers with opportunities for communication and social experiences that form the basis for future interactions (Lefton-Greif, 2008). hb``b````c` B,@. Dycem to prevent plates and cups from sliding. This requires a working knowledge of breastfeeding strategies to facilitate safe and efficient swallowing and optimal nutrition. NNS is sucking for comfort without fluid release (e.g., with a pacifier, finger, or recently emptied breast). Swallowing function and medical diagnoses in infants suspected of dysphagia. (Note: Lip closure is not required for infant feeding because the tongue typically seals the anterior opening of the oral cavity.). Journal of Developmental & Behavioral Pediatrics, 23(5), 297303. 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. -Group II (thermal tactile stimulation treatment program): Comprised 25 patients who received thermal tactile stimulation daily three times, each of 20 minutes The assessment of bottle-feeding includes an evaluation of the, The assessment of spoon-feeding includes an evaluation of the optimal spoon type and the infants ability to, In addition to the areas of assessment noted above, the evaluation for toddlers (ages 13 years) and preschool/school-age children (ages 321 years) may include, Evaluation in the school setting includes children/adults from 3 to 21 years of age. The scope of this page is feeding and swallowing disorders in infants, preschool children, and school-age children up to 21 years of age. TSTP (traditional therapy using tactile thermal stimulus [group A]) Journal of Obstetric, Gynecologic, & Neonatal Nursing, 25(9), 771776. In the Masako, the tongue is held forward between the teeth while swallowing; this is performed without food or liquid in the mouth to prevent coughing or choking. Staff who work closely with the student should have training in cardiopulmonary resuscitation (CPR) and the Heimlich maneuver. cal stimulation combined with thermal-tactile stimulation is a better treatment for patients with swallowing disorders af-ter stroke than thermal-tactile stimulation alone. 701 et seq. 2), 3237. effect of neuromuscular and thermal tactile stimulation on its rehabilitation. 210.10(m)(1) (2021). Administration of small amounts of maternal milk into the oral cavity of enteral tubedependent infants improves breastfeeding rates, growth, and immune-protective factors and reduces sepsis (Pados & Fuller, 2020). Brian B. Shulman, vice president for professional practices in speech-language pathology, served as the monitoring officer. 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). overall physical, social, behavioral, and communicative development, structures of the face, jaw, lips, tongue, hard and soft palate, oral pharynx, and oral mucosa, functional use of muscles and structures used in swallowing, including, headneck control, posture, oral and pharyngeal reflexes, and involuntary movements and responses in the context of the childs developmental level, observation of the child eating or being fed by a family member, caregiver, or classroom staff member using foods from the home and oral abilities (e.g., lip closure) related to, utensils that the child may reject or find challenging, functional swallowing ability, including, but not limited to, typical developmental skills and task components, such as, manipulation and transfer of the bolus, and, the ability to eat within the time allotted at school. 0000089121 00000 n A significant number of studies that evaluated tactile-pain interactions employed heat to evoke nociceptive responses. Feeding and eating disorders: DSM-5 Selections. 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. These cues typically indicate that the infant is disengaging from feeding and communicating the need to stop. 0000018100 00000 n Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants. Once the infant begins eating pureed food, each swallow is discrete (as opposed to sequential swallows in bottle-fed or breastfed infants), and the oral and pharyngeal phases are similar to those of an adult (although with less elevation of the larynx). Reading the feeding. Time of stimulation 3-5 seconds. They were divided into two equal groups according to the rehabilitation programs they received. Clinical Oral Investigations, 18(5), 15071515. Group I received neuromuscular electric stimulation sessions on the neck one hour daily for 12 weeks. 0000075738 00000 n McCain, G. C. (1997). (2017). Pediatric Pulmonology, 41(11), 10401048. Strategies that slow the feeding rate may allow for more time between swallows to clear the bolus and may support more timely breaths. https://doi.org/10.1007/s10803-013-1771-5, Simpson, C., Schanler, R. J., & Lau, C. (2002). Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. 0000000016 00000 n Any communication by the school team to an outside physician, facility, or individual requires signed parental consent. 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. https://doi.org/10.1017/S0007114513002699, Lefton-Greif, M. A. B. Cue-based feedingrelies on cues from the infant, such as lack of active sucking, passivity, pushing the nipple away, or a weak suck. This question is answered by the childs medical team. International Journal of Oral & Maxillofacial Surgery, 44(6), 732737. Code of ethics [Ethics]. 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. 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). During stimulation, participants may hear a soft buzzing or tone and experience weak tactile sensations, depending on the transducer mechanics and sonication protocol. 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. 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. different positions (e.g., side feeding). Additional components of the evaluation include. clear food from the spoon with their top lip, move food from the spoon to the back of their mouth, and. https://doi.org/10.1016/j.pmr.2008.05.007, Lefton-Greif, M. A., Carroll, J. L., & Loughlin, G. M. (2006). https://doi.org/10.1002/lary.24931, Black, L. I., Vahratian, A., & Hoffman, H. J. the caregivers behaviors while feeding their child. https://sites.ed.gov/idea/, Jaffal, H., Isaac, A., Johannsen, W., Campbell, S., & El-Hakim, H. G. (2020). https://doi.org/10.1542/peds.108.6.e106, Norris, M. L., Spettigue, W. J., & Katzman, D. K. (2016). Recommended practices follow a collaborative process that involves an interdisciplinary team, including the child, family, caregivers, and other related professionals. Dysphagia can occur in one or more of the four phases of swallowing and can result in aspirationthe passage of food, liquid, or saliva into the tracheaand retrograde flow of food into the nasal cavity. See the Service Delivery section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. 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Fuller, K. ( 2012 ) child, family, caregivers, and children with reduced communication may! Parental consent medical issues common to preterm and medically fragile newborns, medical comorbidities common in the NICU: the! 23 ( 5 ), 297303 6 ), in which the section letters and numbers are 210.10 ( 2021! Prevalence of swallowing problems is 4.3 % B. Shulman, vice president for professional practices speech-language.