Available 8:30 a.m.5:00 p.m. The SLP also teaches parents and other caregivers to provide positive oral experiences and to recognize and interpret the infants cues during NNS. Neonatal Network, 32(6), 404408. Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. 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). (2010). Staff who work closely with the student should have training in cardiopulmonary resuscitation (CPR) and the Heimlich maneuver. 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. When conducting an instrumental evaluation, SLPs should consider the following: Procedures take place in a child-friendly environment with toys, visual distracters, rewards, and a familiar caregiver, if possible and when appropriate. https://doi.org/10.1097/JPN.0000000000000082, Seiverling, L., Towle, P., Hendy, H. M., & Pantelides, J. Reproduced and adapted with permission. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. 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). 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). 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. The long-term consequences of feeding and swallowing disorders can include. 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. consideration of the infants ability to obtain sufficient nutrition/hydration across settings (e.g., hospital, home, day care setting). The clinical evaluation of infants typically involves. 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. PFD may be associated with oral sensory function (Goday et al., 2019) and can be characterized by one or more of the following behaviors (Arvedson, 2008): Speech-language pathologists (SLPs) are the preferred providers of dysphagia services and are integral members of an interprofessional team to diagnose and manage feeding and swallowing disorders. Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/. Oralmotor treatments include stimulation toor actions ofthe lips, jaw, tongue, soft palate, pharynx, larynx, and respiratory muscles. Rather than setting a goal to empty the bottle, the feeding experience is viewed as a partnership with the infant. 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. International Journal of Pediatric Otorhinolaryngology, 139, 110464. https://doi.org/10.1016/j.ijporl.2020.110464. 0000018888 00000 n https://doi.org/10.1080/09638280701461625, U.S. Department of Agriculture. https://www.ada.gov/regs2016/504_nprm.html, Reid, J., Kilpatrick, N., & Reilly, S. (2006). ; 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 persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: SLPs may screen or make referrals for ARFID but do not diagnose this disorder. 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. 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. feeding and swallowing problems that persist into adulthood, including the risk for choking, malnutrition, or undernutrition. If a natural feeding process (e.g., position, caregiver involvement, and use of familiar foods) cannot be achieved, the results may not represent typical swallow function, and the study may need to be terminated, with results interpreted with caution. https://doi.org/10.1016/j.earlhumdev.2008.12.003. Pediatric feeding and swallowing disorders: General assessment and intervention. Johnson, D. E., & Dole, K. (1999). Additionally, the definition of ARFID considers nutritional deficiency, whereas PFD does not (Goday et al., 2019). Language, Speech, and Hearing Services in Schools, 39, 199213. 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 space between the tongue and the palate increases, and the larynx and the hyoid bone lower, elongating and enlarging the pharynx (Logemann, 1998). Any communication by the school team to an outside physician, facility, or individual requires signed parental consent. (2015). Family and cultural issues in a school swallowing and feeding program. has a complex medical condition and experiences a significant change in status. For infants, pacing can be accomplished by limiting the number of consecutive sucks. The effect of tongue-tie division on breastfeeding and speech articulation: A systematic review. Little is known about the possible mechanisms by which this interventional therapy may work. The clinician requests that the family provide. The effects of TTS on swallowing have not yet been investigated in IPD. See ASHAs resources on interprofessional education/interprofessional practice (IPE/IPP), and collaboration and teaming. For children who have difficulty participating in the procedure, the clinician should allow time to control problem behaviors prior to initiating the instrumental procedure. 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). 0000089204 00000 n Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors. Medical, surgical, and nutritional factors are important considerations in treatment planning. 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. Language, Speech, and Hearing Services in Schools, 39(2), 177191. 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. The ASHA Leader, 18(2), 4247. Additional Resources 0000090013 00000 n 0000089331 00000 n This method involves stroking or rubbing the anterior faucial pillars with a cold probe prior to having the patient swallow. First steps towards development of an instrument for the reproducible quantification of oropharyngeal swallow physiology in bottle-fed children. hb``b````c` B,@. Children with sufficient cognitive skills can be taught to interpret this visual information and make physiological changes during the swallowing process. Behavioral interventions are based on principles of behavioral modification and focus on increasing appropriate actions or behaviorsincluding increasing complianceand reducing maladaptive behaviors related to feeding. 1400 et seq. Pediatrics, 135(6), e1458e1466. https://www.cdc.gov/nchs/data/nhds/8newsborns/2010new8_numbersick.pdf [PDF], National Eating Disorders Association. Infants cannot verbally describe their symptoms, and children with reduced communication skills may not be able to adequately do so. The health and well-being of the child is the primary concern in treating pediatric feeding and swallowing disorders. 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). 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. Developmental Medicine & Child Neurology, 50(8), 625630. In infants, the tongue fills the oral cavity, and the velum hangs lower. International Classification of Functioning, Disability and Health. 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). (2002). 128 0 obj <> endobj xref In addition to the clinical evaluation of infants noted above, breastfeeding assessment typically includes an evaluation of the. Please see ASHAs resource on alternative nutrition and hydration in dysphagia care for further information. https://www.cdc.gov/nchs/products/databriefs/db205.htm, Brackett, K., Arvedson, J. C., & Manno, C. J. American Psychiatric Association. 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). It is also important to consider any behavioral and/or sensory components that may influence feeding when exploring the option to begin oral feeding. Thermal Tactile Stimulation - YouTube Lim, K. B., Lee, H. J., Lim, S. S., & Choi, Y. I. 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. Treatment selection will depend on the childs age, cognitive and physical abilities, and specific swallowing and feeding problems. The primary goals of feeding and swallowing intervention for children are to, Consistent with the WHOs (2001) International Classification of Functioning, Disability and Health (ICF) framework, goals are designed to. Evaluation and treatment of swallowing disorders. Arvedson, J. C., & Brodsky, L. (2002). B. 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. (2008). 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. NNS is sucking for comfort without fluid release (e.g., with a pacifier, finger, or recently emptied breast). Families are encouraged to bring food and drink common to their household and utensils typically used by the child. https://doi.org/10.1542/peds.2017-0731, Bhattacharyya, N. (2015). Therapeutic learning is the motor learning process in which target behavior is achieved by utilizing activity-dependent elements and the assistive system. ( Goday et al., 2019 ) the risk for choking, malnutrition or. 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