The process of identifying the feeding and swallowing needs of students includes a review of the referral, interviews with the family/caregiver and teacher, and an observation of students during snack time or mealtime. 0000016965 00000 n In these cases, intervention might consist of changes in the environment or indirect treatment approaches for improving safety and efficiency of feeding. touch-pain and thermal-pain, in which touch and thermal stimuli reduce the perception of pain) (Bolanowski et al., 2001, Green and Pope, 2003 . See the Treatment section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. See ASHAs resource on transitioning youth for information about transition planning. 0000004839 00000 n Assessment of pediatric dysphagia and feeding disorders: Clinical and instrumental approaches. clear food from the spoon with their top lip, move food from the spoon to the back of their mouth, and. Use: The Swallowing Activator is used for Tactile-Thermal Stimulation (TTS) to enhance bilateral cortical and brainstem activation of the swallow. https://doi.org/10.1002/eat.22350, Erkin, G., Culha, C., Ozel, S., & Kirbiyik, E. G. (2010). The pharyngeal muscles are stimulated through neural pathways. 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). Please see ASHAs resource on alternative nutrition and hydration in dysphagia care for further information. 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. Brian B. Shulman, vice president for professional practices in speech-language pathology, served as the monitoring officer. 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. For an example, see community management of uncomplicated acute malnutrition in infants < 6 months of age (C-MAMI) [PDF]. A thermal stimulus was applied to the left thenar eminence of the hand, corresponding to dermatome C6. safety while eating in school, including having access to appropriate personnel, food, and procedures to minimize risks of choking and aspiration while eating; adequate nourishment and hydration so that students can attend to and fully access the school curriculum; student health and well-being (e.g., free from aspiration pneumonia or other illnesses related to malnutrition or dehydration) to maximize their attendance and academic ability/achievement at school; and. International Classification of Functioning, Disability and Health. https://doi.org/10.1891/0730-0832.32.6.404, Shaker, C. S. (2013b, February 1). breathing difficulties when feeding, which might be signaled by. 0000090091 00000 n Feeding and swallowing disorders may be considered educationally relevant and part of the school systems responsibility to ensure. 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 Journal of Perinatal & Neonatal Nursing, 29(1), 8190. (1998). In this study, the impact that non-noxious heat had on three features of tactile information processing capacity was evaluated: vibrotactile . 205]. The Laryngoscope, 128(8), 19521957. 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. International Journal of Pediatric Otorhinolaryngology, 77(5), 635646. Language, Speech, and Hearing Services in Schools, 39, 199213. For children who have difficulty participating in the procedure, the clinician should allow time to control problem behaviors prior to initiating the instrumental procedure. https://www.cdc.gov/nchs/data/nhds/8newsborns/2010new8_numbersick.pdf [PDF], National Eating Disorders Association. 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). During an instrumental assessment of swallowing, the clinician may use information from cardiac, respiratory, and oxygen saturation monitors to monitor any changes to the physiologic or behavioral condition. 128 0 obj <> endobj xref SLPs develop and typically lead the school-based feeding and swallowing team. Dysphagia, 33(1), 7682. 0000001256 00000 n A. International adoptions: Implications for early intervention. The electrical stimulation protocol was performed using a modified hand- held battery powered electrical stimulator (vital stim) that consists of a symmetric . Dosage depends on individual factors, including the childs medical status, nutritional needs, and readiness for oral intake. cal stimulation combined with thermal-tactile stimulation is a better treatment for patients with swallowing disorders af-ter stroke than thermal-tactile stimulation alone. The tactile and thermal sensitivity, and 2-point . oversee the day-to-day implementation of the feeding and swallowing plan and any individualized education program strategies to keep the student safe from aspiration, choking, undernutrition, or dehydration while in school. a review of any past diagnostic test results. See the treatment in the school setting section below for further information. Alternative feeding does not preclude the need for feeding-related treatment. 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. 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. Rates increase with greater severity of cognitive impairment and decline in gross motor function (Benfer et al., 2014, 2017; Calis et al., 2008; Erkin et al., 2010; Speyer et al., 2019). https://www.ecfr.gov/current/title-7/subtitle-B/chapter-II/subchapter-A/part-210/subpart-C/section-210.10. 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. Neonatal Network, 32(6), 404408. Reproduced and adapted with permission. a review of current programs and treatments. McComish, C., Brackett, K., Kelly, M., Hall, C., Wallace, S., & Powell, V. (2016). Pro-Ed. 0000023230 00000 n 0000090444 00000 n (2010). (2014). 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. As a result, intake is improved (Shaker, 2013a). Concurrent medical issues may affect this timeline. If the child cannot meet nutritional needs by mouth, what recommendations need to be made concerning supplemental non-oral intake and/or the inclusion of orally fed supplements in the childs diet? Other benefits of KMC include temperature regulation, promotion of breastfeeding, parental empowerment and bonding, stimulation of lactation, and oral stimulation for the promotion of oral feeding ability. https://doi.org/10.1111/j.1552-6909.1996.tb01493.x. Positioning limitations and abilities (e.g., children who use a wheelchair) may affect intake and respiration. Instrumental evaluation is completed in a medical setting. The school-based SLP and the school team (OT, PT, and school nurse) conduct the evaluation, which includes observation of the student eating a typical meal or snack. 0000017901 00000 n The health and well-being of the child is the primary concern in treating pediatric 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. A non-instrumental assessment of NNS includes an evaluation of the following: The clinician can determine the appropriateness of NS following an NNS assessment. Family and cultural issues in a school swallowing and feeding program. Precautions, accommodations, and adaptations must be considered and implemented as students transition to postsecondary settings. Methodology: Fifty patients with dysphagia due to stroke were included. 0000088761 00000 n discuss the process of establishing a safe feeding plan for the student at school; gather information about the students medical, health, feeding, and swallowing history; identify the current mealtime habits and diet at home; and. 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. 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