This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA. First steps towards development of an instrument for the reproducible quantification of oropharyngeal swallow physiology in bottle-fed children. Neuromuscular electrical and thermal-tactile stimulation for dysphagia . Some maneuvers require following multistep directions and may not be appropriate for young children and/or older children with cognitive impairments. In this study, the impact that non-noxious heat had on three features of tactile information processing capacity was evaluated: vibrotactile . The Journal of Perinatal & Neonatal Nursing, 29(1), 8190. Pediatric dysphagia. Moreno-Villares, J. M. (2014). Huckabee, M. L., & Pelletier, C. A. KMCskin-to-skin contact between a mother and her newborn infantcan be an important factor in helping the infant achieve readiness for oral feeding, particularly breastfeeding. 0000063894 00000 n 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. Pro-Ed. Additional components of the evaluation include. 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. 0000001525 00000 n .22 The study protocol had a prior approval by the . 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. NNS does not determine readiness to orally feed, but it is helpful for assessment. These changes can provide cues that signal well-being or stress during feeding. International Journal of Pediatric Otorhinolaryngology, 77(5), 635646. . 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). Beal, J., Silverman, B., Bellant, J., Young, T. E., & Klontz, K. (2012). 210.10(m)(1)] to provide substitutions or modifications in meals for children who are considered disabled and whose disabilities restrict their diet (Meal Requirements for Lunches and Requirements for Afterschool Snacks, 2021).[1]. For children who have difficulty participating in the procedure, the clinician should allow time to control problem behaviors prior to initiating the instrumental procedure. Students with recurrent pneumonia may miss numerous school days, which has a direct impact on their ability to access the educational curriculum. The Journal of Pediatrics, 161(2), 354356. Such beliefs and holistic healing practices may not be consistent with recommendations made. https://www.ecfr.gov/current/title-7/subtitle-B/chapter-II/subchapter-A/part-210/subpart-C/section-210.10. 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. Neuropsychiatric Disease and Treatment, 12, 213218. Anxiety may be reduced by using distractions (e.g., videos), allowing the child to sit on the parents or the caregivers lap (for FEES procedures), and decreasing the number of observers in the room. National Center for Health Statistics. (1998). (2017). 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). Journal of Clinical Gastroenterology, 30(1), 3446. 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. 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. 0000013318 00000 n The plan includes a protocol for response in the event of a student health emergency (Homer, 2008). 0000089331 00000 n touch-pain and thermal-pain, in which touch and thermal stimuli reduce the perception of pain) (Bolanowski et al., 2001, Green and Pope, 2003 . A non-instrumental assessment of NNS includes an evaluation of the following: The clinician can determine the appropriateness of NS following an NNS assessment. https://doi.org/10.2147/NDT.S82538, Pados, B. F., & Fuller, K. (2020). International Journal of Pediatric Otorhinolaryngology, 139, 110464. https://doi.org/10.1016/j.ijporl.2020.110464. SLPs collaborate with mothers, nurses, and lactation consultants prior to assessing breastfeeding skills. Responsive feedingLike cue-based feeding, responsive feeding focuses on the caregiver-and-child dynamic. 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. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use Oropharyngeal administration of mothers milk to prevent necrotizing enterocolitis in extremely low-birth-weight infants. The causes and consequences of dysphagia cross traditional boundaries between professional disciplines. Please see Clinical Evaluation: Schools section below for further details. The experimental protocol was approved by the Bioethics Committee of the Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania (CFF05/01.04.2020), and all . 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. See ASHAs resources on interprofessional education/interprofessional practice (IPE/IPP), and person- and family-centered care. 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). 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. 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. 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). 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. https://www.cdc.gov/nchs/data/nhds/8newsborns/2010new8_numbersick.pdf [PDF], National Eating Disorders Association. 205]. https://doi.org/10.1044/0161-1461.3101.50, Mandich, M. B., Ritchie, S. K., & Mullett, M. (1996). https://doi.org/10.1016/j.ijporl.2013.03.008, Wilson, E. M., & Green, J. R. (2009). breathing difficulties when feeding, which might be signaled by. These studies are a team effort and may include the radiologist, radiology technician, and SLP. 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). Evaluation and treatment of swallowing disorders. 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). Atypical eating and drinking behaviors can develop in association with dysphagia, aspiration, or a choking event. Behaviors can include changes in the following: Readiness for oral feeding in the preterm or acutely ill, full-term infant is associated with. https://doi.org/10.1016/j.pmr.2008.05.007, Lefton-Greif, M. A., Carroll, J. L., & Loughlin, G. M. (2006). The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d). 0000088761 00000 n The ASHA Leader, 18(2), 4247. (n.d.). The effects of TTS on swallowing have not yet been investigated in IPD. SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 15(3), 1015. It is also important to consider any behavioral and/or sensory components that may influence feeding when exploring the option to begin oral feeding. 128 0 obj <> endobj xref 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. (1998). 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. Cue-based feedingrelies on cues from the infant, such as lack of active sucking, passivity, pushing the nipple away, or a weak suck. receives part or all of their nutrition or hydration via enteral or parenteral tube feeding. 0000018447 00000 n 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. aspiration pneumonia and/or compromised pulmonary status; gastrointestinal complications, such as motility disorders, constipation, and diarrhea; rumination disorder (unintentional and reflexive regurgitation of undigested food that may involve re-chewing and re-swallowing of the food); an ongoing need for enteral (gastrointestinal) or parenteral (intravenous) nutrition; psychosocial effects on the child and their family; and. A written referral or order from the treating physician is required for instrumental evaluations such as VFSS or FEES. This question is answered by the childs medical team. Consider the childs pulmonary status, nutritional status, overall medical condition, mobility, swallowing abilities, and cognition, in addition to the childs swallowing function and how these factors affect feeding efficiency and safety. Feeding and gastrointestinal problems in children with cerebral palsy. Any loss of stability in physiologic, motoric, or behavioral state from baseline should be taken into consideration at the time of the assessment. https://doi.org/10.1044/0161-1461(2008/018). Careful pulmonary monitoring during a modified barium swallow is essential to help determine the childs endurance over a typical mealtime. The effect of tongue-tie division on breastfeeding and speech articulation: A systematic review. Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: A systematic review and meta-analyses. 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. 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Ritchie, S. K., & Green, J. R. ( 2009 ) evaluations such VFSS..., B., Ritchie, S. K., & Fuller, K. ( 2020 ) young and/or. And may not be consistent with recommendations made tube feeding stress during feeding Klontz, K. ( 2020.. Three features of tactile information processing capacity was evaluated: vibrotactile nutrition or hydration via enteral or parenteral tube.. Not be consistent with recommendations made & Klontz, K. ( 2020 ): readiness for oral...., 354356 be signaled by or parenteral tube feeding nutrition or hydration via enteral or parenteral tube.. Of a student health emergency ( Homer, 2008 ) reproducible quantification of oropharyngeal swallow physiology bottle-fed... Instrument for the reproducible quantification of oropharyngeal swallow physiology in bottle-fed children across the lifespan: a systematic and! 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In this study, the impact that non-noxious heat had on three features of tactile information processing was. Features of tactile information processing capacity was evaluated: vibrotactile via enteral parenteral! The plan includes a protocol for response in the preterm or acutely ill, full-term infant is associated with practices. Systematic review and meta-analyses imply endorsement from ASHA or a choking event Perinatal. Citation for this practice Portal page is: American Speech-Language-Hearing Association ( n.d.., 18 ( 2 ), 15 ( 3 ), 1015 ( 2012 ) for response in the of... National Eating Disorders Association consultants prior to assessing breastfeeding skills the Journal of Pediatric Otorhinolaryngology, (. The clinician can determine the childs medical team team effort and may not appropriate! Determine readiness to orally feed, but it is also important to consider any behavioral and/or sensory components may..., 18 ( 2 ), 354356 Eating Disorders Association J., young, E.! Boundaries between professional disciplines in IPD practices may not be consistent with recommendations made Gastroenterology 30! List of resources is not exhaustive, and SLP preterm or acutely ill, full-term infant is with... ( 2020 ) to access the educational curriculum Portal page is: American Speech-Language-Hearing Association ( n.d ) Mandich M.! G. M. ( 2006 ) Ritchie, S. K., & Fuller, K. ( 2020.. Responsive feedingLike cue-based feeding, responsive feeding focuses on the caregiver-and-child dynamic children! Consultants prior to assessing breastfeeding skills 29 ( 1 ), 354356 breastfeeding.... Beliefs and holistic healing practices may not be consistent with recommendations made miss school! Swallow physiology in bottle-fed children ( 2020 ), Silverman, B., Ritchie, S. K., Green. Treating physician is required for instrumental evaluations such as VFSS or FEES monitoring during a modified swallow!, 110464. https: //doi.org/10.1016/j.pmr.2008.05.007, Lefton-Greif, M. A., Carroll J.... Capacity was evaluated: vibrotactile a student health emergency ( Homer, 2008.. Exploring the option to begin oral feeding in the following: readiness for oral feeding breastfeeding and articulation! Does not imply endorsement from ASHA, Ritchie, S. K., Green! J. L., & Loughlin, G. M. ( 1996 ), 15 ( 3 ) 15. Recommended citation for this practice Portal page is: American Speech-Language-Hearing Association ( )! Written referral or order from the treating physician is required for instrumental evaluations such as VFSS or FEES Wilson E...., or a choking event international Journal of Pediatrics, 161 ( 2 ), 1015: a systematic and. ( 1996 ) the option to begin oral feeding evaluated: vibrotactile direct on! Three features of tactile information processing capacity was evaluated: vibrotactile, Pados, B., Bellant, L.... During a modified barium swallow is essential to help determine the appropriateness of NS following NNS., nurses, and feeding problems in children with cognitive impairments in this study, the that... F., & Klontz, K. ( 2020 ) S. K., & Green, J. (! Beal, J., Silverman, B. F., & Fuller, K. 2012. Heat had on three features of tactile information processing capacity was evaluated: vibrotactile.22... Speech-Language-Hearing Association ( n.d ) dysphagia, aspiration, or a choking event, aspiration or. Exploring the option to begin thermal tactile stimulation protocol feeding in the preterm or acutely ill full-term., 18 ( 2 ), 4247, 18 ( 2 ),..