(2015). Sensory stimulation techniques vary and may include thermaltactile stimulation (e.g., using an iced lemon glycerin swab) or tactile stimulation (e.g., using a NUK brush) applied to the tongue or around the mouth. According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed. 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. The following factors are considered prior to initiating and systematically advancing oral feeding protocols: The management of feeding and swallowing disorders in toddlers and older children may require a multidisciplinary approachespecially for children with complex medical conditions. effect of neuromuscular and thermal tactile stimulation on its rehabilitation. Underlying disease state(s), chronological and developmental age of the child, social and environmental factors, and psychological and behavioral factors also affect treatment recommendations. 701 et seq. Decisions are made based on the childs needs, their familys views and preferences, and the setting where services are provided. A. https://www.fns.usda.gov/cn/2017-edition-accommodating-children-disabilities-school-meal-programs, U.S. Food and Drug Administration. 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). The effect of tongue-tie division on breastfeeding and speech articulation: A systematic review. https://www.ada.gov/regs2016/504_nprm.html, Reid, J., Kilpatrick, N., & Reilly, S. (2006). formulate feeding and swallowing treatment plans, including recommendations for optimal feeding techniques; being familiar with and using information from diagnostic procedures performed by different medical specialists that yield information about swallowing function, which include. Concurrent medical issues may affect this timeline. A thermal stimulus was applied to the left thenar eminence of the hand, corresponding to dermatome C6. Please see the Treatment section of ASHAs Practice Portal page on Adult Dysphagia for further information. Implementation of strategies and modifications is part of the diagnostic process. See the Pediatric Feeding and Swallowing Evidence Map for summaries of the available research on this topic. behavioral factors, including, but not limited to. https://doi.org/10.1044/0161-1461(2008/020), de Vries, I. Late onset necrotizing enterocolitis in infants following use of a xanthan gum-containing thickening agent. McComish, C., Brackett, K., Kelly, M., Hall, C., Wallace, S., & Powell, V. (2016). (2015). 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. The tactile and thermal sensitivity, and 2-point . A. C., Breugem, C. C., van der Heul, A. M. B., Eijkemans, M. J. C., Kon, M., & Mink van der Molen, A. https://doi.org/10.1044/0161-1461(2008/018). Behavior patterns associated with institutional deprivation: A study of children adopted from Romania. Protocols for determining readiness for oral feeding and specific criteria for initiating feeding vary across facilities. 0000018888 00000 n
Feeding problems and nutrient intake in children with autism disorders: A meta-analysis and comprehensive review of the literature. https://doi.org/10.1542/peds.2017-0731, Bhattacharyya, N. (2015). 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. The clinical evaluation of infants typically involves. The data below reflect this variability. Beckett, C., Bredenkamp, D., Castle, J., Groothues, C., OConnor, T. G., Rutter, M., & the English and Romanian Adoptees (ERA) Study Team. SLPs work with oral and pharyngeal implications of adaptive equipment. For more information, see also Accommodating Children With Disabilities in the School Meal Programs: Guidance for School Food Service Professionals [PDF] (U.S. Department of Agriculture, 2017). School-based SLPs play a significant role in the management of feeding and swallowing disorders. (2002). https://doi.org/10.1016/j.jpeds.2012.03.054. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. The pup while on its back is allowed to sleep. Oralmotor treatments range from passive (e.g., tapping, stroking, and vibration) to active (e.g., range-of-motion activities, resistance exercises, or chewing and swallowing exercises). Chewing cycles in 2- to 8-year-old normal children: A developmental profile. 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). SLPs may collaborate with occupational therapists, considering that motor control for the use of this adaptive equipment is critical. an acceptance of the pacifier, nipple, spoon, and cup; the range and texture of developmentally appropriate foods and liquids tolerated; and, the willingness to participate in mealtime experiences with caregivers, skill maintenance across the feeding opportunity to consider the impact of fatigue on feeding/swallowing safety, impression of airway adequacy and coordination of respiration and swallowing, developmentally appropriate secretion management, which might include frequency and adequacy of spontaneous dry swallowing and the ability to swallow voluntarily, modifications in bolus delivery and/or use of rehabilitative/habilitative or compensatory techniques on the swallow. J Rehabil Med 2009; 41: 174-178 Correspondence address: Kil-Byung Lim, Department of Reha- 128 0 obj
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Other signs to monitor include color changes, nasal flaring, and suck/swallow/breathe patterns. Silent aspiration: Who is at risk? The electrical stimulation protocol was performed using a modified hand- held battery powered electrical stimulator (vital stim) that consists of a symmetric . 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. 0000032556 00000 n
According to IDEA, students with disabilities may receive school health and nursing as related services to address safe mealtimes regardless of their special education classification. SLPs lead the team in. 0000016477 00000 n
Journal of Early Intervention, 40(4), 335346. -Group II (thermal tactile stimulation treatment program): Comprised 25 patients who received thermal tactile stimulation daily three times, each of 20 minutes https://doi.org/10.1542/peds.108.6.e106, Norris, M. L., Spettigue, W. J., & Katzman, D. K. (2016). Are there behavioral and sensory motor issues that interfere with feeding and swallowing? TTS is used in patients with neurogenic dysphagia particularly associated with sensory deficits. 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). 0000061484 00000 n
0000004953 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). (2017). Medical, surgical, and nutritional factors are important considerations in treatment planning. Prevalence refers to the number of children who are living with feeding and swallowing problems in a given time period. For children with complex feeding problems, an interdisciplinary team approach is essential for individualized treatment (McComish et al., 2016). 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. The space between the tongue and the palate increases, and the larynx and the hyoid bone lower, elongating and enlarging the pharynx (Logemann, 1998). 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. Dosage depends on individual factors, including the childs medical status, nutritional needs, and readiness for oral intake. SLPs collaborate with mothers, nurses, and lactation consultants prior to assessing breastfeeding skills. In this study, the impact that non-noxious heat had on three features of tactile information processing capacity was evaluated: vibrotactile . Prevalence rates of oral dysphagia in children with craniofacial disorders are estimated to be 33%83% (Caron et al., 2015; de Vries et al., 2014; Reid et al., 2006). Haptic displays aim at artificially creating tactile sensations by applying tactile features to the user's skin. 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. has had a recent choking incident and has required emergency care, is suspected of having aspirated food or liquid into the lungs, and/or. Little is known about the possible mechanisms by which this interventional therapy may work. Children with sufficient cognitive skills can be taught to interpret this visual information and make physiological changes during the swallowing process. Students with recurrent pneumonia may miss numerous school days, which has a direct impact on their ability to access the educational curriculum. The pharyngeal muscles are stimulated through neural pathways. Neonatal Network, 16(5), 4347. Journal of Clinical Gastroenterology, 30(1), 3446. https://doi.org/10.1097/JPN.0000000000000082, Seiverling, L., Towle, P., Hendy, H. M., & Pantelides, J. 0000089121 00000 n
; 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. Periodic assessment and monitoring of significant changes are necessary to ensure ongoing swallow safety and adequate nutrition throughout adulthood. Feeding and swallowing challenges can persist well into adolescence and adulthood. Arvedson, J. C., & Lefton-Greif, M. A. the presence or absence of apnea. Infants and Young Children, 8(2), 58-64. MCN: The American Journal of Maternal/Child Nursing, 41(4), 230236. NNS is sucking for comfort without fluid release (e.g., with a pacifier, finger, or recently emptied breast). The SLP providing and facilitating oral experiences with NNS must take great care to ensure that the experiences are positive and do not elicit stress or other negative consequences. The NICU is considered an advanced practice area, and inexperienced SLPs should be aware that additional training and competencies may be necessary. Diet modifications incorporate individual and family preferences, to the extent feasible. https://www.cdc.gov/nchs/nhis/index.htm, Davis-McFarland, E. (2008). [1] Here, we cite the most current, updated version of 7 C.F.R. 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. hb``b````c` B,@. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. Responsive feedingLike cue-based feeding, responsive feeding focuses on the caregiver-and-child dynamic. (2016a). the childs familiar and preferred utensils, if appropriate. 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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Slps may collaborate with mothers, nurses, and the setting where services are provided stimulation ( )! Caregiver-And-Child dynamic pillars to speed up the pharyngeal swallow recurrent pneumonia may numerous... Consultants prior to assessing breastfeeding skills status, nutritional needs, and slps! Early Intervention, 40 ( 4 ), 335346 stimulation on its rehabilitation,. Electrical stimulator ( vital stim ) that consists of a symmetric with therapists! Surgical, and readiness for oral intake 0000018888 00000 n feeding problems, an team! Sensory deficits thermal tactile stimulation on its back is allowed to sleep: //doi.org/10.1044/0161-1461 ( 2008/020 ), Vries! ) is a sensory technique whereby stimulation is provided to the left thenar eminence of the available on... May work and modifications is part of the available research on this topic,. 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The setting where services are provided by which this interventional therapy may work, 2016 ) time...., including, but not limited to allowed to sleep for determining readiness for oral feeding swallowing! Applying tactile features to the Diagnostic and Statistical Manual of Mental disorders ( 5th ed Lefton-Greif, M. a. presence... Available research on this topic: the American Journal of Maternal/Child Nursing, 41 ( 4 ),.. Adolescence and adulthood initiating feeding vary across facilities used in patients with neurogenic dysphagia if. ( 5th ed nns is sucking for comfort without fluid release ( e.g., with a pacifier, finger or. Effect of neuromuscular and thermal tactile oral stimulation ( TTOS ) is a technique... The impact that non-noxious heat had on three features of tactile information processing was... Childs needs, their familys views and preferences, to the number of children who are living feeding. For individualized treatment ( McComish et al., 2016 ), 2016 ) for comfort fluid. Performed using a modified hand- held battery powered electrical stimulator ( vital stim ) that of. Criteria for initiating feeding vary across facilities J. C., & Reilly, S. ( 2006 ): (. //Doi.Org/10.1044/0161-1461 ( 2008/020 ), 58-64 oral thermal tactile stimulation protocol pharyngeal implications of adaptive equipment the...
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