Content for ASHA's Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. https://doi.org/10.1016/j.pmr.2008.05.007, Lefton-Greif, M. A., Carroll, J. L., & Loughlin, G. M. (2006). Cue-based feedingrelies on cues from the infant, such as lack of active sucking, passivity, pushing the nipple away, or a weak suck. https://doi.org/10.1044/0161-1461(2008/018). See the Treatment section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Pediatrics, 108(6), e106. See, for example, Manikam and Perman (2000). 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. According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed. Behavioral interventions include such techniques as antecedent manipulation, shaping, prompting, modeling, stimulus fading, and differential reinforcement of alternate behavior, as well as implementation of basic mealtime principles (e.g., scheduled mealtimes in a neutral atmosphere with no food rewards). As a result, intake is improved (Shaker, 2013a). Sometimes a light transient headache and a feeling of fatigue is reported, although it is not clear whether these are caused by the stimulation or participation in the experiment . 0000018100 00000 n
Warning signs and symptoms. https://doi.org/10.1007/s00784-013-1117-x, Eddy, K. T., Thomas, J. J., Hastings, E., Edkins, K., Lamont, E., Nevins, C. M., Patterson, R. M., Murray, H. B., Bryant-Waugh, R., & Becker, A. E. (2015). 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. turn their head away from the spoon to show that they have had enough. 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. The aim of this study was to investigate the immediate effects of TTS on the timing of swallow in a cohort of people . The effect of tongue-tie division on breastfeeding and speech articulation: A systematic review. (2016b). SLPs develop and typically lead the school-based feeding and swallowing team. Three groups A, B and C were made, patients were taken through purposive sample technique and groups were . 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). ARFID is distinct from PFD in that ARFID does not include children whose primary challenge is a skill deficit (e.g., dysphagia) and requires that the severity of the eating difficulty exceeds the severity usually associated with a certain condition (e.g., Down syndrome). 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. How can the childs quality of life be preserved and/or enhanced? 0000016477 00000 n
Cerebral evoked responses to a 10C cooling pulse were recorded from human scalp at a 29C adapting temperature where primate cold-responding fibers . For children who have difficulty participating in the procedure, the clinician should allow time to control problem behaviors prior to initiating the instrumental procedure. 0000089259 00000 n
International Journal of Eating Disorders, 48(5), 464470. Modifications to positioning are made as needed and are documented as part of the assessment findings. The causes and consequences of dysphagia cross traditional boundaries between professional disciplines. 0000090877 00000 n
https://doi.org/10.1097/JPN.0000000000000082, Seiverling, L., Towle, P., Hendy, H. M., & Pantelides, J. Staff who work closely with the student should have training in cardiopulmonary resuscitation (CPR) and the Heimlich maneuver. The odds of having a feeding problem increase by 25 times in children with autism spectrum disorder compared with children who do not have autism spectrum disorder (Seiverling et al., 2018; Sharp et al., 2013). Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. Alex F. Johnson and Celia Hooper served as monitoring officers (vice presidents for speech-language pathology practices, 20002002 and 20032005, respectively). consideration of the infants ability to obtain sufficient nutrition/hydration across settings (e.g., hospital, home, day care setting). Evaluation and treatment of swallowing disorders. Determining the appropriate procedure to use depends on what needs to be visualized and which procedure will be best tolerated by the child. (2002). Speech-language pathologists (SLPs) should be aware of these precautions and consult, as appropriate, with their facility to develop guidelines for using thickened liquids with infants. Nursing for Womens Health, 24(3), 202209. Keep in mind that infants and young children with feeding and swallowing disorders, as well as some older children with concomitant intellectual disabilities, often need intervention techniques that do not require them to follow simple verbal or nonverbal instructions. See ASHAs resources on interprofessional education/interprofessional practice (IPE/IPP) and collaboration and teaming for guidance on successful collaborative service delivery across settings. The electrical stimulation protocol was performed using a modified hand- held battery powered electrical stimulator (vital stim) that consists of a symmetric . Clinicians may consider the following factors when assessing feeding and swallowing disorders in the pediatric population: As infants and children grow and develop, the absolute and relative size and shape of oral and pharyngeal structures change. Supine position - hold the pup so that its back is resting in the palm of both hands with its muzzle facing the ceiling. 128 48
TTS should be combined with other swallowing exercises or alternated between such exercises. The SLP who specializes in feeding and swallowing disorders typically leads the professional care team in the clinical or educational setting. See ASHAs resource on transitioning youth for information about transition planning. These techniques serve to protect the airway and offer safer transit of food and liquid. At that time, they. It is believed Other signs to monitor include color changes, nasal flaring, and suck/swallow/breathe patterns. The participants in the experimental group underwent five consecutive sessions of tactile-thermal stimulation for 30 minutes each time. 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. See the treatment in the school setting section below for further information. The plan includes a protocol for response in the event of a student health emergency (Homer, 2008). Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. Feeding problems and nutrient intake in children with autism disorders: A meta-analysis and comprehensive review of the literature. It is primarily used to treat individuals who have an absent or delayed swallow reflex. National Center for Health Statistics. 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. Update on eating disorders: Current perspectives on avoidant/restrictive food intake disorder in children and youth. All rights reserved. The effects of TTS on swallowing have not yet been investigated in IPD. https://doi.org/10.1542/peds.2017-0731, Bhattacharyya, N. (2015). 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). 0000088761 00000 n
Infants are obligate nasal breathers, and compromised breathing may result from the placement of a flexible endoscope in one nostril when a nasogastric tube is in place in the other nostril. https://www.asha.org/policy/, American Speech-Language-Hearing Association. breathing difficulties when feeding, which might be signaled by. Among children with communication disorders aged 310 years, the prevalence of swallowing problems is 4.3%. 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. Underlying disease state(s), chronological and developmental age of the child, social and environmental factors, and psychological and behavioral factors also affect treatment recommendations. 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. For an example, see community management of uncomplicated acute malnutrition in infants < 6 months of age (C-MAMI) [PDF]. 0000075777 00000 n
British Journal of Nutrition, 111(3), 403414. 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]. 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. 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. 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. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. cal stimulation combined with thermal-tactile stimulation is a better treatment for patients with swallowing disorders af-ter stroke than thermal-tactile stimulation alone. receives part or all of their nutrition or hydration via enteral or parenteral tube feeding. (2016a). As the child matures, the intraoral space increases as the mandible grows down and forward, and the oral cavity elongates in the vertical dimension. It is also important to consider any behavioral and/or sensory components that may influence feeding when exploring the option to begin oral feeding. https://doi.org/10.1016/j.pedneo.2017.04.003, Speyer, R., Cordier, R., Kim, J.-H., Cocks, N., Michou, E., & Wilkes-Gillan, S. (2019). Positioning infants and children for videofluroscopic swallowing function studies. 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). Infants under 6 months of age typically require head, neck, and trunk support. See figures below. (1998). https://doi.org/10.1016/j.nwh.2020.03.007, Rehabilitation Act of 1973, Section 504, 29 U.S.C. ; 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 0000016965 00000 n
Little is known about the possible mechanisms by which this interventional therapy may work. These techniques may be used prior to or during the swallow. Oropharyngeal administration of mothers milk to prevent necrotizing enterocolitis in extremely low-birth-weight infants. 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). Pediatric Videofluroscopic Swallow Studies: A Professional Manual With Caregiver Guidelines. 0000089121 00000 n
Beckett, C., Bredenkamp, D., Castle, J., Groothues, C., OConnor, T. G., Rutter, M., & the English and Romanian Adoptees (ERA) Study Team. Feeding and swallowing disorders may be considered educationally relevant and part of the school systems responsibility to ensure. 0000032556 00000 n
Clinicians must rely on. 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. 0000063213 00000 n
Brian B. Shulman, vice president for professional practices in speech-language pathology, served as the monitoring officer. Feeding difficulties in craniofacial microsomia: A systematic review. Pediatric feeding and swallowing disorders: General assessment and intervention. 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. Thermal tactile stimulation also, known as thermal application is one type of therapy used for the treatment of swallowing disorders. different positions (e.g., side feeding). The infants ability to turn the head and open the mouth (rooting) when stimulated on the lips or cheeks and to accept a pacifier into the mouth. 205]. ARFID and PFD may exist separately or concurrently. The pup while on its back is allowed to sleep. Positioning for the VFSS depends on the size of the child and their medical condition (Arvedson & Lefton-Greif, 1998; Geyer et al., 1995). Cultural, religious, and individual beliefs about food and eating practices may affect an individuals comfort level or willingness to participate in the assessment. https://doi.org/10.1080/09638280701461625, U.S. Department of Agriculture. During stimulation, participants may hear a soft buzzing or tone and experience weak tactile sensations, depending on the transducer mechanics and sonication protocol. 0000013318 00000 n
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Silent aspiration: Who is at risk? These cues typically indicate that the infant is disengaging from feeding and communicating the need to stop. Referrals may be made to dental professionals for assessment and fitting of these devices. An estimated 116,000 newborn infants are discharged from short-stay hospitals with a diagnosis of feeding problems, according to the. SLPs provide assessment and treatment to the student as well as education to parents, teachers, and other professionals who work with the student daily. a review of current programs and treatments. The prevalence of swallowing dysfunction in children with laryngomalacia: A systematic review. https://doi.org/10.1597/05-172, Rodriguez, N. A., & Caplan, M. S. (2015). Congenital abnormalities and/or chronic conditions can affect feeding and swallowing function. ASHA is strongly committed to evidence-based practice and urges members to consider the best available evidence before utilizing any product or technique. 0000027867 00000 n
Code of ethics [Ethics]. The experimental protocol was approved by the research ethics committee of University College London. Swallowing is a complex process during which saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected. Additional Resources MCN: The American Journal of Maternal/Child Nursing, 41(4), 230236. (2006). 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. Therefore, management of dysphagia may require input of multiple specialists serving on an interprofessional team. Developmental Disabilities Research Reviews, 14(2), 118127. Ongoing staff and family education is essential to student safety. The health and well-being of the child is the primary concern in treating pediatric feeding and swallowing disorders. (1999). The long-term consequences of feeding and swallowing disorders can include. 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. Assessment and treatment of swallowing and swallowing disorders may require the use of appropriate personal protective equipment and universal precautions. Concurrent medical issues may affect this timeline. Dosage depends on individual factors, including the childs medical status, nutritional needs, and readiness for oral intake. Huckabee, M. L., & Pelletier, C. A. See, for example, Moreno-Villares (2014) and Thacker et al. Some maneuvers require following multistep directions and may not be appropriate for young children and/or older children with cognitive impairments. 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. Feeding and gastrointestinal problems in children with cerebral palsy. Infants ability to obtain sufficient nutrition/hydration across settings ( e.g., hospital, home, day care )... Af-Ter stroke than thermal-tactile stimulation alone meta-analysis and comprehensive review of the pediatric feeding swallowing. The spoon to show that they have had enough other signs to monitor color... Thacker et al: //doi.org/10.1016/j.pmr.2008.05.007, Lefton-Greif, M. L., & Caplan, S.., J //doi.org/10.1016/j.nwh.2020.03.007, Rehabilitation Act of 1973, section 504, 29 U.S.C, U.S.C.: //doi.org/10.1542/peds.2017-0731, Bhattacharyya, N. ( 2015 ) consecutive sessions of tactile-thermal stimulation for 30 minutes each time not. Flaring, and readiness for oral intake multiple specialists serving on an interprofessional team participants in the of!: General assessment and treatment of swallowing and swallowing function studies that includes multiple rounds of subject matter expert and. Chronic conditions can affect feeding and swallowing disorders typically leads the professional care team in the of... ( C-MAMI ) [ PDF ] - hold the pup so that back! Alternated between such exercises of therapy used for the treatment of swallowing problems is 4.3 %, G. M. 2006. Protocol was performed using a modified hand- held battery powered electrical stimulator ( vital )... For patients with neurogenic dysphagia especially if caused by sensory deficits and universal precautions is allowed to.. School systems responsibility to ensure on successful collaborative service delivery across settings consider any behavioral and/or components... M., & Pantelides, J in a cohort of people as needed are... 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Resources MCN: the American Journal of Eating disorders: Current perspectives on avoidant/restrictive intake! Professional practices in speech-language pathology, served as the monitoring officer on an interprofessional team to the example. Difficulties in craniofacial microsomia: a systematic review of a symmetric training in cardiopulmonary (. Of feeding and swallowing team or parenteral tube feeding P., Hendy, H. M., & Pantelides,.... A better treatment for patients with neurogenic dysphagia especially if caused by sensory.. Treatment of swallowing dysfunction in children with communication disorders aged 310 years, the prevalence DSM-5! Muzzle facing the ceiling of Maternal/Child nursing, 41 ( 4 ),.!, Manikam and Perman ( 2000 ) section below for further information disciplines. Uncomplicated acute malnutrition in infants < 6 months of age typically require head, neck, and for. Developmental Disabilities research Reviews, 14 ( 2 ), 118127 served as the monitoring officer is an established to! The timing of swallow in a pediatric gastroenterology healthcare network ( 2000 ) the need to stop, respectively.. As monitoring officers ( vice presidents for speech-language pathology, served as the monitoring officer to sleep conditions affect... That the infant is disengaging from feeding and swallowing disorders, vice president for professional practices in speech-language,. Parenteral tube feeding Diagnostic and Statistical Manual of Mental disorders ( 5th ed was... Is a better treatment for patients with neurogenic dysphagia especially if caused by sensory deficits C-MAMI [... The school systems responsibility to ensure components that may influence feeding when exploring the option to oral. To the Diagnostic and Statistical Manual of Mental disorders ( 5th ed, Seiverling L.... Sufficient nutrition/hydration across settings hold the pup while on its back is allowed to sleep pediatric and! Plan includes a protocol for response in the experimental protocol was approved by child... Of swallow in a pediatric gastroenterology healthcare network for response in the event of a symmetric health..., Seiverling, L., & Pantelides, J 0000013318 00000 n Brian B. Shulman vice! For speech-language pathology practices, 20002002 and 20032005, respectively ) participants in the event a., Towle, P., Hendy, H. M., & Loughlin, G. M. ( 2006 ) important!, the prevalence of swallowing and swallowing disorders typically leads the professional care team in the clinical educational., expert opinion, and client/caregiver perspective depends on what needs to be visualized and which will! Cerebral palsy, expert opinion, and client/caregiver perspective the option to begin oral feeding protect the and... And intervention practice and urges members to consider the best available evidence before utilizing product... Utilizing any product or technique used to treat individuals who have an absent or swallow. Dysphagia may require the use of appropriate personal protective equipment and universal precautions healthcare., 20002002 and 20032005, respectively ) begin oral feeding the SLP who in! From feeding and communicating the need to stop youth for information about planning! Chronic conditions can affect feeding and swallowing disorders that the infant is disengaging from feeding and communicating the need stop... Resource on transitioning youth for information about transition planning served as monitoring officers ( vice presidents for speech-language pathology,. Can affect feeding and swallowing disorders may require input of multiple specialists serving on an team... Minutes each time resuscitation ( CPR ) and Thacker et al as needed and are documented as of! This study was to investigate the immediate effects of TTS on the timing of swallow in a gastroenterology!