Journal of Developmental & Behavioral Pediatrics, 23(5), 297303. Precautions, accommodations, and adaptations must be considered and implemented as students transition to postsecondary settings. The SLP or radiology technician typically prepares and presents the barium items, whereas the radiologist records the swallow for visualization and analysis. How can the childs functional abilities be maximized? Celia Hooper, vice president for professional practices in speech-language pathology (20032005), served as monitoring vice president. See, for example, Moreno-Villares (2014) and Thacker et al. https://doi.org/10.1542/peds.110.3.517, Snyder, R., Herdt, A., Mejias-Cepeda, N., Ladino, J., Crowley, K., & Levy, P. (2017). Positioning limitations and abilities (e.g., children who use a wheelchair) may affect intake and respiration. Electrical stimulation uses an electrical current to stimulate the peripheral nerve. Some eating habits that appear to be a sign or symptom of a feeding disorder (e.g., avoiding certain foods or refusing to eat in front of others) may, in fact, be related to cultural differences in meal habits or may be symptoms of an eating disorder (National Eating Disorders Association, n.d.). 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). Accommodating children with disabilities in the school meal programs: Guidance for school food service professionals. Prevalence of feeding disorders in children with cleft palate only: A retrospective study. behavioral factors, including, but not limited to. 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 . effect of neuromuscular and thermal tactile stimulation on its rehabilitation. Language, Speech, and Hearing Services in Schools, 39(2), 177191. Pediatrics, 135(6), e1458e1466. . TTS is used in patients with neurogenic dysphagia particularly associated with sensory deficits. has suspected structural abnormalities (requires an assessment from a medical professional). The effects of TTS on swallowing have not yet been investigated in IPD. Chewing cycles in 2- to 8-year-old normal children: A developmental profile. The data below reflect this variability. From Arvedson, J.C., & Lefton-Greif, M.A. 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. Any communication by the school team to an outside physician, facility, or individual requires signed parental consent. identifying core team members and support services. 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 evaluation process begins with a referral to a team of professionals within the school district who are trained in the identification and treatment of feeding and swallowing disorders. Pediatric Feeding and Swallowing. Feeding protocols include those that consider infant cues (i.e., responsive feeding) and those that are based on a schedule (i.e., scheduled feeding). Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants. 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). 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://doi.org/10.5014/ajot.42.1.40, Homer, E. (2008). A feeding and swallowing plan may include but not be limited to. 0000089204 00000 n 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. A significant number of studies that evaluated tactile-pain interactions employed heat to evoke nociceptive responses. SLPs work with oral and pharyngeal implications of adaptive equipment. scintigraphy (which, in the pediatric population, may also be referred to as radionuclide milk scanning). The plan includes a protocol for response in the event of a student health emergency (Homer, 2008). According to the Centers for Disease Control and Prevention (CDC), survey interviews indicated that within the past 12 months, 0.9% of children (approximately 569,000) ages 317 years are reported to have swallowing problems (Bhattacharyya, 2015; Black et al., 2015). B. [Transition to adult care for children with chronic neurological disorders: Which is the best way to make it?]. The aim of this study was to investigate the immediate effects of TTS on the timing of swallow in a cohort of people . A. https://doi.org/10.1016/j.earlhumdev.2008.12.003. You do not have JavaScript Enabled on this browser. 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. (2012). DPNS has been shown to have a large effect on swallow function, quickly improving reflexive cough and improving vocal quality. https://www.asha.org/policy/, American Speech-Language-Hearing Association. British Journal of Nutrition, 111(3), 403414. Apnea is strongly correlated with longer transition time to full oral feeding (Mandich et al., 1996). (1998). https://doi.org/10.1097/NMC.0000000000000252, Meal Requirements for Lunches and Requirements for Afterschool Snacks, 7 C.F.R. Setting refers to the location of treatment and varies across the continuum of care (e.g., NICU, intensive care unit, inpatient acute care, outpatient clinic, home, or school). Decisions regarding the initiation of oral feeding are based on recommendations from the medical and therapeutic team, with input from the parent and caregivers. Developmental Medicine & Child Neurology, 50(8), 625630. has a complex medical condition and experiences a significant change in status. As the child matures, the intraoral space increases as the mandible grows down and forward, and the oral cavity elongates in the vertical dimension. American Speech-Language-Hearing Association. 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). 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. Various items are available in the room to facilitate success and replicate a typical mealtime experience, including preferred foods, familiar food containers, utensil options, and seating options. 1 Successful Rehabilitation Strategies Based on Motor Learning in Patients with Swallowing Disorders Motor learning refers to how motor performance is improved and subsequently maintained. https://doi.org/10.1097/JPN.0000000000000082, Seiverling, L., Towle, P., Hendy, H. M., & Pantelides, J. Thermal stimulation of oropharyngeal structures with ice (thermal-tactile stimulation = TTS) is a widely used approach in dysphagia therapy. The VFSS may be appropriate for a child who is currently NPO or has never eaten by mouth to determine whether the child has a functional swallow and which types of food they can manage. The ASHA Leader, 18(2), 4247. World Health Organization. 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). These studies are a team effort and may include the radiologist, radiology technician, and SLP. . See Person-Centered Focus on Function: Pediatric Feeding and Swallowing [PDF] for examples of goals consistent with the ICF framework. 0000075777 00000 n 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. Can the child receive adequate nutrition and hydration by mouth alone, given length of time to eat, efficiency, and fatigue factors? 0000000016 00000 n As indicated in the ASHA Code of Ethics (ASHA, 2016a), SLPs who serve a pediatric population should be educated and appropriately trained to do so. Pediatric feeding disorders. Ongoing staff and family education is essential to student safety. Haptic displays aim at artificially creating tactile sensations by applying tactile features to the user's skin. 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. 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. 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). A. Establishing a foundation for optimal feeding outcomes in the NICU. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d). Language, Speech, and Hearing Services in Schools, 31(1), 5055. The Cleft PalateCraniofacial Journal, 43(6), 702709. . 0000023230 00000 n Biofeedback includes instrumental methods (e.g., surface electromyography, ultrasound, nasendoscopy) that provide visual feedback during feeding and swallowing. The infants oral structures and functions, including palatal integrity, jaw movement, and tongue movements for cupping and compression. Scope of practice in speech-language pathology [Scope of practice]. See ASHAs resources on interprofessional education/interprofessional practice (IPE/IPP), and collaboration and teaming. A feeding and swallowing plan addresses diet and environmental modifications and procedures to minimize aspiration risk and optimize nutrition and hydration. Instrumental evaluation is completed in a medical setting. Yet, thermal feedback is important for material discrimination and has been used to convey . https://doi.org/10.1044/0161-1461(2008/018). turn their head away from the spoon to show that they have had enough. Positioning infants and children for videofluroscopic swallowing function studies. Journal of Adolescent Health, 55(1), 4952. International Classification of Functioning, Disability and Health. The effect of tongue-tie division on breastfeeding and speech articulation: A systematic review. Moreno-Villares, J. M. (2014). the childs familiar and preferred utensils, if appropriate. Journal of Clinical Gastroenterology, 30(1), 3446. an increased respiratory rate (tachypnea); changes in the normal heart rate (bradycardia or tachycardia); skin color change, such as turning blue around the lips, nose, and fingers/toes (cyanosis, mottled); temporary cessation of breathing (apnea); frequent stopping due to an uncoordinated suckswallowbreathe pattern; and, coughing and/or choking during or after swallowing, difficulty chewing foods that are texturally appropriate for age (may spit out, retain, or swallow partially chewed food), difficulty managing secretions (including non-teething-related drooling of saliva), disengagement/refusal shown by facial grimacing, facial flushing, finger splaying, or head turning away from the food source, frequent congestion, particularly after meals, loss of food/liquid from the mouth when eating, noisy or wet vocal quality during and after eating, taking longer to finish meals or snacks (longer than 30 min per meal and less for small snacks), refusing foods of certain textures, brands, colors, or other distinguishing characteristics, taking only small amounts of food, overpacking the mouth, and/or pocketing foods, delayed development of a mature swallowing or chewing pattern, vomiting (more than the typical spit-up for infants), stridor (noisy breathing, high-pitched sound), stertor (noisy breathing, low-pitched sound, like snoring). 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. Singular. Thermal Tactile Stimulation (TTS) Therapidia 8.41K subscribers Subscribe 31K views 5 years ago Speech Therapy (Dysphagia) This and other exercises should only be performed following the. International Journal of Rehabilitation Research, 33(3), 218224. For an example, see community management of uncomplicated acute malnutrition in infants < 6 months of age (C-MAMI) [PDF]. NNS does not determine readiness to orally feed, but it is helpful for assessment. This question is answered by the childs medical team. Medical, surgical, and nutritional factors are important considerations in treatment planning. Alternative feeding does not preclude the need for feeding-related treatment. middle and ring fingers were exposed to the thermal stimulation. Is a sensory motorbased intervention for behavioral issues indicated? 0000017421 00000 n See ASHAs resource on transitioning youth for information about transition planning. 0000032556 00000 n The referral can be initiated by families/caregivers or school personnel. These approaches may be considered by the medical team if the childs swallowing safety and efficiency cannot reach a level of adequate function or does not adequately support nutrition and hydration. Examples of maneuvers include the following: Although sometimes referred to as the Masako maneuver, the Masako (or tongue-hold) is considered an exercise, not a maneuver. Please see the Treatment section of ASHAs Practice Portal page on Adult Dysphagia for further information. To measure pain thresholds, we applied thermal heat stimuli to the center of the posterior region of the left forearm by means of a thermal stimulator (UDH-105, UNIQUE MEDICAL, Tokyo, Japan). It is also important to consider any behavioral and/or sensory components that may influence feeding when exploring the option to begin oral feeding. 0000018447 00000 n Families are encouraged to bring food and drink common to their household and utensils typically used by the child. 0000019458 00000 n (n.d.). American Psychiatric Association. 0000063213 00000 n 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. Indicators of choking risk in adults with learning disabilities: A questionnaire survey and interview study. SLPs conduct assessments in a manner that is sensitive and responsive to the familys cultural background, religious beliefs, dietary beliefs/practices/habits, history of disordered eating behaviors, and preferences for medical intervention. However, there are times when a prescription, referral, or medical clearance from the students primary care physician or other health care provider is indicated, such as when the student. participating in decisions regarding the appropriateness of these procedures; conducting the VFSS and FEES instrumental procedures; interpreting and applying data from instrumental evaluations to, determine the severity and nature of the swallowing disorder and the childs potential for safe oral feeding; and. Dosage refers to the frequency, intensity, and duration of service. Instrumental evaluation is conducted following a clinical evaluation when further information is needed to determine the nature of the swallowing disorder. Diet modifications incorporate individual and family preferences, to the extent feasible. thermal stimulation and swallow maneuvers for treatment of the patients with dysphagia. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 25(9), 771776. The ASHA Action Center welcomes questions and requests for information from members and non-members. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. Determining the appropriate procedure to use depends on what needs to be visualized and which procedure will be best tolerated by the child. Infants under 6 months of age typically require head, neck, and trunk support. Lateral views of infant head, toddler head, and older child head showing structures involved in swallowing. 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And SLP of Adolescent Health, 55 ( 1 ), 218224 of.. Https: //doi.org/10.1097/JPN.0000000000000082, Seiverling, L., Towle, P., Hendy, H. M., Lefton-Greif... Used by the child ( C-MAMI ) [ PDF ] for examples of goals consistent with the framework...