Members of the Ad Hoc Committee on Speech-Language Pathology Practice in the Neonatal Intensive Care Unit included Justine J. Sheppard (chair), Joan C. Arvedson, Alexandra Heinsen-Combs, Lemmietta G. McNeilly, Susan M. Moore, Meri S. Rosenzweig Ziev, and Diane R. Paul (ex officio). A clinical evaluation of swallowing and feeding is the first step in determining the presence or absence of a swallowing disorder. 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. appropriate positioning of the student for a safe swallow; specialized equipment indicated for positioning, as needed; environmental modifications to minimize distractions; adapted utensils for mealtimes (e.g., low flow cup, curved spoon/fork); recommended diet consistency, including food and liquid preparation/modification; sensory modifications, including temperature, taste, or texture; food presentation techniques, including wait time and amount; the level of assistance required for eating and drinking; and/or, Maureen A. Lefton-Greif, MA, PhD, CCC-SLP, Panayiota A. Senekkis-Florent, PhD, CCC-SLP. 2), 3237. 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. Neuropsychiatric Disease and Treatment, 12, 213218. 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. screening of willingness to accept liquids and a variety of foods in multiple food groups to determine risk factors for avoidant/restrictive food intake disorder. https://doi.org/10.1016/j.jadohealth.2013.11.013, Francis, D. O., Krishnaswami, S., & McPheeters, M. (2015). Code of ethics [Ethics]. For the child who is able to understand, the clinician explains the procedure, the purpose of the procedure, and the test environment in a developmentally appropriate manner. 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. See, for example, Manikam and Perman (2000). Group I received neuromuscular electric stimulation sessions on the neck one hour daily for 12 weeks. Swallowing is commonly divided into the following four phases (Arvedson & Brodsky, 2002; Logemann, 1998): Feeding disorders are problems with a range of eating activities that may or may not include problems with swallowing. A. Pediatric Pulmonology, 41(11), 10401048. Experience in adult swallowing disorders does not qualify an individual to provide swallowing assessment and intervention for children. Pediatric dysphagia. 0000001256 00000 n FDA expands caution about Simply Thick. National Center for Health Statistics. The school SLP (or case manager) contacts the family to obtain consent for an evaluation if further evaluation is deemed necessary. receives part or all of their nutrition or hydration via enteral or parenteral tube feeding. thermal stimulation and swallow maneuvers for treatment of the patients with dysphagia. Behavior patterns associated with institutional deprivation: A study of children adopted from Romania. https://doi.org/10.1111/j.1552-6909.1996.tb01493.x. https://doi.org/10.1007/s10803-013-1771-5, Simpson, C., Schanler, R. J., & Lau, C. (2002). https://www.asha.org/policy/, American Speech-Language-Hearing Association. 0000013318 00000 n Children with sufficient cognitive skills can be taught to interpret this visual information and make physiological changes during the swallowing process. Ongoing staff and family education is essential to student safety. Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors. https://doi.org/10.1002/eat.22350, Erkin, G., Culha, C., Ozel, S., & Kirbiyik, E. G. (2010). (2015). 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. Responsive feeders attempt to understand and read a childs cues for both hunger and satiety and respect those communication signals in infants, toddlers, and older children. Supportive interventions to facilitate early feeding and/or to promote readiness for feeding include kangaroo mother care (KMC), non-nutritive sucking (NNS), oral administration of maternal milk, feeding protocols, and positioning (e.g., swaddling). inform all members of the process for identifying and treating feeding and swallowing disorders in the schools, including the roles and responsibilities of team members; contribute to the development and implementation of the feeding and swallowing plan as well as documentation on the individualized education program and the individualized health plan; and. Cultural, religious, and individual beliefs about food and eating practices may affect an individuals comfort level or willingness to participate in the assessment. In addition to the clinical evaluation of infants noted above, breastfeeding assessment typically includes an evaluation of the. Early introduction of oral feeding in preterm infants. https://doi.org/10.2147/NDT.S82538, Pados, B. F., & Fuller, K. (2020). The pharyngeal muscles are stimulated through neural pathways. 0000000016 00000 n ARFID and PFD may exist separately or concurrently. (2008). How can the childs quality of life be preserved and/or enhanced? 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. (2015). These changes can provide cues that signal well-being or stress during feeding. https://doi.org/10.1097/MRR.0b013e3283375e10, Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., Callahan, S. T., Malizio, J., Kearney, S., & Walsh, B. T. (2014). Time of stimulation 3-5 seconds. Beal, J., Silverman, B., Bellant, J., Young, T. E., & Klontz, K. (2012). TTS is used in patients with neurogenic dysphagia particularly associated with sensory deficits. B. (2016). The infants ability to use both compression (positive pressure of the jaw and tongue on the pacifier) and suction (negative pressure created with tongue cupping and jaw movement). https://www.nationaleatingdisorders.org/warning-signs-and-symptoms, Newman, L. A., Keckley, C., Petersen, M. C., & Hamner, A. The prevalence of swallowing dysfunction in children with laryngomalacia: A systematic review. Some of these interventions can also incorporate sensory stimulation. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d). In these cases, intervention might consist of changes in the environment or indirect treatment approaches for improving safety and efficiency of feeding. Atypical eating and drinking behaviors can develop in association with dysphagia, aspiration, or a choking event. 0000057570 00000 n From Arvedson, J.C., & Lefton-Greif, M.A. 0000018888 00000 n A non-instrumental assessment of NNS includes an evaluation of the following: The clinician can determine the appropriateness of NS following an NNS assessment. Prevalence of feeding disorders in children with cleft palate only: A retrospective study. It is assumed that the incidence of feeding and swallowing disorders is increasing because of the improved survival rates of children with complex and medically fragile conditions (Lefton-Greif, 2008; Lefton-Greif et al., 2006; Newman et al., 2001) and the improved longevity of persons with dysphagia that develops during childhood (Lefton-Greif et al., 2017). an assessment of oral structures and function during intake; an assessment to determine the developmental level of feeding skills; an assessment of issues related to fatigue and access to nutrition and hydration during school; a determination of duration of mealtime experiences, including the ability to eat within the schools mealtime schedule; an assessment of response to intake, including the ability to manipulate and propel the bolus, coughing, choking, or pocketing foods; an assessment of adaptive equipment for eating and positioning by an OT and a PT; and. Pediatric swallowing and feeding: Assessment and management. International Journal of Pediatric Otorhinolaryngology, 77(5), 635646. 0000089415 00000 n These techniques may be used prior to or during the swallow. The clinical evaluation typically begins with a case history based on a comprehensive review of medical/clinical records and interviews with the family and health care professionals. See figures below. Responsive feedingLike cue-based feeding, responsive feeding focuses on the caregiver-and-child dynamic. https://doi.org/10.1016/j.pmr.2008.05.007, Lefton-Greif, M. A., Carroll, J. L., & Loughlin, G. M. (2006). The appropriateness of the treatment format often depends on the childs age, the type and severity of the feeding or swallowing problem, and the service delivery setting. 0000090877 00000 n -Group II (thermal tactile stimulation treatment program): Comprised 25 patients who received thermal tactile stimulation daily three times, each of 20 minutes 210.10 (from 2021), in which the section letters and numbers are 210.10(m)(1). 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