(Justus-Liebig University, protocol number 149/16 . Cue-based feedingrelies on cues from the infant, such as lack of active sucking, passivity, pushing the nipple away, or a weak suck. See International Dysphagia Diet Standardisation Initiative (IDDSI). Although thermal tactile oral stimulation is a common method to treat dysphagic patients to improve swallowing movement, little is known about the possible mechanisms. These techniques may be used prior to or during the swallow. SLPs treating preterm and medically fragile infants must be well versed in typical infant behavior and development so that they can recognize and interpret changes in behavior. 0000019458 00000 n Communication disorders and use of intervention services among children aged 317 years: United States, 2012 [NCHS Data Brief No. The SLP who specializes in feeding and swallowing disorders typically leads the professional care team in the clinical or educational setting. Please see Clinical Evaluation: Schools section below for further details. Although thermal perception is a haptic modality, it has received scant attention possibly because humans process thermal properties of objects slower than other tactile properties. Scope of practice in speech-language pathology [Scope of practice]. https://doi.org/10.1044/sasd15.3.10, Calis, E. A. C., Veuglers, R., Sheppard, J. J., Tibboel, D., Evenhuis, H. M., & Penning, C. (2008). https://doi.org/10.1016/j.ijporl.2013.03.008, Wilson, E. M., & Green, J. R. (2009). Behavioral state activity during nipple feedings for preterm infants. SLPs should be sensitive to family values, beliefs, and access regarding bottle-feeding and breastfeeding and should consult with parents and collaborate with nurses, lactation consultants, and other medical professionals to help identify parent preferences. See Person-Centered Focus on Function: Pediatric Feeding and Swallowing [PDF] for examples of assessment data consistent with the International Classification of Functioning, Disability and Health framework. Those section letters and numbers from 2011 are 210.10(g)(1) and can be found at https://www.govinfo.gov/content/pkg/CFR-2011-title7-vol4/pdf/CFR-2011-title7-vol4-sec210-10.pdf. 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. 0000089658 00000 n SLPs may collaborate with occupational therapists, considering that motor control for the use of this adaptive equipment is critical. In these articles, we hear from both sides on the controversial use of neuromuscular electrical stimulation (e-stim) in dysphagia treatment. 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. Families are encouraged to bring food and drink common to their household and utensils typically used by the child. The Cleft PalateCraniofacial Journal, 43(6), 702709. Pacingmoderating the rate of intake by controlling or titrating the rate of presentation of food or liquid and the time between bites or swallows. 1400 et seq. American Journal of Occupational Therapy, 42(1), 4046. 210.10 (from 2021), in which the section letters and numbers are 210.10(m)(1). The original version was codified in 2011and has had many updates since. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. 0000018100 00000 n Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Feeding protocols include those that consider infant cues (i.e., responsive feeding) and those that are based on a schedule (i.e., scheduled feeding). Determining the appropriate procedure to use depends on what needs to be visualized and which procedure will be best tolerated by the child. 2), 3237. (2009). Tube feeding includes alternative avenues of intake such as via a nasogastric tube, a transpyloric tube (placed in the duodenum or jejunum), or a gastrostomy tube (a gastronomy tube placed in the stomach or a gastronomyjejunostomy tube placed in the jejunum). . https://doi.org/10.1891/0730-0832.32.6.404, Shaker, C. S. (2013b, February 1). Pediatric videofluoroscopic swallow studies: A professional manual with caregiver guidelines. Estimated reports of the incidence and prevalence of pediatric feeding and swallowing disorders vary widely due to factors including variations in the conditions and populations sampled; how pediatric feeding disorders, avoidant/restrictive food intake disorder (ARFID; please see above for further details), and/or swallowing impairment are defined; and the choice of assessment methods and measures (Arvedson, 2008; Lefton-Greif, 2008). (2017). The prevalence rises to 14.5% in 11- to 17-year-olds with communication disorders (CDC, 2012). Instrumental evaluation is completed in a medical setting. International Journal of Pediatric Otorhinolaryngology, 77(5), 635646. 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). If the child cannot meet nutritional needs by mouth, what recommendations need to be made concerning supplemental non-oral intake and/or the inclusion of orally fed supplements in the childs diet? breathing difficulties when feeding, which might be signaled by. has recently been hospitalized with aspiration pneumonia. The clinician requests that the family provide. (Figure 4) Thermal stimulationuse a damp towel that has been cooled in a refrigerator for at least five minutes. Typical feeding practices and positioning should be used during assessment. The SLP or radiology technician typically prepares and presents the barium items, whereas the radiologist records the swallow for visualization and analysis. Communication Skill Builders. Congenital abnormalities and/or chronic conditions can affect feeding and swallowing function. 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. Cerebral evoked responses to a 10C cooling pulse were recorded from human scalp at a 29C adapting temperature where primate cold-responding fibers . Do these behaviors result in family/caregiver frustration or increased conflict during meals? middle and ring fingers were exposed to the thermal stimulation. (1998). Additional Resources Deep Pharyngeal Neuromuscular Stimulation (DPNS) is a therapeutic program that restores muscle strength and reflexes within the pharynx for better swallowing. behavioral factors, including, but not limited to. Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/. Members of the dysphagia team may vary across settings. Assessment of NS includes an evaluation of the following: The infants communication behaviors during feeding can be used to guide a flexible assessment. Journal of Adolescent Health, 55(1), 4952. Reproduced and adapted with permission. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. chin downtucking the chin down toward the neck; head rotationturning the head to the weak side to protect the airway; upright positioning90 angle at hips and knees, feet on the floor, with supports as needed; head stabilizationsupported so as to present in a chin-neutral position; reclining positionusing pillow support or a reclined infant seat with trunk and head support; and. 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. See ASHAs resource on transitioning youth for information about transition planning. https://doi.org/10.1017/S0007114513002699, Lefton-Greif, M. A. has a complex medical condition and experiences a significant change in status. Additional medical and rehabilitation specialists may be included, depending on the type of facility, the professional expertise needed, and the specific population being served. (Practice Portal). According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed. 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. 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. Please see the Treatment section of ASHAs Practice Portal page on Adult Dysphagia for further information. J Rehabil Med 2009; 41: 174-178 Correspondence address: Kil-Byung Lim, Department of Reha- 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. For children who have difficulty participating in the procedure, the clinician should allow time to control problem behaviors prior to initiating the instrumental procedure. The effects of TTS on swallowing have not yet been investigated in IPD. National Health Interview Survey. Postural/position techniques redirect the movement of the bolus in the oral cavity and pharynx and modify pharyngeal dimensions. identify any parental or student concerns or stress regarding mealtimes. The health and well-being of the child is the primary concern in treating pediatric feeding and swallowing disorders. TTS should be combined with other swallowing exercises or alternated between such exercises. The scope of this page is feeding and swallowing disorders in infants, preschool children, and school-age children up to 21 years of age. This might involve decisions about whether the individual can safely eat an oral diet that meets nutritional needs, whether that diet needs to be modified in any way, and whether the individual needs compensatory strategies to eat the diet. https://doi.org/10.1007/s10803-013-1771-5, Simpson, C., Schanler, R. J., & Lau, C. (2002). The pharyngeal muscles are stimulated through neural pathways. 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). For an example, see community management of uncomplicated acute malnutrition in infants < 6 months of age (C-MAMI) [PDF]. https://doi.org/10.1542/peds.2015-0658. 0000032556 00000 n Format refers to the structure of the treatment session (e.g., group and/or individual). determine whether the child will need tube feeding for a short or an extended period of time. Similar to treatment for infants in the NICU, treatment for toddlers and older children takes a number of factors into consideration, including the following: Management of students with feeding and swallowing disorders in the schools addresses the impact of the disorder on the students educational performance and promotes the students safe swallow in order to avoid choking and/or aspiration pneumonia. %PDF-1.7 % Neuromuscular electrical and thermal-tactile stimulation for dysphagia . 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. Feeding and swallowing challenges can persist well into adolescence and adulthood. A. C., Breugem, C. C., van der Heul, A. M. B., Eijkemans, M. J. C., Kon, M., & Mink van der Molen, A. The clinical evaluation of infants typically involves. data from monitoring devices (e.g., for patients in the neonatal intensive care unit [NICU]); nonverbal forms of communication (e.g., behavioral cues signaling feeding or swallowing problems); and. 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). Can the child receive adequate nutrition and hydration by mouth alone, given length of time to eat, efficiency, and fatigue factors? Infants under 6 months of age typically require head, neck, and trunk support. 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. TTS may help to increase stimulation and sensation of the oral cavity by providing a sensory stimulus to the brain. Decisions are made based on the childs needs, their familys views and preferences, and the setting where services are provided. . Further investigative research to clarify NMES protocols and patient population is needed to optimize results. Feeding strategies for children may include alternating bites of food with sips of liquid or swallowing 23 times per bite or sip. 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). Administration of small amounts of maternal milk into the oral cavity of enteral tubedependent infants improves breastfeeding rates, growth, and immune-protective factors and reduces sepsis (Pados & Fuller, 2020). 0000089331 00000 n (2002). Treatment of ankyloglossia and breastfeeding outcomes: A systematic review. skill development for eating and drinking efficiently during meals and snack times so that students can complete these activities with their peers safely and in a timely manner. Assessment and treatment of swallowing and swallowing disorders may require the use of appropriate personal protective equipment and universal precautions. 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). This requires a working knowledge of breastfeeding strategies to facilitate safe and efficient swallowing and optimal nutrition. has suspected structural abnormalities (requires an assessment from a medical professional). Dysphagia can occur in one or more of the four phases of swallowing and can result in aspirationthe passage of food, liquid, or saliva into the tracheaand retrograde flow of food into the nasal cavity. This method . 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. Logemann, J. The effects of TTS on swallowing have not yet been investigated in IPD. The SLP frequently serves as coordinator for the team management of dysphagia. 0000055191 00000 n Management of adult neurogenic dysphagia. Swallowing is a complex process during which saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected. 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). Haptic displays aim at artificially creating tactile sensations by applying tactile features to the user's skin. https://www.asha.org/policy/, Arvedson, J. C. (2008). 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. 0000018447 00000 n 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]. Infants cannot verbally describe their symptoms, and children with reduced communication skills may not be able to adequately do so. 0000090444 00000 n National Center for Health Statistics. Incidence refers to the number of new cases identified in a specified time period. Pediatric feeding disorder (PFD) is impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction (Goday et al., 2019). A population of cold-responding fibers with response properties similar to those innervating primate skin were determined to be mediating the thermal evoked response to skin cooling in man. Group I received neuromuscular electric stimulation sessions on the neck one hour daily for 12 weeks. (1999). Prevalence of feeding problems in young children with and without autism spectrum disorder: A chart review study. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. 0000018888 00000 n Other signs to monitor include color changes, nasal flaring, and suck/swallow/breathe patterns. 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. Sensory stimulation may be needed for children with reduced responses, overactive responses, or limited opportunities for sensory experiences. These changes can provide cues that signal well-being or stress during feeding. 0000063894 00000 n 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. Please enable it in order to use the full functionality of our website. 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). 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