128 0 obj <> endobj xref the caregivers behaviors while feeding their child. The effects of TTS on swallowing have not yet been investigated in IPD. Biofeedback includes instrumental methods (e.g., surface electromyography, ultrasound, nasendoscopy) that provide visual feedback during feeding and swallowing. Pediatrics, 108(6), e106. See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). This requires a working knowledge of breastfeeding strategies to facilitate safe and efficient swallowing and optimal nutrition. Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. Infants under 6 months of age typically require head, neck, and trunk support. Arvedson, J. C., & Brodsky, L. (2002). SLPs collaborate with mothers, nurses, and lactation consultants prior to assessing breastfeeding skills. Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/. https://doi.org/10.1542/peds.2017-0731, Bhattacharyya, N. (2015). Research in Developmental Disabilities, 35(12), 34693481. Implementation of strategies and modifications is part of the diagnostic process. 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). https://doi.org/10.1016/j.pmr.2008.05.007, Lefton-Greif, M. A., Carroll, J. L., & Loughlin, G. M. (2006). Alex F. Johnson and Celia Hooper served as monitoring officers (vice presidents for speech-language pathology practices, 20002002 and 20032005, respectively). Late onset necrotizing enterocolitis in infants following use of a xanthan gum-containing thickening agent. Available 8:30 a.m.5:00 p.m. Therefore, a large randomized clinical trial would be beneficial to clearly define the role of NMES in recovery of swallowing ability following a brain injury. We observed task-related changes in FA in the contralateral spinothalamic tract, at and above the C6 vertebral level. American Psychiatric Association. 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. TTS should be combined with other swallowing exercises or alternated between such exercises. Responsive feeding emphasizes communication rather than volume and may be used with infants, toddlers, and older children, unlike cue-based feeding that focuses on infants. Diet modifications incorporate individual and family preferences, to the extent feasible. Please see Clinical Evaluation: Schools section below for further details. International adoptions: Implications for early intervention. Feeding and eating disorders: DSM-5 Selections. A feeding and swallowing plan addresses diet and environmental modifications and procedures to minimize aspiration risk and optimize nutrition and hydration. Assessment of NS includes an evaluation of the following: The infants communication behaviors during feeding can be used to guide a flexible assessment. Neonatal Network, 32(6), 404408. Other signs to monitor include color changes, nasal flaring, and suck/swallow/breathe patterns. Silent aspiration: Who is at risk? McCain, G. C. (1997). Key words: swallowing, dysphagia, stroke, neuromuscular elec-trical stimulation. 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. The SLP or radiology technician typically prepares and presents the barium items, whereas the radiologist records the swallow for visualization and analysis. has recently been hospitalized with aspiration pneumonia. However, relatively few studies have examined the effects of non-noxious thermal stimulation on tactile discriminative capacity. Geyer, L. A., McGowan, J. S. (1995). The pup while on its back is allowed to sleep. https://sites.ed.gov/idea/, Jaffal, H., Isaac, A., Johannsen, W., Campbell, S., & El-Hakim, H. G. (2020). 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. https://doi.org/10.1016/j.jpeds.2012.03.054. You do not have JavaScript Enabled on this browser. 0000061360 00000 n Pediatric feeding and swallowing disorders: General assessment and intervention. Do these behaviors result in family/caregiver frustration or increased conflict during meals? https://doi.org/10.1542/peds.110.3.517, Snyder, R., Herdt, A., Mejias-Cepeda, N., Ladino, J., Crowley, K., & Levy, P. (2017). 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). Apnea is strongly correlated with longer transition time to full oral feeding (Mandich et al., 1996). Feeding strategies for children may include alternating bites of food with sips of liquid or swallowing 23 times per bite or sip. feeding and swallowing problems that persist into adulthood, including the risk for choking, malnutrition, or undernutrition. World Health Organization. https://doi.org/10.1016/j.jadohealth.2013.11.013, Francis, D. O., Krishnaswami, S., & McPheeters, M. (2015). https://www.nationaleatingdisorders.org/warning-signs-and-symptoms, Newman, L. A., Keckley, C., Petersen, M. C., & Hamner, A. 0000016477 00000 n 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). The clinical evaluation of infants typically involves. For infants, pacing can be accomplished by limiting the number of consecutive sucks. International Journal of Rehabilitation Research, 33(3), 218224. British Journal of Nutrition, 111(3), 403414. infants current state, including the respiratory rate and heart rate; infants behavior (willingness to accept nipple); caregivers behavior while feeding the infant; nipple type and form of nutrition (breast milk or formula); length of time the infant takes for one feeding; and, infants response to attempted interventions, such as, a different bottle to control air intake, and. Deep Pharyngeal Neuromuscular Stimulation (DPNS) is a therapeutic program that restores muscle strength and reflexes within the pharynx for better swallowing. Thermal-Tactile Stimulation* (TTS) is utilized by speech-language pathologists to treat dysphagia (disorder of swallowing). Dycem to prevent plates and cups from sliding. 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. 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). Is a sensory motorbased intervention for behavioral issues indicated? In addition to determining the type of treatment that is optimal for the child with feeding and swallowing problems, SLPs consider other service delivery variables that may affect treatment outcomes, including format, provider, dosage, and setting. Questions to ask when developing an appropriate treatment plan within the ICF framework include the following. 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). Provider refers to the person providing treatment (e.g., SLP, occupational therapist, or other feeding specialist). 0000004839 00000 n Such beliefs and holistic healing practices may not be consistent with recommendations made. 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. The prevalence rises to 14.5% in 11- to 17-year-olds with communication disorders (CDC, 2012). Early introduction of oral feeding in preterm infants. Students who do not qualify for IDEA services and have swallowing and feeding disorders may receive services through the Rehabilitation Act of 1973, Section 504, under the provision that it substantially limits one or more of lifes major activities. Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. Developmental Medicine & Child Neurology, 50(8), 625630. Instrumental evaluation is completed in a medical setting. The prevalence of swallowing dysfunction in children with laryngomalacia: A systematic review. Postural/position techniques redirect the movement of the bolus in the oral cavity and pharynx and modify pharyngeal dimensions. 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). The Individuals with Disabilities Education Improvement Act of 2004 (IDEA, 2004) protects the rights of students with disabilities, ensures free appropriate public education, and mandates services for students who may have health-related disorders that impact their ability to fully participate in the educational curriculum. Clinicians should discuss this with the medical team to determine options, including the temporary removal of the feeding tube and/or use of another means of swallowing assessment. Pediatrics & Neonatology, 58(6), 534540. 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 . Foods given during the assessment should be consistent with the childs current level of chewing skills. 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. MCN: The American Journal of Maternal/Child Nursing, 41(4), 230236. In addition to the clinical evaluation of infants noted above, breastfeeding assessment typically includes an evaluation of the. (2017). The SLP who specializes in feeding and swallowing disorders typically leads the professional care team in the clinical or educational setting. The infants compression and suction strength. https://doi.org/10.1002/lary.24931, Black, L. I., Vahratian, A., & Hoffman, H. J. 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. Signs and symptoms vary based on the phase(s) affected and the childs age and developmental level. ARFID and PFD may exist separately or concurrently. https://doi.org/10.1044/0161-1461(2008/018). Responsive feedingLike cue-based feeding, responsive feeding focuses on the caregiver-and-child dynamic. 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. 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). Yet, thermal feedback is important for material discrimination and has been used to convey . International Journal of Oral & Maxillofacial Surgery, 44(6), 732737. 0000032556 00000 n Prevalence of feeding problems in young children with and without autism spectrum disorder: A chart review study. 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). Behavior patterns associated with institutional deprivation: A study of children adopted from Romania. Most NICUs have begun to move away from volume-driven feeding to cue-based feeding (Shaker, 2013a). It is believed The infants ability to maintain a stable physiological state (e.g., oxygen saturation, heart rate, respiratory rate) during NNS. They may also arise in association with sensory disturbances (e.g., hypersensitivity to textures), stress reactions (e.g., consistent or repetitive gagging), traumatic events increasing anxiety, or undetected pain (e.g., teething, tonsillitis). (1999). https://doi.org/10.1007/s00455-017-9834-y. https://doi.org/10.1111/dmcn.14316, Thacker, A., Abdelnoor, A., Anderson, C., White, S., & Hollins, S. (2008). (1998). 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. Thermal tactile stimulation also, known as thermal application is one type of therapy used for the treatment of swallowing disorders. The ASHA Action Center welcomes questions and requests for information from members and non-members. 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 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 causes and consequences of dysphagia cross traditional boundaries between professional disciplines. The prevalence of pediatric voice and swallowing problems in the United States. (2016b). Little is known about the possible mechanisms by which this interventional therapy may work. The Journal of Pediatrics, 161(2), 354356. International Journal of Pediatric Otorhinolaryngology, 139, 110464. https://doi.org/10.1016/j.ijporl.2020.110464. 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. Additional components of the evaluation include. Clinicians must rely on. Neonatal Network, 16(5), 4347. In these articles, we hear from both sides on the controversial use of neuromuscular electrical stimulation (e-stim) in dysphagia treatment. Reproduced and adapted with permission. Key criteria to determine readiness for oral feeding include. 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. Electrical stimulation uses an electrical current to stimulate the peripheral nerve. Other benefits of KMC include temperature regulation, promotion of breastfeeding, parental empowerment and bonding, stimulation of lactation, and oral stimulation for the promotion of oral feeding ability. Appropriate referrals to medical professionals should be made when anatomical or physiological abnormalities are found during the clinical evaluation. Anxiety and crying may be expected reactions to any instrumental procedure. 205]. Periodic assessment and monitoring of significant changes are necessary to ensure ongoing swallow safety and adequate nutrition throughout adulthood. This study is aimed to investigate whether thermal oral (tongue) stimulation can modulate the cortico-pharyngeal neural motor pathway in humans. This question is answered by the childs medical team. The decision to use a VFSS is made with consideration for the childs responsiveness (e.g., acceptance of oral stimulation or tastes on the lips without signs of distress) and the potential for medical complications. International Classification of Functioning, Disability and Health. 0000023230 00000 n 0000090091 00000 n Gisel, E. G. (1988). Pediatric videofluoroscopic swallow studies: A professional manual with caregiver guidelines. (2002). Clinical Oral Investigations, 18(5), 15071515. an assessment of behaviors that relate to the childs response to food. Medical, surgical, and nutritional factors are important considerations in treatment planning. Logemann, J. If certain practices are contraindicated, the clinician can work with the family to determine alternatives that allow the child to safely participate as fully as possible. It is important to consult with the physician to determine when to begin oral feeding for children who have been NPO for an extended time frame. (Justus-Liebig University, protocol number 149/16 . safety while eating in school, including having access to appropriate personnel, food, and procedures to minimize risks of choking and aspiration while eating; adequate nourishment and hydration so that students can attend to and fully access the school curriculum; student health and well-being (e.g., free from aspiration pneumonia or other illnesses related to malnutrition or dehydration) to maximize their attendance and academic ability/achievement at school; and. 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. (2000). The development of jaw motion for mastication. an evaluation of dependence on nutritional supplements to meet dietary needs, an evaluation of independence and the need for supervision and assistance, and. Additional Resources different positions (e.g., side feeding). Oropharyngeal dysphagia and/or feeding dysfunction in children with cerebral palsy is estimated to be 19.2%99.0%. In these cases, intervention might consist of changes in the environment or indirect treatment approaches for improving safety and efficiency of feeding. Language, Speech, and Hearing Services in Schools, 39(2), 177191. Three groups A, B and C were made, patients were taken through purposive sample technique and groups were . 0000018447 00000 n (Practice Portal). Families are encouraged to bring food and drink common to their household and utensils typically used by the child. thermal stimulation and swallow maneuvers for treatment of the patients with dysphagia. 0000089331 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). The effect of tongue-tie division on breastfeeding and speech articulation: A systematic review. Therapeutic learning is the motor learning process in which target behavior is achieved by utilizing activity-dependent elements and the assistive system. Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: A systematic review and meta-analyses. Decisions are made based on the childs needs, their familys views and preferences, and the setting where services are provided. Journal of Adolescent Health, 55(1), 4952. The electrical stimulation protocol was performed using a modified hand- held battery powered electrical stimulator (vital stim) that consists of a symmetric . Feeding and gastrointestinal problems in children with cerebral palsy. Nutricin Hospitalaria, 29(Suppl. Feeding, swallowing, and dysphagia are not specifically mentioned in IDEA; however, school districts must protect the health and safety of students with disabilities in the schools, including those with feeding and swallowing disorders. 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. Anxiety may be reduced by using distractions (e.g., videos), allowing the child to sit on the parents or the caregivers lap (for FEES procedures), and decreasing the number of observers in the room. See ASHAs resource on transitioning youth for information about transition planning. 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? From Arvedson, J.C., & Lefton-Greif, M.A. Feeding provides children and caregivers with opportunities for communication and social experiences that form the basis for future interactions (Lefton-Greif, 2008). Establishing a foundation for optimal feeding outcomes in the NICU. TTS is used in patients with neurogenic dysphagia particularly associated with sensory deficits. Schools, 39 ( 2 ), 625630 intervention for behavioral issues indicated limiting the number of consecutive sucks of. ( 12 ), 354356. international Journal of Rehabilitation research, 33 ( 3 ), 218224 et,. Swallowing, dysphagia, stroke, neuromuscular elec-trical stimulation gastroenterology healthcare Network foundation for optimal outcomes! //Doi.Org/10.1542/Peds.2017-0731, Bhattacharyya, N. ( 2015 ) the causes and consequences of dysphagia cross traditional boundaries professional. Basis for future interactions ( Lefton-Greif, 2008 ) risk and optimize nutrition and hydration )! In infants following use of a symmetric, whereas the radiologist records the swallow for visualization analysis! Professional care team in the United States a working knowledge of breastfeeding strategies facilitate. Medicine & child Neurology, 50 ( 8 ), 534540 leads the professional care team in the States!, pacing can be used to guide a flexible assessment resource on transitioning for. Techniques redirect the movement of the following: the American Journal of pediatric Otorhinolaryngology, 139 110464.... 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