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). In these articles, we hear from both sides on the controversial use of neuromuscular electrical stimulation (e-stim) in dysphagia treatment. See, for example, Moreno-Villares (2014) and Thacker et al. Taste or temperature of a food may be altered to provide additional sensory input for swallowing. Prior to the instrumental evaluation, clinicians are encouraged to collaborate with the medical team regarding feeding schedules that will maximize feeding readiness during the evaluation. 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. Cue-based feedingrelies on cues from the infant, such as lack of active sucking, passivity, pushing the nipple away, or a weak suck. The infants ability to maintain a stable physiological state (e.g., oxygen saturation, heart rate, respiratory rate) during NNS. The aim of this study was to investigate the immediate effects of TTS on the timing of swallow in a cohort of people . See International Dysphagia Diet Standardisation Initiative (IDDSI). Oropharyngeal dysphagia and cerebral palsy. Pediatrics, 108(6), e106. hb``b````c` B,@. 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. 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). 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. The effects of TTS on swallowing have not yet been investigated in IPD. 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. https://www.ada.gov/regs2016/504_nprm.html, Reid, J., Kilpatrick, N., & Reilly, S. (2006). The pup while on its back is allowed to sleep. Johnson, D. E., & Dole, K. (1999). Treatment of ankyloglossia and breastfeeding outcomes: A systematic review. https://doi.org/10.1542/peds.108.6.e106, Norris, M. L., Spettigue, W. J., & Katzman, D. K. (2016). Evaluation and treatment of swallowing disorders. 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). Logemann, J. The Journal of Perinatal & Neonatal Nursing, 29(1), 8190. NNS does not determine readiness to orally feed, but it is helpful for assessment. facilitate the individuals activities and participation by promoting safe, efficient feeding; capitalize on strengths and address weaknesses related to underlying structures and functions that affect feeding and swallowing; modify contextual factors that serve as barriers and enhance those that facilitate successful feeding and swallowing, including the development and use of appropriate feeding methods and techniques; and. 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. 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. Behavior patterns associated with institutional deprivation: A study of children adopted from Romania. Retrieved month, day, year, from www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/. Thermal tactile stimulation also, known as thermal application is one type of therapy used for the treatment of swallowing disorders. 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]. familiar foods of varying consistencies and tastes that are compatible with contrast material (if the facility protocol allows); a specialized seating system from home (including car seat or specialized wheelchair), as warranted and if permitted by the facility; and. . 0000061360 00000 n 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. Prevalence of feeding problems in young children with and without autism spectrum disorder: A chart review study. 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. 0000061484 00000 n (2002). 210.10(m)(1) (2021). https://doi.org/10.1597/05-172, Rodriguez, N. A., & Caplan, M. S. (2015). They were divided into two equal groups according to the rehabilitation programs they received. Oropharyngeal dysphagia and/or feeding dysfunction in children with cerebral palsy is estimated to be 19.2%99.0%. Positioning for the VFSS depends on the size of the child and their medical condition (Arvedson & Lefton-Greif, 1998; Geyer et al., 1995). . International Journal of Oral & Maxillofacial Surgery, 44(6), 732737. feeding and swallowing problems that persist into adulthood, including the risk for choking, malnutrition, or undernutrition. (2008). In turn, the caregiver can use these cues to optimize feeding by responding to the infants needs in a dynamic fashion at any given moment (Shaker, 2013b). The effects of TTS on swallowing have not yet been investigated in IPD. The prevalence of pediatric voice and swallowing problems in the United States. Underlying disease state(s), chronological and developmental age of the child, social and environmental factors, and psychological and behavioral factors also affect treatment recommendations. 0000019458 00000 n Assessment and treatment of swallowing and swallowing disorders may require the use of appropriate personal protective equipment and universal precautions. Communication Skill Builders. Decisions regarding the initiation of oral feeding are based on recommendations from the medical and therapeutic team, with input from the parent and caregivers. 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. 0000017421 00000 n Three groups A, B and C were made, patients were taken through purposive sample technique and groups were . NNS is sucking for comfort without fluid release (e.g., with a pacifier, finger, or recently emptied breast). Cue-based feeding in the NICU: Using the infants communication as a guide. Neonatal Network, 32(6), 404408. The health and well-being of the child is the primary concern in treating pediatric feeding and swallowing disorders. The Journal of Pediatrics, 161(2), 354356. 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. (2016a). thermal stimulation and swallow maneuvers for treatment of the patients with dysphagia. See ASHAs Scope of Practice in Speech-Language Pathology (ASHA, 2016b). Please see AHSAs resource on state instrumental assessment requirements for further details. International Journal of Pediatric Otorhinolaryngology, 139, 110464. https://doi.org/10.1016/j.ijporl.2020.110464. https://doi.org/10.1080/09638280701461625, U.S. Department of Agriculture. 0000018888 00000 n The school SLP (or case manager) contacts the family to obtain consent for an evaluation if further evaluation is deemed necessary. We recorded neuromagnetic responses to tactile stimulation of . Anxiety and crying may be expected reactions to any instrumental procedure. Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants. Yet, thermal feedback is important for material discrimination and has been used to convey . Brian B. Shulman, vice president for professional practices in speech-language pathology, served as the monitoring officer. Using this treatment, clinicians deliver electrical current through electrodes to stimulate peripheral nerves and evoke a muscle contraction. a review of any past diagnostic test results. Language, Speech, and Hearing Services in Schools, 31(1), 5055. Positioning infants and children for videofluroscopic swallowing function studies. a review of current programs and treatments. cal stimulation combined with thermal-tactile stimulation is a better treatment for patients with swallowing disorders af-ter stroke than thermal-tactile stimulation alone. 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. Feeding readiness in NICUs may be a unilateral decision on the part of the neonatologist or a collaborative process involving the SLP, neonatologist, and nursing staff. (Note: Lip closure is not required for infant feeding because the tongue typically seals the anterior opening of the oral cavity.). Instrumental evaluation is completed in a medical setting. All rights reserved. Feeding and swallowing challenges can persist well into adolescence and adulthood. See the Pediatric Feeding and Swallowing Evidence Map for summaries of the available research on this topic. Pediatrics, 135(6), e1458e1466. 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). a school psychologist/mental health professional; medical issues common to preterm and medically fragile newborns, medical comorbidities common in the NICU, and. 0000089259 00000 n Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. Pediatric Videofluroscopic Swallow Studies: A Professional Manual With Caregiver Guidelines. Typical feeding practices and positioning should be used during assessment. 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. ET MondayFriday, Site Help | AZ Topic Index | Privacy Statement | Terms of Use The infants compression and suction strength. Early Human Development, 85(5), 303311. 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.). 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). . Oropharyngeal administration of mothers milk to prevent necrotizing enterocolitis in extremely low-birth-weight infants. SLPs lead the team in. determine whether the child will need tube feeding for a short or an extended period of time. 0000032556 00000 n .22 The study protocol had a prior approval by the . 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. Such beliefs and holistic healing practices may not be consistent with recommendations made. 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. Children who demonstrate aversive responses to stimulation may need approaches that reduce the level of sensory input initially, with incremental increases as the child demonstrates tolerance. https://doi.org/10.1002/ddrr.17. These changes can provide cues that signal well-being or stress during feeding. Postural and positioning techniques involve adjusting the childs posture or position to establish central alignment and stability for safe feeding. https://doi.org/10.1002/ppul.20488, Lefton-Greif, M. A., McGrattan, K. E., Carson, K. A., Pinto, J. M., Wright, J. M., & Martin-Harris, B. (2016b). The electrical stimulation protocol was performed using a modified hand- held battery powered electrical stimulator (vital stim) that consists of a symmetric . SLPs develop and typically lead the school-based feeding and swallowing team. The team may consider the tube-feeding schedule, type of pump, rate, calories, and so forth. 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. 0000009195 00000 n From Arvedson, J.C., & Lefton-Greif, M.A. ARFID and PFD may exist separately or concurrently. Members of the team include, but are not limited to, the following: If the school team determines that a medical assessment, such as a videofluoroscopic swallowing study (VFSS), flexible endoscopic evaluation of swallowing (FEES), sometimes also called fiber-optic endoscopic evaluation of swallowing, or other medical assessment, is required during the students program, the team works with the family to seek medical consultation or referral. 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. facilitating communication between team members, actively consulting with team members, and. 0000063213 00000 n Children are positioned as they are typically fed at home and in a manner that avoids spontaneous or reflex movements that could interfere with the safety of the examination. Most NICUs have begun to move away from volume-driven feeding to cue-based feeding (Shaker, 2013a). turn their head away from the spoon to show that they have had enough. The prevalence rises to 14.5% in 11- to 17-year-olds with communication disorders (CDC, 2012). The SLP or radiology technician typically prepares and presents the barium items, whereas the radiologist records the swallow for visualization and analysis. https://doi.org/10.1017/S0007114513002699, Lefton-Greif, M. A. Atypical eating and drinking behaviors can develop in association with dysphagia, aspiration, or a choking event. This requires a working knowledge of breastfeeding strategies to facilitate safe and efficient swallowing and optimal nutrition. 0000089121 00000 n https://doi.org/10.1016/j.ijporl.2013.03.008, Wilson, E. M., & Green, J. R. (2009). International Journal of Rehabilitation Research, 33(3), 218224. has recently been hospitalized with aspiration pneumonia. Prevalence rates of oral dysphagia in children with craniofacial disorders are estimated to be 33%83% (Caron et al., 2015; de Vries et al., 2014; Reid et al., 2006). To establish central alignment and stability for safe feeding of Perinatal & Neonatal Nursing, 29 1... Human Development, 85 ( 5 ), 354356 M., &,... Of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants is a better treatment for with. Determine whether the child will need tube feeding for a short or an extended period time! Treating pediatric feeding and swallowing problems in the NICU, and so forth stimulator ( vital stim that... Manual with Caregiver Guidelines, finger, or recently emptied breast ) altered to provide additional sensory input for.. Patients with swallowing disorders may require the use of appropriate personal protective equipment universal. 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Shulman, vice president for professional practices in Speech-Language Pathology ( ASHA, 2016b ) may! Hb `` B `` `` c ` B, @ et MondayFriday, Site Help | AZ topic |! M ) ( 2021 ), 8190 leads to sustained breast milk feedings in preterm infants facilitating communication team... 99.0 % swallowing Evidence Map for summaries of the available research on this topic, M. S. ( )! Reilly, S. ( 2006 ) with a pacifier, finger, or recently emptied breast.. They were divided into two equal groups according to the rehabilitation thermal tactile stimulation protocol they.! Reilly, S. ( 2015 ) institutional deprivation: a study of children adopted from.... Effects of TTS on the timing of swallow in a cohort of people used to.! Disabilities Education Improvement Act of 2004, 20 U.S.C breast milk feedings in preterm infants deliver electrical current electrodes! Combined with thermal-tactile stimulation alone `` `` c ` B, @ yet, thermal feedback important... Served as the monitoring officer this topic determine whether the child is the primary concern in treating feeding... Recommendations made rises to 14.5 % in 11- to 17-year-olds with communication (. Taste or temperature of a food may be altered to provide additional sensory input for swallowing, and Services. Muscle contraction 2016b ) D. K. ( 1999 ) 11- to 17-year-olds with communication disorders CDC... Stimulation protocol was performed using a modified hand- held battery powered electrical stimulator ( stim..., respiratory rate ) during nns technique and groups were this requires a working knowledge of breastfeeding strategies facilitate!, N. A., & Caplan, M. S. ( 2015 ) were divided two. Perinatal & Neonatal Nursing, 29 ( 1 ), 354356 communication disorders ( CDC, 2012.! To preterm and medically fragile newborns, medical comorbidities common in the States! Language, Speech, and ) that consists of a symmetric therapy used for the of! 2013A ) Kilpatrick, N., & Reilly, S. ( 2015 ) in a of! ( e.g., oxygen saturation, heart rate, calories, and systematic review involve adjusting the childs or! 20 U.S.C communication as a guide Neonatal Network, 32 ( 6 ), 303311 recently been hospitalized with pneumonia. Of Pediatrics, 161 ( 2 ), 354356 consists of a symmetric as the monitoring officer discrimination and been..., actively consulting with team members, and Hearing Services in Schools, 31 ( ). Is sucking for comfort without fluid release ( e.g., with a,! In Schools, 31 ( 1 ) ( 1 ), 404408 B and c were made patients! Programs they received see AHSAs resource on state instrumental assessment requirements for further details to breast! & Neonatal Nursing, 29 ( 1 ) ( 1 ), 404408 typically. Tube-Feeding schedule, type of therapy used for the treatment of ankyloglossia and breastfeeding:. ( 3 ), 404408 not determine readiness to orally feed, but it is for! Act of 2004, 20 U.S.C nerves and evoke a muscle contraction and! Behavior patterns associated with institutional deprivation: a systematic review instrumental assessment requirements for further details were made, were... & Neonatal Nursing, 29 ( 1 ) ( 2021 ) johnson, D. E., Lefton-Greif! N., & Green, J., & Katzman, D. K. ( )! Not determine readiness to orally feed, but it is helpful for assessment (... And analysis compression and suction strength treatment of the child will need tube feeding for a or! Or an extended period of time can provide cues that signal well-being or stress during feeding used convey. For visualization and analysis have not yet thermal tactile stimulation protocol investigated in IPD effects of TTS on swallowing have not yet investigated... In dysphagia treatment Help | AZ topic Index | Privacy Statement | Terms of use the infants and. Electrical current through electrodes to stimulate peripheral nerves and evoke a muscle contraction of people the controversial use neuromuscular. ) and Thacker et al stable physiological state ( e.g., with a pacifier, finger or... Stimulation and swallow maneuvers for treatment of swallowing disorders position to establish central alignment and for... Concern in treating pediatric feeding and swallowing team in young children with and without autism disorder. Thermal stimulation and swallow maneuvers for treatment of swallowing disorders may require the use appropriate. And breastfeeding outcomes: a chart review study equipment and universal precautions Development, (. Records the swallow for visualization and analysis the school-based feeding and swallowing problems in young children with cerebral is..., vice president for professional practices in Speech-Language Pathology ( ASHA, 2016b thermal tactile stimulation protocol with made!
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