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Pediatric Feeding and Swallowing Therapy

Pediatric Dysphagia Evaluation and Treatment
by

Hannah Hawke

on 1 June 2015

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Transcript of Pediatric Feeding and Swallowing Therapy

Pediatric Feeding and Swallowing Therapy
Hannah Hawke, M.A., CCC-SLP, BCS-S
Anne Stuck, MOT, OTR/L

Common Diagnoses
Sensory Processing Disorders
Structural abnormalities (e.g. cleft lip/palate)
Genetic syndromes/birth defects
GI disorders
Prematurity
Failure to thrive
Picky eaters
Low muscle tone
Abuse/neglect
Respiratory compromise/tracheostomy
Neurological injury (TBI, CP)
Apraxia

Long-Term Goal:
Age-appropriate feeding and swallowing abilities with functional volume and variety of oral intake to support nutritional needs.
Thank you!
Questions?
The Regional Center for Feeding, Swallowing, and Voice
Difficulty swallowing can happen at any age. We offer expert care in the treatment of feeding and swallowing disorders.

The Regional Center for Feeding, Swallowing, and Voice offers state of the art, interdisciplinary assessment and management of pediatric and adult feeding, swallowing, and voice disorders with expertise and scope that is unmatched in a seven county area.

The Developmental Food Continuum
Feeding and swallowing problems (dysphagia) are extremely complex and surprisingly common in both children and adults.

The dysphagia treatment that we provide is designed very specifically to a patient’s anatomical, physiological, and even psychological needs as determined through the evaluation process.
Evaluation
Speech Pathology
Therapeutic Intervention
Active exercise plans
Swallowing strategies
Introduction of new foods
Normalization of the sensory system
Developing self-feeding skills
Adaptive equipment
Family-centered feeding plans
Work toward nutrition by mouth if the child has a feeding tube
Adaptive Equipment
The Psychological Piece
Example Goals for ST
Example Goals for OT
At Mary Rutan Hospital Physical Rehabilitation Center
Positioning/posture/core support
Highchair
Keekaroo chair/booster
Pediatric chair with foot rest
Plates/bowls
Baby dipper bowl
Bottles
Haberman Feeder/Medela Special Needs Feeder
Podee Baby Feeding System
Controlled flow nipples
Cups
InfaTrainer
Reflo cup
Spoons/Forks
Weighted
Gripper
Textured
Bent
Z-vibe spoon attachment
Patient will demonstrate improved visual sensory modulation with ability to tolerate 3 non-preferred foods being on his plate with no aversive behaviors in 3 consecutive trials.

Patient will demonstrate improved modulation of the oral sensory system by inserting utensils in to mouth with Mod I.

Patient will demonstrate improved modulation of oral sensory system with no more than 3 aversive behaviors noted during a 45 minute treatment session (i.e.: food/utensil throwing).

Patient will demonstrate improved modulation of tactile sensory system by successfully touching 5 bites of a non-preferred solid food with SBA.

Patient's parents will be Mod I with sensory diet to improve age appropriate feeding skills.

Patient will improve oral motor abilities for functional management of soft, hard, and thin boluses, with limited oral residue, in 8 of 10 trials, with minimal cues from clinician.

Patient will improve secretion management by completing a dry swallow every 45-60 seconds in structured tasks with minimal-moderate cues from clinician.

Patient will tolerate and display safe/efficient management of thin liquids via controlled flow cup (Reflo) and via spoon with no signs/symptoms of aspiration in 9 of 10 trials.

Patient will display functional bite size/bolus size and functional inhibition during structured tasks in 8 of 10 trials, with minimal cues from clinician.

Patient will tolerate and display safe/efficient management/mastication of soft solid and regular solid consistencies, with no adverse effects, in 8/10 trials given minimal cues.
Sensory Readiness
Eating begins with sensory processing (the first 20-25 steps of eating occur before the food comes to the mouth)
Eating is a multi-sensory task the requires an adaptive response in multiple environments
Habituation is needed for the child to modulate arousal in order for child to deal with stimuli
Modulation disorders result in reactions caused by the CNS inaccurately organizing and regulating sensory messages
Dysfunctional Modulation Patterns
 Over Responsive
Actively avoids non-preferred input (NO!)
fearful and cautious or negative and defiant
 Under Responsive
Fewer or flattened overt responses to stimuli that is slower
Withdraw and difficult to arouse of may not register the information
Sensory changes with spoon feedings and table foods are totally different and all 8 senses have to be re-integrated with every chew (often results in decreased intake)

Occupational Therapy
Fear and Anxiety
Children are unable to assess situations logically, and therefore adults are unable to rationalize with them.
Children process and encode events differently than adults, as their language skills are not yet fully developed. Fear and anxiety can easily be associated with any of the five senses.
Behavioral approaches are often successful in attempts to desensitize fear and anxiety. We strive to develop trust with the child, treat in a controlled environment, maintain predictable routines, present clear expectations, provide verbal/visual/tactile cues, use positive reinforcement, and use the chaining technique to build on skills.
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