6.2 - Pediatric Dysphagia

Question 1

What is performed in a Bedside Swallow Evaluation of a child?

(5)

Answer 1

Clinical evaluation of the child’s swallowing

Involves SLP only unless tactile/sensory issues

Use the cups/utensils the child was using PTA (bottle, soppy cup, open cup, nosey cup, sport’s bottle)

Use the food/liquid that have been introduced to the child PTA (purged foods, chopped foods, finger foods, table foods, formula, milk, water, juice, thin vs. thickened)

Chart review, imaging, obtain birth/medical history, parent/staff interview

Question 2

What do we need from a child before beginning dysphagia treatment?

What might affect this? (2)

Answer 2

Readiness + alertness

//

Medication

Oxygenation needs

Question 3

How do we perform a dysphagia exam on a child?

3

Answer 3

Oral mechanism examination

Clinical signs and symptoms of oral difficulty:

Clinical signs and symptoms of pharyngeal difficulty

Question 4

What are some clinical signs and symptoms of Oral Difficulty in a Child?

(6)

Answer 4

Inefficient extraction from bottle/sippy cup

Poor labial seal on spoon/cup/straw

Decreased mastication

Anterior spillage

Decreased bolus control

Disorganized tongue/jaw function

Question 5

What are some clinical signs and symptoms of Pharyngeal Difficulty in a Child?

(5)

Answer 5

Immediate or delayed coughing/throat clearing

Gagging or emesis (vomiting)

Physiological changes such as drop in O2 saturations, increase in heart or respiratory rate

Changes in upper airway sounds via cervical auscultation

Wet, gurgly vocal quality

Question 6

What are clinical decisions that an SLP might make for an pediatric dysphagia patient?

(9)

Answer 6

Cleared for a PO (oral) diet without restrictions

Put on a modified diet temporarily

Keep NPO (non-oral)

Begin treatment

Allow time to improve

Change medications

Wean from O2

Proceed with a Video Swallow Study

Need a temporary NGT/NDT or a G-tube

(Exam results may be impacted by presence of NGT/NDT

Question 7

How do we rule out silent aspiration in pediatric patients?

2

Answer 7

Video Swallow Study

FEES

Question 8

What is the difference between Acute vs Chronic Dysphagia?

Answer 8

Acute = Related to intubation, trauma, medication

Chronic = Related to neurogenic cause, pulmonary conditions, feeding difficulty as an infant or oral aversion

Question 9

What do we need to consider when treating pediatric dysphagia?

Answer 9

The “whole child”

Question 10

What is the goal in treating Pediatric Dysphagia?

Answer 10

To facilitate safe, successful and positive feeding/swallowing experiences