6.3 - Outpatient Pediatric Dysphagia Flashcards
Who treats pediatric dysphagia patients in an outpatient setting?
(4)
Speech/Language Pathologists
Occupational Therapist
Nutritionists
Physicians (Pediatricians, GI, Pulmonologist, Neurologist, etc.)
Who refers pediatric patients for outpatient dysphagia treatment?
(2)
Outside physician referrals (pediatricians, pulmonologists, GI, neurologists)
Acute/rehab teams when children are discharged from the acute hospital and inpatient rehab.
What are the 5 main reasons children are referred for outpatient feeding treatment?
Picky eater (i.e. will not eat any fruits/vegetables)
Trouble transitioning from baby foods to table foods
Choking/gagging on foods
Dysphagia (oral or pharyngeal)
Children who are NPO and families either need guidance on oral stimulation or are ready to try oral feeds again
What disorders are seen for pediatric outpatient feeding treatment?
(5)
Sensory based feeding disorders
Oral motor dysfunction including tongue/lip ties
Pharyngeal dysphagia
GI issues
Home programs for oral stimulation
Who completes pediatric outpatient feeding evaluations?
3
OT + SLP simultaneously
Sometimes nutritionist is brought in
Referral information is also considered
What is included in a pediatric outpatient feeding evaluation?
(7)
History of feeding problem
Medications
Medical History/Surgeries (neurological impairments? previous pharyngeal dysphagia?)
Weight/Height
Allergies
Bowel habits
Current feeding restrictions (thickened liquids?)
What questions do we need to ask parents in a pediatric outpatient feeding evaluation?
(10)
What is the child’s current development like?
Do they have trunk and head control for sitting? Do they need external support? (i.e. specially adapted stroller with head rest)
Where does the child eat? Are they walking around or sit? What do they sit in? Do they have good foot support?
What is the child’s feeding schedule like? What kinds of foods will the child typically eat? Do they eat orally or through alternate means?
What liquids are they drinking and how much of each per day?
What utensils/cups are they using?
How long does it take for an entire feeding?
Can they use a pincer grasp to pick up small pieces of food?
How does the child tolerate different sensory inputs, especially during daily routines? (e.g. tooth brushing, bath time, haircuts, spicy foods vs. bland foods, noises around the home, vestibular activities on the playground)
Are they receiving special services at school, early intervention services, special therapies?
What oral motor skills are we looking for in children?
5
Jaw stability
Lip closure
Tongue protrusion/retraction
Tongue lateralization
How many teeth does the child have?
How do we approach food in an pediatric feeding evaluation?
2
We observe the child eat and drink foods/liquids brought from home.
Sometimes we introduce new foods to observe how they react.
What treatments can be concluded from a pediatric feeding evaluation?
(4)
Direct feeding therapy by OT or ST
Modified Barium Swallow Study (MBSS)
Refer back to GI or pediatrician for management of reflux or constipation
Refer to nutritionist if there is not one aelready involved
What environmental changes can we recommend based on a pediatric feeding evaluation?
(4)
Establish a feeding schedule
Seating/positioning adjustments
Change in feeding utensils/cups
Change in textures of foods offered
What foods are appropriate at Birth?
2
Breast
Bottle
What foods are appropriate for 4-6 months?
Thin baby food cereals
What foods are appropriate for 5½-6½ months?
Slightly thicker baby food cereals
What foods are appropriate for 6-7 months?
2
Thin baby food purees
Stage 1 foods
What foods are appropriate for 7-8 months?
3
Thicker baby food cereals
Smooth puree
Stage 2 foods
What foods are appropriate for 8-9 months?
2
Soft mashed table foods
Table food smooth purees
What foods are appropriate for 8-9 months?
Hard munchables
raw carrot sticks, bell pepper strips, bagel strips, frozen pancakes, beef jerky, etc.
What foods are appropriate for 9-9 ½ months?
Meltable hard solids
biter biscuits, ritz crackers, cheese puffs
What foods are appropriate for 11 months?
Soft mechanical single texture
muffins, soft small pastas, thin deli meats
What foods are appropriate for 12 months?
2
Mixed textures
Stage 3 baby foods
(lasagna, soft chicken nuggets, French fries)
What foods are appropriate for 13-14 months?
Soft table foods
boiled potatoes, bananas, peas, soft cooked carrots
What foods are appropriate for 15-18 months?
Hard mechanicals
cheerios, hard cookies, chips, raw fruits and vegetables
What skills are being developed between 18-24 months?
Skills refinement
How do we treat children with Pharyngeal Dysphagia/NPO (non-oral feeders) in outpatient clinics?
(2)
Oral stimulation
Neuromuscular electrical stimulation (NMES)
What are Oral Motor Treatments performed in outpatient pediatric clinics?
(8)
Proper seating with support
Jaw stability
Lip closure
Tongue lateralization
Chewing
Altering how we present foods (e.g. textures/utensils)
Not scraping infant/child’s face with spoon (confusing for some children)
Beckman’s massage
How do we treat Sensory/Behavior Based Feeding Difficulties in pediatric outpatient clinics?
(5)
First address any pain while eating (this must be addressed before any feeding therapy)
Decrease anxiety around foods
Make any interaction with food enjoyable (You cannot trick these children!!)
Wilbarger Deep Pressure and
Proprioceptive Technique as well as encouraging other proprioceptive input
Encourage messy play
How many different steps are there to learning how to eat a new food?
27
What is a common mistake parents may make?
Going from stage 1 and 2 baby foods to stage 3 baby foods due to product packaging.
How might foods be introduced when treating Sensory/Behavioral Feeding Difficulties in pediatric outpatient clinics?
(2)
Pair foods with the same color together
Food chaining (Start with foods that the child will eat and only change one characteristic at a time, string cheese -> square cheese)
What level of interaction with the food are we looking for when treating Sensory/Behavioral Feeding Difficulties in pediatric outpatient clinics?
Engage the child in food play during therapy sessions with the idea that the child is going to move further along with each food.
(For example, if a child will only touch a food with utensils, we will encourage the child to touch the food with just a single finger)
How might we modify food when treating Sensory/Behavioral Feeding Difficulties in pediatric outpatient clinics?
(3)
Use of nuk brushes, vibration, spicy vs. bland foods
Encourage the child to help prepare foods at home and in therapy
Use traditional behavioral strategies such as checklists, special placemats, special utensils
