Paediatric Dysphagia Flashcards
What is the normal feeding development from 0 to 6 months?
Semi-reclining supported seated position
Sucking liquid forward and backward pattern with up and down tongue movement.
What is the normal feeding development from 6 months?
- Upright position
- Pureed solids introduced
- Jaw movement more controlled
- Lateral tongue movements beginning to appear
- Lips begin to take food off spoons, introduction of cup
What is the normal feeding development from 9 to 12 months?
- Independent sitting
- Mashed with soft lumps and appropriate bite and dissolve finger food.
- Tongue begins to transfer food from centre of mouth to sides for chewing
- Upper lip more active in removing food from utensils
- Cup drinking more established
- Plays with food
What is the normal feeding development from 12 to 24 months?
- Skills continue to develop becoming more refined and efficient with establishment of full self feeding
- Able to manage increased variety of firmer foods.
- Can chew with lips closed but may lose food or saliva when chewing
What is the normal feeding development from 24 months?
- Full range of jaw movements used to move and grind firm foods.
- Can maintain lip closure to retain foods.
What is different about an infant and an adult’s head and neck anatomy?
- Oral cavity much smaller
- Jaw smaller
- Tongue is larger
- Newborns have large buccal fat pads
}All assist sucking - Larynx higher in neck, uvula and epiglottis in contact giving increased airway protection against aspiration.
What must a professional have before referral?
Parents consent
What is the process of referral before seeing an SLT?
Referral.
Vetting to determine appropriateness and urgency of referral.
Allocation/non acceptance- depends on locality and SLT’s capacity/
What is the outcome of vetting after referral?
Inpatient= seen within 48 hours. Urgent= seen within 2 weeks Non-urgent= seen within 4 weeks
What may happen if child is not accepted after referral?
May be given pre-referral work (eg. advice given to referrer or parent/ carer
What might happen in an initial visit for paediatric dysphagia?
- Case history
- Information gathering including caregiver/ parental concerns
- Assessment may/may not take place
- Consent from parents to share info with other agencies
- Consent from parents to provide SLT input
What assessment will be undertaken?
Mainly structured observation including:
- position
- oral structures at rest and during movement
- respiration
- control of secretions
- textures of food taken
- utensils used
- protective reflexes (eg. coughing)
- signs of aspiration
- environment
- self feeding
- impact of allergies (eg. lactose) and gastro-oesophageal reflux (GOR)
Observation for short time afterwards.
What is monitored in the non-oral assessment section of the Neonatal Eds Screening?
Respiratory state (O2, breath sounds) Non-oral nutrition Facial features (dysmorphic) Potential aversive factors Postural tone Position for feeding
What is monitored in the observations pre-feed section of the Neonatal Eds Screening?
- Respiration before feed
- Oral area at rest (lips, jaw & tongue)
- Behaviour as bottle approaches
- Reflex activity
- Other comments
What is monitored in the observations during feed section of the Neonatal Eds Screening?
Respiration during feed Teat used Lip seal Sucking coordination pattern Endurance Volume taken (any lost) Time taken Other comments
What is monitored in the observations post-feed section of the Neonatal Eds Screening?
Response to feed (alert, lethargic, irritable)
Respiration post-feed
Signs of distress
Other comments (winding, vomiting)
Who might the SLT refer a paediatric dysphagia patient to?
Radiologist (Videofluoroscopy assessment) Dietician ENT Psychology OT PT Combined Assessment and Therapy Team
What happens in the management of the patient?
- Agreeing and providing written EDS (eating, drinking and swallowing) guidelines appropriate to location of child including goals and review date.
- Working with MDT where appropriate
- Transfer/ discharge
What enteral feeding would be used in paediatrics?
Oro-gastric and nasogastric- generally short term (eg. neonates, young children or older who present with a change in EDS abilities)
Percutaneous Endoscopic Gastronomy- longer-term but reversible
Oral feeding can be continued with these to some degree.
What are the different levels of support?
Universal
Targeted
Specialist
What would an SLT do for the universal level of support?
Awareness raising, information sharing with (eg. health visitors, other AHP’s, parents, non dysphagia trained SLT colegues
Monitoring of premature babies
MD workshops for parents
Telephone advice line
What would an SLT do for the targeted level of support?
In-service training within schools, nurseries etc not specific to any child.
Advice/ information to reduce risk for children seen in other clinics.
Input to multi-agency groups.
Checklist for non-dysphagia trained SLT’s
What would an SLT do for the specialist level of support?
Hospital, home, nursery, schools etc. specific individualised programmes of management. Specific training related to individual children if required.
What are the quick look guidelines and where would you usually see them?
Mainly for nurseries for staff to see and agreed with parents. So they know what/how to feed child.
