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Dysphagia > Paediatric Dysphagia > Flashcards

Paediatric Dysphagia Flashcards

1
Q

What is the normal feeding development from 0 to 6 months?

A

Semi-reclining supported seated position

Sucking liquid forward and backward pattern with up and down tongue movement.

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2
Q

What is the normal feeding development from 6 months?

A
  • 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
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3
Q

What is the normal feeding development from 9 to 12 months?

A
  • 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
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4
Q

What is the normal feeding development from 12 to 24 months?

A
  • 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
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5
Q

What is the normal feeding development from 24 months?

A
  • Full range of jaw movements used to move and grind firm foods.
  • Can maintain lip closure to retain foods.
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6
Q

What is different about an infant and an adult’s head and neck anatomy?

A
  • 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.
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7
Q

What must a professional have before referral?

A

Parents consent

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8
Q

What is the process of referral before seeing an SLT?

A

Referral.
Vetting to determine appropriateness and urgency of referral.
Allocation/non acceptance- depends on locality and SLT’s capacity/

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9
Q

What is the outcome of vetting after referral?

A 
Inpatient= seen within 48 hours.
Urgent= seen within 2 weeks
Non-urgent= seen within 4 weeks
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10
Q

What may happen if child is not accepted after referral?

A

May be given pre-referral work (eg. advice given to referrer or parent/ carer

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11
Q

What might happen in an initial visit for paediatric dysphagia?

A
  • 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
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12
Q

What assessment will be undertaken?

A

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.

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13
Q

What is monitored in the non-oral assessment section of the Neonatal Eds Screening?

A 
Respiratory state (O2, breath sounds)
Non-oral nutrition
Facial features (dysmorphic)
Potential aversive factors
Postural tone
Position for feeding
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14
Q

What is monitored in the observations pre-feed section of the Neonatal Eds Screening?

A
  • Respiration before feed
  • Oral area at rest (lips, jaw & tongue)
  • Behaviour as bottle approaches
  • Reflex activity
  • Other comments
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15
Q

What is monitored in the observations during feed section of the Neonatal Eds Screening?

A 
Respiration during feed
Teat used
Lip seal
Sucking coordination pattern
Endurance 
Volume taken (any lost)
Time taken 
Other comments
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16
Q

What is monitored in the observations post-feed section of the Neonatal Eds Screening?

A

Response to feed (alert, lethargic, irritable)
Respiration post-feed
Signs of distress
Other comments (winding, vomiting)

17
Q

Who might the SLT refer a paediatric dysphagia patient to?

A 
Radiologist (Videofluoroscopy assessment)
Dietician
ENT
Psychology
OT
PT
Combined Assessment and Therapy Team
18
Q

What happens in the management of the patient?

A
  • 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
19
Q

What enteral feeding would be used in paediatrics?

A

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.

20
Q

What are the different levels of support?

A

Universal
Targeted
Specialist

21
Q

What would an SLT do for the universal level of support?

A

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

22
Q

What would an SLT do for the targeted level of support?

A

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

23
Q

What would an SLT do for the specialist level of support?

A

Hospital, home, nursery, schools etc. specific individualised programmes of management. Specific training related to individual children if required.

24
Q

What are the quick look guidelines and where would you usually see them?

A

Mainly for nurseries for staff to see and agreed with parents. So they know what/how to feed child.

25
Q

What are the different parts of the quick look guidelines?

A
  • Important considerations= eg. visual difficulty so might let child smell food, or make sure not to give them thin liquids as they aspirate.
  • Position= mentions how child should be positioned when fed.
  • Food and drink= what textures child can eat and drink including how many and size of spoonfuls.
  • Equipment= what they can use (eg. can use fork or can only use weaning spoon)
  • Communication= eg. talk about what child is eating using simple language.
  • Methods and techniques= others must help, must have plenty of time between spoonfuls etc.
26
Q

What are full guidelines and where would they be used?

A

Mainly used in schools or with more complex pre-school children. Individualised and more complex.

27
Q

What is the aspiration and choking checklist?

A

List of signs of aspiration and choking that all parents/ carers/ staff members must be aware of.
Eg. coughing, gurgly wet breathing, gasping for breath, change of colour, pain when swallowing, recurring chest infections.

28
Q

What other paperwork might be involved with children?

A

Information sheets regarding food/liquid descriptors

Finger foods

29
Q

Who would the 0-5 years old dysphagia team work with?

A
  • dysphagia giving rise to potential risk to health and safety of the child
  • delay in progress of typical development of EDS milestones.
  • complex developmental/ medical profile which may include moderate to sever learning difficulty.

Dysphagia (3 decks)

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