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Clinical Evaluation of Dysphagia in School-Aged Children Kelly Dailey Hall, Ph.D. CCC/SLP Pediatric Speech & Language Services, Inc. Greensboro, NC firstname.lastname@example.org Swallowing/Feeding Disorders is educationally relevant Students must be safe while eating at school
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Kelly Dailey Hall, Ph.D. CCC/SLP
Pediatric Speech & Language Services, Inc.
Roles of speech-Language Pathologists in Swallowing and Feeding Disorders, ASHA 2001a, b
(Manikam & Perman 2000)
Summarized in Oct. 2006 Brackett, Arvedson & Manno in SID #13 newsletter
1. Food Refusal
Refusal to eat all or most foods so the extent that the child fails to meet his/her nutritional needs
Eating a narrow range of food that is nutritionally inappropriate
Refusal to eat food textures that are developmentally appropriate
3. Oral Motor Problems
Difficulty with mastication, lip closure, tongue mvts
4. Pharyngeal dysphagia
Is the student at risk for aspiration?
Yes? Then you need to establish strategies for oral intake that minimizes the risk.
No? Then you need normalize feeding behavior.
Cervical auscultation during oral intake of ________________ revealed changes in the respiratory sounds following the swallow which may be indicative of aspiration.
Most students who require compensatory strategies will
have these strategies identified on their MBSS. We implement
a program to be sure that the child is using these strategies
to reduce aspiration risk.
1. Oral Motor Exercises Lingual strengthening
2. Development of Normal Feeding Skills
have similar features (taste texture temperature) to those in the child’s core diet (consistently accepted foods)
Rating scales (1-10) are used weekly to: measure reaction to new foods, measure change in preferences over time to help select next targeted food items.
3. Bite and remove
4. Bite, chew and spit
5. Bite, chew, swallow
6. Consider taste, temperature, texture
7. Structure movement through hierarchy with an “all done” bowl
Young children with feeding and swallowing issues related to a sensory disorder may benefit from stimulation activities that can be done at home by a caregiver at home or in a child care setting. Always consult with a speech-language pathologist or occupational therapist before embarking on a program to affect oral defensiveness.
Gentle massage with a NUK brush
Gentle massage with a small finger toothbrush brush
Offer a strong piece of sterile rubber tubing to practice biting and increase jaw strength
Offer foods of different textures: pretzels, crackers, puddings, jell-o, ice cream, mashed potatoes, etc.
Offer drinks of different temperatures and composition
Offer gentle vibrating toys for facial massage or oral exploration
Gentle facial massage with different textures of cloth
1. Allow the child to watch others eat.
2. Experience smells, tastes, and play with food.
3. Mealtime should be fun/social.