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Power-deFur LA. Legal Issues and Opportunities Associated With Serving Children With Pediatric Feeding Disorders in Schools. Lang Speech Hear Serv Sch 2024; 55:434-443. [PMID: 37285467 DOI: 10.1044/2023_lshss-23-00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
PURPOSE This review of federal statutes, regulations, administrative directions, and case law related to special education, disabilities, and school nutrition is designed to provide speech-language pathologists (SLPs) with information essential for determining eligibility children with pediatric feeding disorder (PFD). Despite the absence of mention of dysphagia or PFD in federal statutes and regulations, special education, disability, and school food service requirements provide direction for serving children with health care needs, which include children with dysphagia. The federal requirements, court cases, and policy interpretations are detailed to provide guidance to SLPs and their school teams when working with children with PFDs. METHOD Federal statutes and regulations, administrative directions, and case law were reviewed. This review details the application of federal statutes and regulations for children with PFDs. Furthermore, administrative direction and case law identify the importance of attending to the safety of children with dysphagia. RESULTS As a result of this review, sections of the various federal statutes and regulations that support provision of services to children with PFD are identified. In addition, information from case law and administrative reviews further highlights the importance of attending to the rights and needs of children with PFD. CONCLUSIONS The rights of all children with disabilities are established through statutes, regulations, and case law, and children with PFDs benefit from these rights. These requirements can guide SLPs in working with school teams, so that children with dysphagia can be found eligible for and receive school-based services for dysphagia.
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Martin-Harris B, Carson KA, Pinto JM, Lefton-Greif MA. BaByVFSSImP © A Novel Measurement Tool for Videofluoroscopic Assessment of Swallowing Impairment in Bottle-Fed Babies: Establishing a Standard. Dysphagia 2020; 35:90-98. [PMID: 30955137 PMCID: PMC6778717 DOI: 10.1007/s00455-019-10008-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
Abstract
AIM This investigation tested the construct validity of the first standardized assessment tool, the BaByVFSS Impairment Profile, (BaByVFSSImP©), developed for the quantification of swallowing observations made from videofluoroscopic swallow studies (VFSS) in bottle-fed babies. METHOD Construct validity of the measures was tested using descriptive methods and confirmatory factor analysis (CFA) of swallowing scores obtained from a cohort of bottle-fed babies (median age 3 months 1 day, interquartile range 1 month 4 days-7 months 4 days) sequentially referred for VFSS based on clinical signs, symptoms, or risk factors associated with dysphagia and/or aspiration. Main outcome measures were emergence of functional domains derived from swallowing component impairment scores. RESULTS Confirmatory factor analysis resulted in 21 significant components (factor loadings ≥ 0.5) grouping into five functional domains labeled for common contribution to overall swallowing function. The tool was organized into the BaByVFSSImP. Clinical relevance was explored using correlational analyses between domain scores, maximum penetration/aspiration scores, feeding status, and caregiver burden. INTERPRETATION Quantification of physiologic swallowing impairment captured by BaByVFSSImP holds promise for identification of physiologically based targets for intervention, clinical decisions regarding enteral feeding, and tracking the trajectory of swallowing impairment throughout development in young children.
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Affiliation(s)
- Bonnie Martin-Harris
- Department of Communication Sciences and Disorders, Department of Otolaryngology Head and Neck Surgery, Department of Radiation Oncology, School of Communication, Feinberg School of Medicine, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA.
- Department of Otolaryngology Head and Neck Surgery, Evelyn Trammell Institute for Voice and Swallowing, College of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425, USA.
- Research Service, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL, 60141, USA.
| | - Kathryn A Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 East Monument Street, Suite 2-500, Baltimore, MD, 21287, USA
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Jeanne M Pinto
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, The Johns Hopkins University School of Medicine, David M. Rubenstein Building, Suite 3070, 200 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Maureen A Lefton-Greif
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, The Johns Hopkins University School of Medicine, David M. Rubenstein Building, Suite 3017, 200 North Wolfe Street, Baltimore, MD, 21287, USA
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
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Gosa MM, Carden HT, Jacks CC, Threadgill AY, Sidlovsky TC. Evidence to support treatment options for children with swallowing and feeding disorders: A systematic review. J Pediatr Rehabil Med 2017; 10:107-136. [PMID: 28582883 DOI: 10.3233/prm-170436] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE A rise in pediatric patients with swallowing and feeding problems has resulted in increased interest in multidisciplinary treatments to address these issues. This evidence based systematic review (EBSR) examined the published evidence for the use of common strategies used by clinicians across disciplines to treat pediatric swallowing and feeding problems. METHODS A systematic search of 10 electronic databases was completed to identify relevant, peer reviewed literature published in English prior to December 2015 reporting original data that addressed at least one of the five identified clinical questions. RESULTS Sixty-one studies of varying methodological quality were included. The majority of the included studies (60/61) focused on the use of behavioral therapies to remediate swallowing and feeding disorders in children and reported mixed findings across all of the targeted outcomes. CONCLUSION There is insufficient quantity of evidence to determine the effects of oral motor, sensory, and pharmaceutical therapies on functional feeding outcomes in pediatric populations. A larger body of phase 1 evidence is available that establishes the efficacy of behavioral strategies to treat some swallowing and feeding difficulties in small cohort and single subject studies. This analysis identified limited high quality (phase 4) research articles that establish the efficacy and benefit of joint nutrition and behavior intervention programs and systematic desensitization and operant conditioning behavioral therapy approaches to improve functional feeding and swallowing outcomes in children.
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Affiliation(s)
- Memorie M Gosa
- The University of Alabama, Tuscaloosa, AL, USA
- Le Bonheur Children's Hospital, Memphis, TN, USA
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Abstract
Early identification and management of aspiration associated with oral intake will help contribute to the best possible outcome for infants and children who have airway protection issues with swallowing. Though the incidence and prevalence of aspiration specifically related to swallowing dysfunction across medical conditions in the pediatric population is unknown, there is accumulating evidence of swallowing-related aspiration in infants and children with diagnoses that include structural abnormalities of the upper airway, central nervous system abnormalities, and progressive neurological disease. Chronic aspiration is associated with compromised respiratory health, progressive lung disease, bronchiectasis, and respiratory failure; thus, early detection and appropriate management is crucial. Determining the etiology and effect of aspiration is complex, and multiple evaluations are often required. This article will focus on instrumental studies of swallowing physiology used in the diagnosis and management of swallowing dysfunction and aspiration. Therapeutic strategies to improve airway protection during swallowing will also be described.
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Abstract
PURPOSE OF REVIEW There is increased recognition in the range of feeding and swallowing problems that occur in conjunction with congenital and acquired pediatric conditions. Differential diagnosis and management of these problems is often not straightforward and requires consideration and collaboration between multiple disciplines that are involved in the care of this special population. This article reviews recent investigations across disciplines regarding the cause and evaluation of pediatric feeding and swallowing issues, intervention efficacy, and available evidence to guide clinical practice. RECENT FINDINGS Knowledge of the basis for feeding issues associated with a variety of causes has advanced. Recent investigations of specific feeding and swallowing issues accompanying prematurity, selected diagnoses, and congenital syndromes are described. Significant advancements in the objective analysis of nonnutritive sucking have been made and provide increased understanding of the precursors for transition to oral feeding. Preliminary evidence regarding the effectiveness of selected clinical interventions to treat feeding and swallowing issues is highlighted. SUMMARY Research is increasingly available to guide practitioners in evidence-based evaluation and management of pediatric feeding and swallowing issues. These continued advancements increase our understanding of the causes of pediatric dysphagia, the efficacy of treatment, and underscore the opportunities for continued research for best practice in clinical evaluation and management.
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Affiliation(s)
- Claire Kane Miller
- Cincinnati Children's Hospital Medical Center, Aerodigestive and Sleep Center/Interdisciplinary Feeding Team, Cincinnati, Ohio 45229, USA.
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