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Garcia R. What School-Based Speech-Language Pathologists Need to Know About Pediatric Swallowing and Feeding Development and Disorders. Lang Speech Hear Serv Sch 2024; 55:458-468. [PMID: 38241673 DOI: 10.1044/2023_lshss-23-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
PURPOSE School-based speech-language pathologists are at the frontline for treating children with pediatric feeding disorders (PFDs). Often, speech-language pathologists are the primary allied health professionals who are charged with maximizing safety, supporting nutrition and neurodevelopmental growth. Due to the increasing need for assessment and treatment of PFDs in schools, it is fundamental that PFDs and dysphagia are detected, differentially diagnosed, and addressed to support developing children. This tutorial addresses the anatomy, physiology, and development of functional feeding and swallowing patterns across the spectrum of childhood for both PFDs and dysphagia. METHOD A clinical expert review of the anatomy, physiology, and development of functional feeding and swallowing patterns in children across the spectrum of childhood will be completed. CONCLUSIONS The aim of this tutorial is to support school-based speech-language pathologists in their understanding of the anatomy and physiology of feeding and swallowing. School-based speech-language pathologists should complete this tutorial with an increased understanding and breadth of knowledge related to typical anatomy and physiology versus atypical or disordered presentations. This tutorial would support school-based speech-language pathologists in determining whether a child presents with characteristics of oropharyngeal dysphagia and/or a PFD.
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Affiliation(s)
- Raquel Garcia
- Nova Southeastern University, Fort Lauderdale, FL
- Joe DiMaggio Children's Hospital, Hollywood, FL
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Cemali M, Cemali Ö, Günal A, Pekçetin S. Relationship between Sensory Processing Skills and Feeding Behaviors in Children Aged 3-6 Years with Cerebral Palsy with Cerebral Visual Impairment. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1188. [PMID: 37508685 PMCID: PMC10378492 DOI: 10.3390/children10071188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/04/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023]
Abstract
The current study aimed to examine the relationship between sensory processing skills and feeding behavior in cerebral palsy (CP) children aged 3-6 years with cerebral visual impairment (CVI). A total of ninety mothers participated in the study in three groups: thirty mothers of children with CP with CVI, thirty mothers of children with CP without CVI, and thirty mothers of children with typical development (TD). The sensory processing skill of the children was evaluated with the Sensory Profile (SP), and feeding behavior was evaluated with the the Behavioral Pediatric Feeding Assessment Scale (BPFAS). In the triple comparison, a significant difference was found between the groups in all SP parameter and BPFAS scores (p < 0.001). Post hoc analysis revealed statistically significant differences between the groups in all parameters (p < 0.001). Feeding problems were detected in 65% of all groups. In the correlation analysis, a significant relationship was found between all parameters of the SP and the BPFAS (p < 0.05). In terms of sensory processing skills and feeding status, it was determined that children with CVI with CP had more problems than children with CP without CVI, and children with CP without CVI had more problems than children with TD. With these results, it was concluded that sensory processing problems affect feeding status, and visual impairment causes both sensory problems and feeding problems.
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Affiliation(s)
- Mustafa Cemali
- Department of Occupational Therapy, Faculty of Health Sciences, Lokman Hekim University, 06510 Ankara, Turkey
| | - Özge Cemali
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, 06490 Ankara, Turkey
| | - Ayla Günal
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Tokat Gaziosmanpaşa University, 60250 Tokat, Turkey
| | - Serkan Pekçetin
- Department of Occupational Therapy, Faculty of Gülhane Health Sciences, University of Health Sciences, 06010 Ankara, Turkey
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Sherman V, Moharir M, Beal DS, E Thorpe K, Martino R. Generating Items for a Novel Bedside Dysphagia Screening Tool Post Acute Pediatric Stroke. Dysphagia 2023; 38:278-289. [PMID: 35701690 DOI: 10.1007/s00455-022-10466-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/11/2022] [Indexed: 01/27/2023]
Abstract
Bedside dysphagia assessment protocols are not well developed in acute pediatric stroke unlike adults. The objective of this study was to identify items deemed relevant and feasible by expert consensus to inform the development of a bedside dysphagia screening tool for acute pediatric stroke. A two-phase study was conducted: (1) literature review and expert consultation generated a comprehensive list of dysphagia assessment items; (2) items were formatted in an online survey asking respondents opinion of relevance to acute pediatric stroke and feasibility for bedside administration by a trained health professional. The Dillman Tailored Design approach optimized response rate. Respondents were identified using the snowball method. Speech-language pathologists with > 2 years in pediatric dysphagia were invited to complete the survey. Demographic and practice variables were compared using univariate statistics. Item relevance and feasibility were made using binary or ordinal responses, combined to derive item-content validity indices (I-CVI) to guide item reduction. Items with I-CVI > 0.78 (excellent content validity) were moved forward to tool development. Of the 71 invited respondents, 57(80.3%) responded, of which 34(59.6%) were from North America. Sixty-one items were generated of which 4(6.6%) items were rated 'to keep'. These were face symmetry (I-CVI:0.89), salivary control (I-CVI:0.95), alertness (I-CVI:0.89) and choking (I-CVI:0.84). Of all respondents, 31(54.4%) endorsed swallowing trials, of which 25(80.6%) endorsed thin liquid by teaspoon (n = 17, 68%) or open cup (n = 20, 80%). We identified candidate items for bedside dysphagia screening with excellent content validity for acute pediatric stroke patients. Next steps include assessment of the psychometric value of each item in identifying dysphagia in children in the acute stage of recovery from stroke.
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Affiliation(s)
- Victoria Sherman
- Speech-Language Pathology, University of Toronto, 160- 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Rehabilitation Sciences Institute, University of Toronto, 160- 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Mahendranath Moharir
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Deryk S Beal
- Speech-Language Pathology, University of Toronto, 160- 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Rehabilitation Sciences Institute, University of Toronto, 160- 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rosemary Martino
- Speech-Language Pathology, University of Toronto, 160- 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Rehabilitation Sciences Institute, University of Toronto, 160- 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
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Keles MN, Ertoy Karagol HI, Serel Arslan S, Egritas Gurkan O, Sari S, Elbasan B, Dalgic B, Bakirtas A. Oropharyngeal Dysphagia in Children with Eosinophilic Esophagitis. Dysphagia 2023; 38:474-482. [PMID: 35781555 DOI: 10.1007/s00455-022-10489-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/20/2022] [Indexed: 01/27/2023]
Abstract
Dysphagia is the most troublesome symptom of eosinophilic esophagitis (EoE). This study aimed to investigate oropharyngeal dysphagia in children with EoE and possible related factors. Children with a definite diagnosis of EoE were included in the study. Medical and feeding histories were recorded. A disease control level was determined for each child. An oral structure examination, the Turkish version of the Mastication and Observation Evaluation (T-MOE), the Pediatric version of the Eating Assessment Tool-10 (PEDI-EAT-10) and the 3-oz water swallow test were applied in screening for oropharyngeal dysphagia. Fifty-two children participated in the study. Oropharyngeal dysphagia took the form of abnormal swallowing (PEDI-EAT-10 score ≥ 4) and increased aspiration risk (PEDI- EAT-10 score ≥ 13) in 51.9% and 25.0% of the children, respectively. Seven children failed the 3-oz water swallow test. Abnormal swallowing and aspiration risk were significantly higher in children with prolonged mealtimes, impaired chewing function, and uncontrolled disease (p < 0.05). Chewing function was the most important risk factor for abnormal swallowing and increased aspiration (R2 = 0.36, R2 = 0.52, p < 0.001, respectively). Oropharyngeal dysphagia is common in children with EoE and associated with increased aspiration risk in a subpopulation. Uncontrolled disease, prolonged mealtimes, and impaired chewing function may provide clues for oropharyngeal dysphagia in EoE.
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Affiliation(s)
- Muserrefe Nur Keles
- Department of Physiotherapy and Rehabilitation, Gazi University Faculty of Health Sciences, Cankaya, 06490, Ankara, Turkey.
| | | | - Selen Serel Arslan
- Faculty of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Odul Egritas Gurkan
- Department of Pediatric Gastroenterology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sinan Sari
- Department of Pediatric Gastroenterology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Bulent Elbasan
- Department of Physiotherapy and Rehabilitation, Gazi University Faculty of Health Sciences, Cankaya, 06490, Ankara, Turkey
| | - Buket Dalgic
- Department of Pediatric Gastroenterology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Arzu Bakirtas
- Department of Pediatric Allergy, Faculty of Medicine, Gazi University, Ankara, Turkey
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Malandraki GA, Arkenberg RH. Advances in Swallowing Neurophysiology across Pediatric Development: Current Evidence and Insights. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021; 9:267-276. [PMID: 34956736 DOI: 10.1007/s40141-021-00334-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review This review article analyzes current evidence on the neurophysiology of swallowing during development and offers expert opinion on clinical implications and future research directions. Recent Findings In the past five years, basic and clinical research has offered advances in our understanding of pediatric swallowing neurophysiology. Animal models have elucidated the role of brainstem circuits and the peripheral and central nervous system in neonatal swallowing. Recent human studies have further showcased that fetal and infant swallowing require cerebral inputs in order to develop functionally. Finally, neurophysiological and neuroimaging studies are starting to better define these cerebral inputs, as well as neuroplastic adaptations that may be needed for optimal feeding development. Summary The neural development of swallowing is a complex and dynamic process. Continued research is needed to better understand influences on swallowing neural development, which can be essential for improving prevention, diagnosis, and interventions for pediatric dysphagia.
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Affiliation(s)
- Georgia A Malandraki
- Purdue University, Speech, Language, & Hearing Sciences, West Lafayette, Indiana, United States of America
- Purdue University, Weldon School of Biomedical Engineering, West Lafayette, Indiana, United States of America
| | - Rachel Hahn Arkenberg
- Purdue University, Speech, Language, & Hearing Sciences, West Lafayette, Indiana, United States of America
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Translation, Cultural Adaptation, Reliability, and Validity Evidence of the Feeding/Swallowing Impact Survey (FS-IS) to Brazilian Portuguese. Dysphagia 2021; 37:1226-1237. [PMID: 34779911 DOI: 10.1007/s00455-021-10383-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to translate and adapt the Feeding/Swallowing Impact Survey (FS-IS) into Brazilian Portuguese and provide a validated instrument for caregivers of children with feeding/swallowing disorders. This cross-cultural study involved initial translation, synthesis of translations, back-translation, Committee of Experts, and pre-test. The sample consisted of 95 primary caregivers of children with feeding/swallowing disorders classified by Pediatric Dysphagia Evaluation Protocol (PDEP) in mild (n = 9), moderate-severe (n = 40), or profound (n = 46) dysphagia. Reliability and evidence of validity based on test content, response processes, internal structure and the relations to other variables were investigated. Internal consistency, test-retest, exploratory and confirmatory factor analysis were performed, in addition to the correlation with PedsQL™ Family Impact Module (PedsQLTMFIM). The pre-test participants did not report any difficulties in understanding the translated version. The Brazilian Portuguese version of FS-IS (Pt-Br-FS-IS) presented Cronbach's Alpha of 0.83, Exploratory Factor Analysis verified that the instrument would not be unifactorial (KMO = 0.74 and Bartlett's sphericity test p < 0.001) and Confirmatory Factor Analysis confirmed the original model in three subscales with χ2/df = 1.23, CFI = 0.92, TLI = 0.90, RMSEA (90% CI) 0.049 (0.011-0.073) adjustment indexes and the ICC was excellent in all subscales and total score. The correlation with PedsQL™FIM was significant in the total score and subscales. This study successfully translated and cross-culturally adapted the FS-IS instrument to the Brazilian Portuguese language and the investigation of its reliability and validity evidence suggests that the Pt-Br-FS-IS is a reliable and valid tool to measure the impact of feeding/swallowing disorders on the quality of life of caregivers of affected children.
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Perinatal stroke: mapping and modulating developmental plasticity. Nat Rev Neurol 2021; 17:415-432. [PMID: 34127850 DOI: 10.1038/s41582-021-00503-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 02/04/2023]
Abstract
Most cases of hemiparetic cerebral palsy are caused by perinatal stroke, resulting in lifelong disability for millions of people. However, our understanding of how the motor system develops following such early unilateral brain injury is increasing. Tools such as neuroimaging and brain stimulation are generating informed maps of the unique motor networks that emerge following perinatal stroke. As a focal injury of defined timing in an otherwise healthy brain, perinatal stroke represents an ideal human model of developmental plasticity. Here, we provide an introduction to perinatal stroke epidemiology and outcomes, before reviewing models of developmental plasticity after perinatal stroke. We then examine existing therapeutic approaches, including constraint, bimanual and other occupational therapies, and their potential synergy with non-invasive neurostimulation. We end by discussing the promise of exciting new therapies, including novel neurostimulation, brain-computer interfaces and robotics, all focused on improving outcomes after perinatal stroke.
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Ubeda Tikkanen A, Berry E, LeCount E, Engstler K, Sager M, Esteso P. Rehabilitation in Pediatric Heart Failure and Heart Transplant. Front Pediatr 2021; 9:674156. [PMID: 34095033 PMCID: PMC8170027 DOI: 10.3389/fped.2021.674156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022] Open
Abstract
Survival of pediatric patients with heart failure has improved due to medical and surgical advances over the past decades. The complexity of pediatric heart transplant patients has increased as medical and surgical management for patients with congenital heart disease continues to improve. Quality of life in patients with heart failure and transplant might be affected by the impact on functional status that heart failure, heart failure complications or treatment might have. Functional areas affected might be motor, exercise capacity, feeding, speech and/or cognition. The goal of rehabilitation is to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. Some of these rehabilitation interventions such as exercise training have been extensively evaluated in adults with heart failure. Literature in the pediatric population is limited yet promising. The use of additional rehabilitation interventions geared toward specific complications experienced by patients with heart failure or heart transplant are potentially helpful. The use of individualized multidisciplinary rehabilitation program that includes medical management, rehabilitation equipment and the use of physical, occupational, speech and feeding therapies can help improve the quality of life of patients with heart failure and transplant.
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Affiliation(s)
- Ana Ubeda Tikkanen
- Department of Pediatric Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, United States
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
| | - Emily Berry
- Department of Physical Therapy and Occupational Therapy Services, Boston Children’s Hospital, Boston, MA, United States
| | - Erin LeCount
- Department of Physical Therapy and Occupational Therapy Services, Boston Children’s Hospital, Boston, MA, United States
| | - Katherine Engstler
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, United States
| | - Meredith Sager
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, United States
- Augmentative Communication Program, Boston Children’s Hospital, Boston, MA, United States
| | - Paul Esteso
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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Jordan LC, Beslow LA. Hard to Swallow: Dysphagia and Feeding After Ischemic Stroke in Children and Neonates. Stroke 2021; 52:1319-1321. [PMID: 33641381 DOI: 10.1161/strokeaha.120.033524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN (L.C.J.)
| | - Lauren A Beslow
- Division of Child Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania (L.A.B.)
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Sherman V, Martino R, Bhathal I, DeVeber G, Dlamini N, MacGregor D, Pulcine E, Beal DS, Thorpe KE, Moharir M. Swallowing, Oral Motor, Motor Speech, and Language Impairments Following Acute Pediatric Ischemic Stroke. Stroke 2021; 52:1309-1318. [PMID: 33641384 DOI: 10.1161/strokeaha.120.031893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Following adult stroke, dysphagia, dysarthria, and aphasia are common sequelae. Little is known about these impairments in pediatric stroke. We assessed frequencies, co-occurrence and associations of dysphagia, oral motor, motor speech, language impairment, and caregiver burden in pediatric stroke. METHODS Consecutive acute patients from term birth-18 years, hospitalized for arterial ischemic stroke (AIS), and cerebral sinovenous thrombosis, from January 2013 to November 2018 were included. Two raters reviewed patient charts to detect documentation of in-hospital dysphagia, oral motor dysfunction, motor speech and language impairment, and caregiver burden, using a priori operational definitions for notation and assessment findings. Other variables abstracted included demographics, preexisting conditions, stroke characteristics, and discharge disposition. Impairment frequencies were obtained by univariate and bivariate analysis and associations by simple logistic regression. RESULTS A total of 173 patients were stratified into neonates (N=67, mean age 2.9 days, 54 AIS, 15 cerebral sinovenous thrombosis) and children (N=106, mean age 6.5 years, 73 AIS, 35 cerebral sinovenous thrombosis). Derived frequencies of impairments included dysphagia (39% neonates, 41% children); oral motor (6% neonates, 41% children); motor speech (37% children); and language (31% children). Common overlapping impairments included oral motor and motor speech (24%) and dysphagia and motor speech (23%) in children. Associations were found only in children between stroke type (AIS over cerebral sinovenous thrombosis) and AIS severity (more severe deficit at presentation) for all impairments except feeding impairment alone. Caregiver burden was present in 58% patients. CONCLUSIONS For the first time, we systematically report the frequencies and associations of dysphagia, oral motor, motor speech, and language impairment during acute presentation of pediatric stroke, ranging from 30% to 40% for each impairment. Further research is needed to determine long-term effects of these impairments and to design standardized age-specific assessment protocols for early recognition following stroke.
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Affiliation(s)
- Victoria Sherman
- Speech-Language Pathology, University of Toronto, ON, Canada (V.S., R.M., D.S.B.).,Rehabilitation Sciences Institute, University of Toronto, ON, Canada (V.S., R.M., D.S.B.).,Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada (V.S., I.B., G.D., N.D., D.M., E.P., M.M.)
| | - Rosemary Martino
- Speech-Language Pathology, University of Toronto, ON, Canada (V.S., R.M., D.S.B.).,Rehabilitation Sciences Institute, University of Toronto, ON, Canada (V.S., R.M., D.S.B.).,Otolaryngology Head and Neck Surgery, University of Toronto, ON, Canada (R.M.).,Krembil Research Institute, University Health Network, Toronto, ON, Canada (R.M.)
| | - Ishvinder Bhathal
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada (V.S., I.B., G.D., N.D., D.M., E.P., M.M.)
| | | | - Nomazulu Dlamini
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada (V.S., I.B., G.D., N.D., D.M., E.P., M.M.).,Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada (N.D.)
| | - Daune MacGregor
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada (V.S., I.B., G.D., N.D., D.M., E.P., M.M.)
| | - Elizabeth Pulcine
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada (V.S., I.B., G.D., N.D., D.M., E.P., M.M.)
| | - Deryk S Beal
- Speech-Language Pathology, University of Toronto, ON, Canada (V.S., R.M., D.S.B.).,Rehabilitation Sciences Institute, University of Toronto, ON, Canada (V.S., R.M., D.S.B.).,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada (D.S.B)
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, ON, Canada (K.E.T.).,Applied Health Research Centre St. Michael's Hospital, Toronto, ON, Canada (K.E.T.)
| | - Mahendranath Moharir
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada (V.S., I.B., G.D., N.D., D.M., E.P., M.M.)
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Gilleland J, Bayfield D, Bayliss A, Dryden-Palmer K, Fawcett-Arsenault J, Gordon M, Hartfield D, Iacolucci A, Jones M, Ladouceur L, McNamara M, Middaugh K, Moore G, Murray S, Noble J, Singh S, Stuart-Minaret J, Williams C, Parshuram CS. Severe illness getting noticed sooner - SIGNS-for-Kids: developing an illness recognition tool to connect home and hospital. BMJ Open Qual 2019; 8:e000763. [PMID: 31803854 PMCID: PMC6887512 DOI: 10.1136/bmjoq-2019-000763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/09/2019] [Accepted: 11/01/2019] [Indexed: 11/27/2022] Open
Abstract
Background Delays to definitive treatment for time-sensitive acute paediatric illnesses continue to be a cause of death and disability in the Canadian healthcare system. Our aim was to develop the SIGNS-for-Kids illness recognition tool to empower parents and other community caregivers to recognise the signs and symptoms of severe illness in infants and children. The goal of the tool is improved detection and reduced time to treatment of acute conditions that require emergent medical attention. Methods A single-day consensus workshop consisting of a 17-member panel of parents and multidisciplinary healthcare experts with content expertise and/or experience managing children with severe acute illnesses was held. An a priori agreement of ≥85% was planned for the final iteration SIGNS-for-Kids tool elements by the end of the workshop. Results One hundred percent consensus was achieved on a five-item tool distilled from 20 initial items at the beginning of the consensus workshop. The final items included four child-based items consisting of: (1) behaviour, (2) breathing, (3) skin, and (4) fluids, and one context-based item and (5) response to rescue treatments. Conclusions Specific cues of urgent child illness were identified as part of this initial development phase. These cues were integrated into a comprehensive tool designed for parents and other lay caregivers to recognise the signs of serious acute illness and initiate medical attention in an undifferentiated population of infants and children. Future validation and optimisation of the tool are planned.
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Affiliation(s)
- Jonathan Gilleland
- Department of Pediatrics, Section of Pediatric Intensive Care Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - David Bayfield
- Department of Emergency Medicine, Georgian Bay General Hospital, Midland, Ontario, Canada
| | - Ann Bayliss
- Children's Health Division, Trillium Health Partners, Mississauga, Ontario, Canada.,Department of Paediatrics, University of Toronto, Mississauga, Ontario, Canada
| | - Karen Dryden-Palmer
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Michelle Gordon
- Department of Neonatal and Pediatric Medicine, Orillia Soldiers Memorial Hospital, Orillia, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Dawn Hartfield
- Department of Pediatrics, Division of Pediatrics, Hospital Medicine Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anthony Iacolucci
- Acute Care Transport Services (ACTS), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa Jones
- SickKids Foundation, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisa Ladouceur
- Nurse Practitioner Clinic, Georgian Bay General Hospital, Midland, Ontario, Canada
| | - Martin McNamara
- Department of Emergency Medicine, Georgian Bay General Hospital, Midland, Ontario, Canada
| | - Kristen Middaugh
- Paediatric Critical Care Medicine, Center for Safety Research, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gregory Moore
- Department of Obstetrics and Gynecology, Division of Newborn Care, Ottawa Hospital General Campus, Ottawa, Ontario, Canada.,Department of Pediatrics, Division of Neonatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Sean Murray
- NEO Kids and Family Program, Health Sciences North, Sudbury, Ontario, Canada
| | - Joanna Noble
- Healthcare Insurance Reciprocal of Canada, Lead Clinical Risk, Healthcare Safety and Risk Management, Toronto, Ontario, Canada
| | - Simran Singh
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jane Stuart-Minaret
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carla Williams
- Canadian Patient Safety Institute, Ottawa, Ontario, Canada
| | - Christopher S Parshuram
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Pediatrics, Critical Care, Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
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