Pediatric Feeding and Swallowing Problems: An Interdisciplinary Team Approach

Pediatric Dysphagia: A Look Into the Training Received During Graduate Speech-Language Pathology Programs to Support This Population

PURPOSE

The purpose of this study was to examine academic preparation in pediatric swallowing and feeding, specifically, how speech-language pathology graduate programs were addressing pediatric swallowing and feeding, both academically and clinically, prior to guideline changes and modifications in 2020 due to updates and the global health pandemic.

METHOD

To gain a rounded image of speech-language pathology academic programs, two different methodological approaches were utilized. First, courses from 272 accredited programs were analyzed. Second, survey results from 100 participants were analyzed to investigate clinical clock hours and experiences received during participation in a graduate speech-language pathology academic program.

RESULTS

Less than 1% (0.4%) of academic courses analyzed were categorized as pediatric swallowing and feeding. Greater than 90% of participants reported receiving 20 hr or less in pediatric dysphagia, assessment, or treatment. Sixty percent of participants reported not feeling well prepared at all to provide pediatric swallowing and feeding services.

CONCLUSIONS

There are a growing number of children requiring swallowing and feeding services, a trend that looks to continue its rise. Pediatric dysphagia is a complex area requiring unique knowledge and skills. Academic programs have a responsibility to their students, and the individuals requiring speech-language pathology services, to provide experiences that allow for knowledge and skill development across the entire scope of practice and life span.

The Quality, Reliability, and Accuracy of Videos Regarding Exercises and Management for Dysphagia in Pediatric Populations Uploaded on YouTube

Objectives: YouTube is well known for providing easy access to various kinds of video content. In this study, we investigated the quality and reliability of videos on YouTube addressing exercise or dysphagia management in the pediatric population. Methods: Video quality and reliability were assessed by using the Global Quality Scale (GQS) and a modified DISCERN tool, respectively. The accuracy of the information in each video was also evaluated. Other information, including the video source, length, date of upload, as well as the number of views, likes, dislikes, and comments were investigated, and statistical significance was determined. Results: In total, 22 videos on exercises and dysphagia management in pediatric populations were evaluated; 36.4% and 72.7% of these videos did not have high quality or reliability, respectively. Moreover, half of the videos did not contain accurate information. Even when videos were created by medical specialists, many of these YouTube videos were of low quality, reliability, and accuracy. Conclusions: The reliability, quality, and accuracy of many videos on exercise or dysphagia management in the pediatric population were low. Video creators, especially medical specialists, should strive to create videos with high quality, reliability, and accuracy.

A pan-Canadian study of registered dietitians' perceptions and experiences of interprofessional collaboration

Little is known about Canadian dietitians' perceptions and experiences of interprofessional collaboration. To address this knowledge gap, a cross-sectional online survey was administered to registered dietitians in Canada. Quantitative data was analyzed in SPSS using descriptive and inferential statistics, while thematic analysis was used for open-text responses. A total of N = 469 registered dietitians representing 10 provinces participated in the study. Results showed a significant difference (p < .001) between the frequency with which dietitians collaborated with other health and social care providers and their desired frequency, with 61.0% indicating they wanted more frequent collaboration. A majority of dietitians (59.2%) had negative views of interprofessional interactions. Nearly all respondents felt there is a need to raise better awareness about the dietetic profession (95.4%) and that dietitians are underutilized in the world of healthcare (92.5%). On three measures, a majority of participants (ranging from 65.6% to 81.5%) reported that their dietetic training helped equip them for interprofessional collaboration. Insufficient time/availability was the obstacle to interprofessional collaboration cited most frequently by dietitians. Results suggest that interprofessional collaboration is an area in need of attention in the Canadian dietetic profession, as well as with health and social care providers who work with dietitians. The study's findings point to potential areas for improvement.

New trends in rehabilitation of children with ENT disorders

In the last 20 years, neonatal survival has progressively increased due to the constant amelioration of neonatal medical treatment and surgical techniques. Thus, the number of children with congenital malformations and severe chronic pathologies who need rehabilitative care has progressively increased. Rehabilitation programs for paediatric patients with disorders of voice, speech and language, communication and hearing, deglutition and breathing are not widely available in hospital settings or in long-term care facilities. In most countries, the number of physicians and technicians is still inadequate; moreover, multidisciplinary teams dedicated to paediatric patients are quite rare. The aim of the present study is to present some new trends in ENT paediatric rehabilitation.

Prevalence of Auditory Problems in Children With Feeding and Swallowing Disorders

PURPOSE

Although an interdisciplinary approach is recommended for assessment and management of feeding or swallowing difficulties, audiologists are not always included in the interdisciplinary team. The purpose of this study is to report the prevalence of middle ear and hearing problems in children with feeding and swallowing disorders and to compare this prevalence with that in typical children.

METHOD

A total of 103 children were included in the study: 44 children with feeding and swallowing disorders and 59 children without any such disorders. Audiological examinations included case-history information, visualization of the ear canals through otoscopy, middle ear evaluation through tympanometry, and hearing screenings using an audiometer.

RESULTS

The odds of excessive cerumen (p = .0000, small effect size), middle ear dysfunction (p = .0148, small effect size), and hearing screening failure (p = .0000, large effect size) were 22.14%, 2.97%, and 13.5% higher, respectively, in children with feeding and swallowing disorders compared with typically developing children.

CONCLUSION

The significantly higher prevalence of hearing problems in children with feeding and swallowing disorders compared with typically developing children suggests that inclusion of an audiologist on the interdisciplinary team is likely to improve overall interventional outcomes for children with feeding and swallowing disorders.

Parent questionnaires measuring feeding disorders in preschool children: a systematic review

AIM

Preschool feeding disorders are common and debilitating and are associated with a range of developmental and medical issues. Parent report allows assessment of feeding in a naturalistic environment over time, with advantages over time-limited, clinic-based observations. However, little is understood about the limitations and advantages of current parent-report measures. We aimed to systematically review the psychometrics and clinometrics of parent-administered feeding questionnaires.

METHOD

Five search engines were used to identify questionnaires that met inclusion criteria, i.e. being norm-or criterion-referenced, child focused, appropriate for preschool children, and measured two or more feeding domains (e.g. dysphagia/oral motor delay, food refusal).

RESULTS

In total 3535 abstracts were identified and 215 full-text articles were evaluated. Five questionnaires met the criteria. The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was the most reliable questionnaire identified, with good test-retest reliability and internal consistency. More predictive and concurrent validity data was available for the BPFAS, the Mealtime Behavior Questionnaire, and the Montreal Children's Hospital Feeding Scale than for other measures.

INTERPRETATION

Further research is needed on the psychometric properties of feeding questionnaires used in research and clinical practice. To date, the BPFAS has the most comprehensive reliability and validity data of any parent-administered feeding questionnaire for preschool children.

Improvement of dysphagia in a child affected by Pompe disease treated with enzyme replacement therapy

AIM

Dysphagia is a known complication in Pompe Disease (PD), a severe metabolic myopathy due to alpha-glucosidase deficiency. Enzyme replacement therapy (ERT) with alglucosidase alfa is the only approved therapy for PD. Presently no data are available on the effects of ERT on dysphagia in PD patients. The aim of this work is to evaluate the course of this complication in a 6 years old boy affected by PD after treatment with ERT.

METHODS

Dysphagia was assessed by Videofluoroscopic Swallowing Study (VFSS) at baseline, before the start of ERT and after 36 months of therapy. We used the Dysphagia Severity Rating Scale (DSS) to define the severity grade of dysphagia.

RESULTS

VFSS performed at baseline revealed complete incoordination of oral stage swallowing which was classified as a grade 1 dysphagia according to DSS. After 36 months of treatment VFSS revealed normal swallowing, classified as grade 0 by DSS.

CONCLUSION

Our results suggest that ERT is effective in improving dysphagia. VFSS may be a useful tool to investigate and monitor swallowing disorders in patients affected by PD.

An Oral, Motor, Medical, and Behavioral Approach to Pediatric Feeding and Swallowing Disorders: An Interdisciplinary Model

Feeding and swallowing problems are reported in 10-25% of all children, 40-70% in premature infants, and 70-90% in children with medical/developmental delays (Graham, 1985; Rogers & Arvedson, 2005; Sullivan et al., 2000). The etiologies of feeding disorders are as varied as the multiple disciplines, approaches, and interventions available. This paper illustrates, through case presentation, an interdisciplinary feeding team model that incorporates an oral, motor, medical, and behavioral approach to treating children with feeding disorders.