Treatment Efficacy Summary Pediatric Feeding and Swallowing Disorders by cgz15130


									Treatment Efficacy Summary                                                                                                                   A MERICAN
                                                                                                                                             SPEECH - ANGUAGE -
                                                                                                                                             H EARING

                                                                                                                                             A SSOCIATION

Pediatric Feeding and                                 psychosocial and behavioral issues.                    Speech-language pathologists have
                                                      Incidence estimates for children                       extensive knowledge and skills in ana-
Swallowing Disorders                                  with cerebral palsy (CP) range from                    lyzing, interpreting, and facilitating
Difficulties in sucking, swallowing,                  85–90% at some time in life. During                    communication. These skills are
and breathing can severely compro-                    the first year of life, 57% of all chil-               critical when evaluating and making
mise nutrition and hydration status                   dren with CP are estimated to have                     management plans related to feeding
in infants who get their nutrition                    problems with sucking, 38% with                        and swallowing, safety and efficacy.
needs met via breast or bottle.                       swallowing, and 33% with malnutri-
Difficulty in swallowing in infants                   tion.i As the severity of CP increases,
and children, as in older children                    the severity of swallowing problems                    Contributors:
and adults, can cause food or liquid                  also increases.                                        Joan Arvedson, PhD
to enter the airway resulting in some                 A meta-analysis of randomized con-                     Children’s Hospital of Wisconsin
or all of the following: coughing,                    trolled trials in 19 studies revealed
choking, pulmonary problems, or                       that the development of nonnutri-
inadequate nutrition and/or hydra-                    tive sucking is found to significantly
tion with lack of weight gain—which                   decrease the length of hospital stay
is like a weight loss in adults and                   in preterm infants.ii Examples of
older children. Clinical evidence has                 oral sensorimotor treatment with
documented that children with swal-                   children with CP point out that
lowing and feeding problems benefit                   success typically occurs when “total
from the services of a speech-                        child” focuses are implemented.iii, iv
language pathologist, who may                         Another example showed that intra-
function as part of a team of                         oral appliance (ISMAR) therapy for
professionals.                                        one year resulted in significant
Feeding and swallowing disorders in                   improvements in jaw stability in
infants and children are usually                      some children who demonstrated
caused by multiple factors. They can                  better lip closure, chewing, and oral
result from congenital or acquired                    manipulation of food.v, vi Functional
neurologic damage (e.g.,                              feeding skills in children with
encephalopathies), anatomic and                       moderate dysphagia improved with
structural problems (e.g., craniofa-                  this type of therapy.vii Efficacy stud-
cial anomalies, tracheoesophageal                     ies indicate improvements in swal-
fistula), genetic conditions (chromo-                 lowing safety (reduced aspiration),
somal, syndromic, or inborn errors                    improved nutrition, and efficiency as
of metabolism), systemic illness                      a result of both compensatory and
(bronchopulmonary dysplasia,                          direct treatment procedures in
gastrointestinal dysmotility), and                    adults.

i Reilly, S., Skuse, D., & Poblete, X. (1996). Prevalence of feeding problems   v Gisel, E.G., Schwartz, S., & Haberfellner, H. (1999). The Innsbruck sen-
and oral motor dysfunction in children with cerebral palsy: A community         sorimotor activator and regulator (ISMAR): Construction of an intraoral
survey, Journal of Pediatrics, 129, 877–882.                                    appliance to facilitate ingestive function. Journal of Dentistry for Children, 66,
ii Pinelli, J., & Symington, A. (2000). Non-nutritive sucking for promoting     180–187.
physiologic stability and nutrition in preterm infants. Cochrane Database       vi Gisel, E.G., Schwartz, S., Petryk, A., Clarke, D., & Haberfellner, H.
System Review, 2, CD-01071.                                                     (2000). "Whole body" mobility after one year of intraoral appliance
iii Gisel, E. (1994). Oral-motor skills following sensorimotor intervention     therapy in children with cerebral palsy and moderate eating impairment.
in the moderately eating-impaired child with cerebral palsy. Dysphagia, 9,      Dysphagia, 15, 226–235.
180–192.                                                                        vii Haberfellner, H., Schwartz, S., & Gisel, E.G. (2001). Feeding skills and
iv Gisel E.G., Applegate-Ferrante, T., Benson, J., & Bosma, J. (1995). Effect   growth after one year of intraoral appliance therapy in moderately
of oral sensorimotor treatment on measures of growth, eating efficiency,        dysphagic children with cerebral palsy. Dysphagia, 16, 83–96.
and aspiration in the dysphagic child with cerebral palsy. Developmental
Medicine and Child Neurology, 37, 528–543.

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