Assessment of Pediatric Dysphagia & Feeding Disorders (2008) PDF

DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 14: 118 – 127 (2008) ASSESSMENT OF PEDIATRIC DYSPHAGIA AND FEEDING DISORDERS: CLINICAL AND INSTRUMENTAL APPROACHES Joan C. Arvedson*...

DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 14: 118 – 127 (2008) ASSESSMENT OF PEDIATRIC DYSPHAGIA AND FEEDING DISORDERS: CLINICAL AND INSTRUMENTAL APPROACHES Joan C. Arvedson* Children’s Hospital of Wisconsin-Milwaukee, Medical College of Wisconsin-Milwaukee, Milwaukee, Wisconsin Assessment of infants and children with dysphagia (swallowing INTERDISCIPLINARY FEEDING/SWALLOWING problems) and feeding disorders involves significantly more considerations TEAM APPROACH than a clinical observation of a feeding. In addition to the status of feed- ing in the child, considerations include health status, broad environment, An interdisciplinary approach allows for coordinated parent–child interactions, and parental concerns. Interdisciplinary team consultation with focus on the whole child (and caregivers) approaches allow for coordinated global assessment and management who may have multiple interrelated health and developmental decisions. Underlying etiologies or diagnoses must be delineated to every issues. Individuals involved in the problem solving have extent possible because treatment will vary according to history and cur- opportunities to provide patient care and case coordination rent status in light of all factors that are often interrelated in complex ways. A holistic approach to evaluation is stressed with a primary goal that is difficult to obtain when professionals function inde- for every child to receive adequate nutrition and hydration without pendently. Of course, not all disciplines are needed for all chil- health complications and with no stress to child or to caregiver. Instru- dren, and as children change over time, primary team players mental swallow examinations that aid in defining physiological swallow- may change as well. These kinds of teams demonstrate several ing status are needed for some children. Successful oral feeding must be measured in quality of meal time experiences with best possible oral important characteristics that include (1) a shared group phi- sensorimotor skills and safe swallowing while not jeopardizing a child’s losophy related to diagnostic approaches and management pro- functional health status or the parent–child relationship. ' 2008 Wiley-Liss, Inc. tocols, (2) team leadership with organization for evaluation Dev Disabil Res Rev 2008;14:118–127. and sharing information, (3) collegial interaction among var- ied specialists, and (4) time commitment for the labor inten- Key Words: infant; child; swallowing; feeding; assessment; evaluation sive nature of this kind of work [Brodsky and Arvedson, 2002,a]. Interdisciplinary teams may be in medical settings or in school-based settings [ASHA, 2007]. School-based team mem- bers work closely with medical team colleagues so that find- ings from all evaluations or assessments can be incorporated into appropriate coordinated recommendations. Physician INTRODUCTION input is of utmost importance in the development of manage- ment plans and for monitoring the health status of children. C omprehensive assessment of infants and children with dysphagia and feeding disorders involves considerations Treatment options vary by history, physical examination, find- of the broad environment, parent–child interactions, ings during clinical feeding evaluations, and instrumental swal- parental concerns, and health status of the child. All of those lowing evaluations. To set the stage for evaluating infants and factors must be taken into account by professionals in order to young children with feeding and swallowing disorders, a few make optimal management decisions for every child to assure operational definitions are in order. that nutrition and hydration needs are met for adequate growth. It is not enough to determine the levels of oral senso- Operational Definitions rimotor skills and safety of swallowing in isolation. Professionals involved in assessment and management of  Feeding disorders: Problems in a broad range of eating infants and children with swallowing and feeding problems activities that may or may not be accompanied by a must have adequate knowledge and skills about associated health conditions and specific feeding/swallowing issues. Improper diagnoses and management decisions increase risk *Correspondence to: Joan C. Arvedson, Children’s Hospital of Wisconsin- for poor nutrition and health outcomes. In contrast, thorough Milwaukee, Medical College of Wisconsin-Milwaukee, Milwaukee, WI. problem solving and interdisciplinary management can E-mail: [email protected] enhance the lives of children and their caregivers. Children Received 23 May 2008; Accepted 23 May 2008 Published online in Wiley InterScience (www.interscience.wiley.com). and families are better served by an interdisciplinary team than DOI: 10.1002/ddrr.17 by a single discipline in isolation [Arvedson et al., 2002]. ' 2008 Wiley -Liss, Inc.  difficulty with swallowing food muscular conditions, orthopedic for 12.7% of 4.14 million births in the and liquid. Feeding disorders conditions (body function United States in 2004–2005, which rep- may be characterized by food level). resents an increase of 20% since 1990 refusal, disruptive mealtime [Hamilton et al., 2007]. The survival With this approach, the first considera- behavior, rigid food prefer- rate of preterm infants delivered at tion in a clinical feeding evaluation is ences, less than optimal growth,