PAEDIATRIC COMMUNITY
DYSPHAGIA IN THE COMMUNITY: A PAEDIATRIC PERSPECTIVE Jenni Simmons Highly Specialist Speech and Language Therapist, Betsi Cadwaladr University Health Board (NHS) Jenni has worked as a Paediatric Speech and Language Therapist for eight years. She currently works with children with complex needs, assessing and providing intervention to develop both communication and feeding skills.
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Speech and language therapists (SALTs) play an important role in supporting children with feeding and swallowing difficulties. Promoting safety and ensuring adequate nutritional intake are always primary goals1 for all SALTs and this is no different when working in the community. Swallowing difficulties are collectively labelled ‘dysphagia’. Infants or young people who suffer from dysphagia may have: • problems with sucking, chewing, or swallowing effectively and safely; • difficulties developing their feeding skills; • aversion to a particular taste, texture or method of feeding; • behavioural difficulties associated with eating, drinking and mealtimes.2 Children with a neurodisability and those born prematurely are at a higher risk of having feeding difficulties; however, we cannot exclude a number of children in the typically developing population. The Royal College of Speech and Language Therapists (RCSLT) has summarised the incidence of feeding difficulties as occurring:2 • between 25% and 45% in a typically developing paediatric population; • between 32% and 44% for children with general neuro-development disabilities; • between 26.8% and 40% of infants born prematurely. Although some of these children may be seen in the hospital setting, a large proportion of them will be assessed and given intervention in the community, either in their homes or in an educational setting. Many of the children on a SALT’s caseload will be seen in an educational setting, which is important, as children spend a large portion of their week in school and will
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www.NHDmag.com August/September 2018 - Issue 137
have the opportunity for meals and snacks. Dysphagia can cause impaired health and nutrition, which clearly has an effect on a learner’s ability to attend to instruction and participate in the learning process. Educational settings offer unique challenges for SALTs.1 The therapist will rely on teachers, support workers and school staff to feed the child, food for the child will often be prepared by the school kitchen and modified to meet the specific recommendations for the individual child and there are many school-day distractions within the environment that may need adapting. Management of dysphagia is an educational priority because it threatens the academic, social and emotional wellbeing of students with disabilities.1 Building relationships within the school is vital. School nurses assigned to students with swallowing and feeding disorders can help facilitate communication3 between health and educational colleagues. A MULTIDISCIPLINARY APPROACH
Today’s schools often have a diverse cultural population which needs to be considered. The American SpeechLanguage-Hearing Association (2007) (ASHA) comments that one of the most significant aspects of a culture is its relationship between food and eating. Guidelines from this source state that:4 ‘Professionals who work with students with swallowing and feeding disorders need to be aware of the cultural beliefs and attitudes of each student’s family.