Speech-language pathology services in Australian and New Zealand pediatric burn units and chemical ingestion injury

To date, little is known regarding the extent and nature of involvement of speech-language pathology (SLP) services within pediatric burn settings. The aim of this clinical service study was to investigate the role of SLP services within burn teams across Australia and New Zealand. Eleven pediatric burn units were identified as members of the Australian and New Zealand Burn Association Bi National Burns Registry. Representatives from both burn units and SLP departments at each setting were sent a link to a purpose-built online questionnaire. Seven responses from eight centers were received, with paired responses (burn units and SLP departments) being obtained from six centers. Pediatric burn units and SLP departments were found to differ in perceptions of SLP involvement in burn care. No burn units reported utilization of a protocol for referral to SLP. Dysphagia, followed by orofacial contracture management was the most frequently reported areas of SLP involvement, and multidisciplinary contribution within these areas was recognized. A majority (71%) of SLP departments reported involvement with chemical ingestion injury; however, referral rates were low. This study confirms that SLP services are utilized within Australian and New Zealand pediatric burn units, and SLPs are involved with pediatric patients with chemical ingestion injuries. However, potential exists for increased SLP input. There is also evident needed for established guidelines surrounding referrals and greater education regarding the role of SLPs within pediatric burn care

Speech-language pathology in acute pediatric chemical or button battery ingestion injury

Objectives: Dysphagia is a common consequence of pediatric ingestion injury, yet there is a lack of data relating to recommencement of oral (per os; PO) intake or use of feeding therapy. We describe patterns of early PO intake, and referral to speech-language pathology (SLP) for feeding therapy, during the acute admission of a pediatric cohort postchemical or button battery ingestion injury

Dysphagia and feeding difficulties post-pediatric ingestion injury: perspectives of the primary caregiver

To explore the experiences of children with dysphagia and/or feeding difficulties post-chemical or button battery ingestion injury from the perspective of the primary caregiver.Five primary caregivers of children with a history of dysphagia and/or feeding difficulties post-ingestion injury (4 chemical, 1 button battery) completed the Children's Picky Eating Questionnaire (CPEQ), and participated in a semi-structured interview. Interviews explored experiences of caring for a child with dysphagia and/or feeding difficulties, impressions of services and supports, and additional impacts to the child and family. Content analysis was used to identify key themes.Primary caregiver report and CPEQ results confirmed all children had some degree of persisting dysphagia and/or feeding difficulties at time of interview (mean 4.13 years' post-injury). Interviews identified five key themes: 1) The initial trauma of the injury, 2) The experience of associated and ongoing medical issues, 3) Managing altered oral intake, 4) Experiences of services and support, and 5) Impacts on the child, primary caregiver, and wider family unit. All caregivers reported significant challenges and concerns, and potential areas of service improvement were highlighted.The current data highlights specific issues experienced by primary caregivers, and poses areas for improving primary caregiver and family supports. Family-centered models of care are needed to support the whole family unit in caring for a child with dysphagia and/or feeding difficulties post-ingestion injury

Dysphagia progression and feeding skills following pediatric alkali ingestion injury: two case reports

Purpose: There is limited information regarding the nature of dysphagia and feeding difficulties following alkali ingestion injury to inform multidisciplinary intervention. The aim was to describe the history and nature of chronic dysphagia and feeding difficulties in two children following severe alkali ingestion injury. Methods: Medical records, primary caregiver report, and clinical assessment were used to compile detailed case histories and assess current dysphagia and feeding skills. Results: Both cases demonstrated heterogeneous oral motor and feeding outcomes, including delayed oral motor skills, restricted dietary variety, and difficult mealtime behaviors that contributed to protracted recovery of age-appropriate PO intake. Both children required ongoing diet and/or fluid modification and supplemental non-PO feeding via gastrostomy at the time of review, that is, 2-year post-injury. Conclusions: Recovery from dysphagia post-alkali ingestion is protracted and complex. Dysphagia, delayed oral motor skills, and difficult mealtime behaviors may persist secondary to ingestion injury and its associated complications. These cases highlight the importance of considering early referral for feeding assessment and intervention to assist children and families with recovery. Progression through safe and effective oral (per os, PO) intake is needed, as well as provision of support for primary caregivers. Implications for Rehabilitation Pediatric chemical ingestion injury can cause long-term dysphagia and long-term feeding difficulties Initial injury severity does not reliably correlate with eventuating level of aerodigestive impairment. Clinical and instrumental assessment is required to monitor swallow function to enable commencement of targeted rehabilitation when appropriate. Early involvement of a feeding therapist is recommended to minimize the long-term effects on oral motor skill development, progression to age-appropriate diet, and provision of family-centered care