Assessing children's swallowing: Parent and professional perceptions

Purpose-For infants and children who have difficulties with eating, drinking and swallowing (dysphagia), there are significant health risks that include aspiration (food and fluid entering the lungs) and poor growth. Videofluoroscopy is often the instrumental method of assessment used to exclude or confirm aspiration. The purpose of this paper is to investigate parental and referrer perceptions of the reasons for and the outcomes of videofluoroscopy. Design/methodology/approach-Data were gathered through the use of structured telephone interviews before and after videofluoroscopy. Findings-Four key themes emerged: first, the importance of identifying specifically the problems with swallowing; second, understanding the rationale for videofluoroscopy; third, preparing a child for videofluoroscopy; and fourth, using videofluoroscopy to inform management. Referrers used videofluoroscopy to confirm their concerns about a child's ability to swallow safely. Practical implications-Parents understood that the purpose of videofluoroscopy was to identify specific swallowing difficulties. They reported anxieties with managing the child's positioning during the procedure and whether the child would eat. They also had concerns about outcomes from the study. Some of these issues raise questions about the true value and benefits of videofluoroscopy. Originality/value-This is the first study that considers parent views of an instrumental assessment. For some parents of children with learning disabilities, mealtimes are an important social occasion. Further studies that focus on decision making about children with learning disabilities who find feeding difficult are warranted as parents feel loss and disempowerment when decisions are made about non-oral feeding

Pediatric feeding and swallowing rehabilitation: An overview

Children with neurological disabilities frequently have problems with feeding and swallowing. Such problems have a significant impact on the health and well-being of these children and their families. The primary aims in the rehabilitation of pediatric feeding and swallowing disorders are focused on supporting growth, nutrition and hydration, the development of feeding activities, and ensuring safe swallowing with the aim of preventing choking and aspiration pneumonia. Pediatric feeding and swallowing disorders can be divided into four groups: transient, developmental, chronic or progressive. This article provides an overview of the available literature about the rehabilitation of feeding and swallowing disorders in infants and children. Principles of motor control, motor learning and neuroplasticity are discussed for the four groups of children with feeding and swallowing disorders

Speech sound development in typically developing 2-7-year-old Dutch-speaking children:A normative cross-sectional study

Background: Dutch is a West-Germanic language spoken natively by around 24 million speakers. Although studies on typical Dutch speech sound development have been conducted, norms for phonetic and phonological characteristics of typical development in a large sample with a sufficient age range are lacking. Aim: To give a detailed description of the speech sound development of typically developing Dutch-speaking children from 2 to 7 years. Methods & Procedures: A total of 1503 typically developing children evenly distributed across the age range of 2;0–6;11 years participated in this normative cross-sectional study. The picture-naming task of the Computer Articulation Instrument (CAI) was used to collect speech samples. Speech development was described in terms of (1) percentage consonants correct—revised (PCC-R) and percentage vowels correct (PVC); (2) consonant, vowel and syllabic structure inventories; (3) degrees of complexity (phonemic feature hierarchy); and (4) phonological processes. Outcomes & Results: A two-way mixed analysis of variance (ANOVA) confirmed a significant increase in the number of PCC-R and PVC between the ages of 2;0 and 6;11 years (p < 0.001). The consonant inventory was found to be complete at 3;7 years of age for the syllable-initial consonants, with the exception of the voiced fricatives /v/ and /z/, and the liquid /r/. All syllable-final consonants were acquired before age 4;4 years. At age 3;4 years, all children had acquired a complete vowel inventory, and at age 4;7 years they produced most syllable structures correctly, albeit that the syllable structure CCVCC was still developing. All phonological contrasts were produced correctly at 3;8 years of age. Children in the younger age groups used more phonological simplification processes than the older children, and by age 4;4 years, all had disappeared, except for the initial cluster reduction from three to two consonants and the final cluster reduction from two to one consonant. Conclusions & Implications: This paper describes a large normative cross-sectional study of Dutch speech sound development which, in clinical practice, can help Dutch speech–language pathologists to differentiate children with delayed or disordered speech development from typically developing children. What this paper adds What is already known on this subject In recent years many studies have been conducted worldwide to investigate speech sound development in different languages, including several that explored the typical speech sound development of Dutch-speaking children, but none of these latter studies explored both phonetic and phonological progress within a comprehensive age range and a large sample that is representative of the Dutch population. What this study adds to existing knowledge This study serves to fill this gap by providing normative cross-sectional results obtained in 1503 typically developing Dutch-speaking children aged between 2;0 and 6;11 years on informative parameters of speech development: PCC-R and PVC, consonant, vowel and syllabic structure inventories, degrees of complexity (phonemic feature hierarchy), and phonological simplification processes. What are the potential or actual clinical implications of this work? The detailed description of typical Dutch speech sound development provides speech–language pathologists with pertinent information to determine whether a child's speech development progresses typically or is delayed or disordered

Maximum repetition rate in a large cross-sectional sample of typically developing Dutch-speaking children

Item does not contain fulltextPurpose: The current study aims to provide normative data for the maximum repetition rate (MRR) development of Dutch-speaking children based on a large cross-sectional study using a standardised protocol.Method: A group of 1014 typically developing children aged 3;0 to 6;11 years performed the MRR task of the Computer Articulation Instrument (CAI). The number of syllables per second was calculated for mono-, bi-, and trisyllabic sequences (MRR-pa, MRR-ta, MRR-ka, MRR-pata, MRR-taka, MRR-pataka). A two-way mixed ANOVA was conducted to compare the effects of age and gender on MRR scores in different MRR sequences.Result: The data analysis showed that overall MRR scores were affected by age group, gender and MRR sequence. For all MRR sequences the MRR increased significantly with age. MRR-pa was the fastest sequence, followed by respectively MRR-ta, MRR-pata, MRR-taka, MRR-ka and MRR-pataka. Overall MRR scores were higher for boys than for girls, for all MRR sequences.Conclusion: This study presents normative data of MRR of Dutch-speaking children aged 3;0 to 6;11 years. These norms might be useful in clinical practice to differentiate children with speech sound disorders from typically developing children. More research on this topic is necessary. It is also suggested to collect normative data for other individual languages, using the same protocol

Mastication and Oral Motor Function in McArdle Disease: Patient Reported Complaints

Background: Exertional myalgia and cramps of the limb and trunk muscles are typical in McArdle disease, but mastication and oral motor limitations have not been systematically investigated before. Objective: Determine the reported prevalence and characteristics of limitations on oral motor activities, mastication, swallowing, and other oral motor activities in patients with McArdle disease. Methods: An observational study was carried out in 28 patients using a standardised questionnaire on mastication and oral motor function. Results: 57% of the participants reported difficulties with mastication. Muscle cramps during mastication occurred in 57% of the patients. A feeling that food remains in the throat occurred in 32%. Adaptations during mastication were needed in 42% of the patients. Mastication difficulties, muscle cramps during mastication and mastication adjustments were inversely correlated with age (r2 = –0.445, p < 0.05; r2 = –0.509, p < 0.01; r2 = –0.456, p < 0.05). Feeling of food remaining in throat, cramps during mastication and during other oral motor muscle activities, were correlated with disease severity (r2 = 0.476, p < 0.01; r2 = 0.463, p < 0.01; r2 = 0.461, p < 0.01; r2 = 0.432, p < 0.05). Conclusions: In short, reported mastication difficulties are prevalent in people with McArdle disease, most frequently in younger people. Therefore, awareness of mastication and oral motor problems is require

International standardisation of the test of masticating and swallowing solids in children

The Test of Masticating and Swallowing Solids (TOMASS) is a validated assessment tool measuring the efficiency of solid bolus intake by four quantitative parameters: discrete bites, masticatory cycles, swallows and time to ingest a single cracker. A normative database for adults (20-80+ years) has previously been established. The objective of this study was to investigate the applicability and reliability of the TOMASS in children and adolescents (TOMASS-C) and to establish the normative database for this younger population. We collected data from 638 participants (male: 311, female: 327) in five age groups (4-18\ua0years) with five different but very similar test crackers in four countries. Significant effects of bolus type (cracker), age group and gender on the TOMASS parameters were identified, requiring stratification of the TOMASS-C database by these variables. Intra-rater reliability was excellent (ICC\ua0>\ua00.94) for all parameters; inter-rater reliability was moderate for "number of swallows" (ICC\ua0=\ua00.54), good for "bites" (ICC\ua0=\ua00.78) and "time" (ICC\ua0=\ua00.82), and excellent for "masticatory cycles" (ICC\ua0=\ua00.96). The "Test of Masticating and Swallowing Solids in Children (TOMASS-C)" was identified to be a reliable diagnostic tool for the comprehensive measurement of discrete oral stage components of solid bolus ingestion, standardised by a large normative database that covers age groups from preschoolers to young adults. While differences between gender groups were less pronounced than in the adult population, previous results relating to changes in masticatory and swallowing as a function of age are confirmed by our data

Mastication in Patients with Spinal Muscular Atrophy Types 2 and 3 is Characterized by Abnormal Efficiency, Reduced Endurance, and Fatigue

Mastication problems can have a negative impact on the intake of food and quality of life. This cross-sectional study characterizes mastication problems using clinical and instrumental assessments in patients with spinal muscular atrophy (SMA) types 2 and 3 with self-reported bulbar problems. We included 27 patients (aged 13–67 years), 18 with SMA type 2 and 9 patients with SMA type 3 (of whom three were still ambulant) and applied a questionnaire, clinical mastication tests (TOMASS and 6-min mastication test), and muscle ultrasound of the mastication muscles. Non-ambulant patients demonstrated inefficient mastication as reflected by median z scores for masticatory cycles (z = 1.8), number of swallows (z = 4.3) and time needed to finish the cracker (z = 3.4), and limited endurance of continuous mastication as demonstrated by the median z scores of the 6-min mastication test (z = − 1.5). Patients reported increased fatigue directly after the 6-min mastication test as well as 5 min after completing the test (p < 0.001; p = 0.003). Reduced maximal mouth opening was associated with mastication problems (p < 0.001). Muscle ultrasound of the mastication muscles showed an abnormal muscle structure in 90% of both ambulant and non-ambulant patients. This study aims to understand the nature and underlying mechanisms of mastication problems in patients with SMA types 2 and 3 with reported bulbar problems

Challenges experienced with early introduction and sustained consumption of allergenic foods in the Enquiring About Tolerance (EAT) study: A qualitative analysis.

BACKGROUND: The early introduction group participants of the Enquiring About Tolerance study were asked to undertake a proscriptive regimen of early introduction and sustained consumption of 6 allergenic foods. It was envisaged that this might be challenging, and early introduction group families were presented with an open-text question to express any problems they were experiencing with the regimen in recurring online questionnaires. OBJECTIVE: We sought to analyze these open-text questionnaire responses with the aim of identifying challenges associated with the introduction and regular consumption of allergenic foods. METHODS: Three combinations of interim questionnaire responses were selected for analysis, representing the early period (4, 5, and 6 months), middle period (8 and 12 months), and late period (24 and 36 months) of participation in the Enquiring About Tolerance study. Responses were assigned a code to describe their content and subsequently grouped into themes to portray key messages. A thematic content analysis allowed for conversion of qualitative codes into quantitative summaries. RESULTS: Three main challenges to allergenic food consumption were identified. First, some children refused the allergenic food, causing a sense of defeat among caregivers. Second, caregivers were concerned that allergenic foods might be causing a reaction, triggering a need for reassurance. Third, practical problems associated with the regimen compromised caregivers' capacity to persist. CONCLUSION: Understanding the challenges experienced with allergenic food introduction and sustained consumption is the necessary precursor to developing specific communication and support strategies that could be used by caregivers, practitioners, policymakers, and key stakeholders to address these problems

Appropriate age range for introduction of complementary feeding into an infant’s diet

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