Treatment of the Pediatric-Dysphagia 2

Maneuvers

Maneuvers are specific strategies used to change the timing or strength of particular movements of swallowing (Logemann, 2000). Some maneuvers require following multi-step directions and may not be appropriate for young children and/or older children with cognitive impairments. Examples of maneuvers include

:

Effortful swallow-increases posterior tongue base movement to facilitate bolus clearance.

Masako or tongue hold-tongue is held forward between the teeth while swallowing; this is performed without food or liquid in the mouth to prevent coughing or choking.

Mendelsohn maneuver-designed to elevate the larynx and open the esophagus during the swallow to prevent food/liquid from falling into the airway.

Supraglottic swallow-vocal folds are usually closed by voluntarily holding breath before and during swallow in order to protect the airway.

Super-supraglottic swallow-effortful breath hold tilts the arytenoid forward which closes the airway entrance before and during the swallow.

www.asha.org

 

Treatment of the Pediatric-Dysphagia

Postural/Positioning Techniques

Positioning techniques involve adjusting the child's posture or position during feeding. These techniques serve to protect the airway and offer safe transit of food and liquid. No single posture will provide improvement to all patients/clients, and in fact, postural changes differ between infants and older children. However, the general goal is to establish central alignment and stability for safe feeding. Techniques include

:

chin down-tucking chin down toward neck,

chin up-slighty tilting head up,

head rotation-turning head to the weak side to protect the airway,

upright positioning-45 degree angle at hips and knees, with supports as needed,

head stabilization-supported so as to present in chin neutral position,

cheek and jaw assist,

reclining position-e.g., using Boppy pillow or reclined infant seat with trunk and head support,

side-lying positioning for infants.

www.asha.org

Oral Motor And Feeding Red Flags

Lack of oral-exploration with non-food items as an infant
Difficulties transitioning between different textures of foods
Weaknesses sucking, chewing, and swallowing
Frequent coughing and/or gagging when eating
Vomiting during or after meals
Refusal to eat certain textures of foods
Rigidity with diet
Avoidance of touch on face and around mouth
Loss of food and liquids when eating
Obvious preference for certain textures or flavors of foods
Increased congestion during and after meals
Grimacing/odd facial expressions when eating
Consistent wiping of hands and face during meals
Pocketing of food in cheeks, or residue observed after swallow
Irritability and anxiety during mealtime
Excessive drooling and lack of saliva management
Sudden refusal to eat previously tolerated foods
Excessive weight gain or loss

Oral-Motor Skill Improvement
 
Fortunately, there are also many activities you can easily incorporate at home to facilitate improvements with oral-motor skills.

Blowing activities (blow-pens, instruments, whistles, etc.) help to improve posture, breath control, lip rounding, and motor-planning skills.
Infant massage may also help to increase oral-awareness and facial tone.
Straws, sour candies, and bubbles may help with drooling.
Constantly exposing your child to a variety of new foods will help to avoid food jags, and increase their tolerance to different textures and tastes.
 
If you notice that your child presents with some of the above-mentioned characteristics and does not seem to be improving, it would be advantageous to speak with a Speech-Language Pathologist about your concerns.
 
nspt4kids.com

Body Positions and Functional Training to Reduce Aspiration in Patients with Dysphagia

Hitoshi KAGAYA & et all

Body positions that minimize aspiration include the reclining position, chin down, head rotation, side inclination, the recumbent position, and combinations of these. Patients with severe dysphagia often use a 30° reclining position. But in reality, the patient must be more than 60° higher than a supine position in order to eat without assistance. There are 3 types of “chin down” positions: head flexion, neck flexion, and compound flexion (head flexionneck flexion). Patients whose pharynx are more paralyzed on either side can turn their head toward the paralyzed side to narrow the piriform fossa on the paralyzed side or use the force of gravity from a side-lying or recumbent position to guide a food bolus to the non-paralyzed side. Training methods include cervical range of motion exercises, thermal-tactile stimulation, supraglottic swallow, the Mendelsohn maneuver, head raising exercises, balloon training, respiratory physiotherapy, training for activities of daily living, and physical strength training. There is no one best body position or training method that is effective for all patients, so it is crucial that effectiveness be confirmed before use.