Pediatric Dysphagia
Summary Activity

In groups of two, review each of the following cases and respond to the discussion questions

Case #1

Charlie is six weeks old and was referred for a feeding evaluation secondary to FTT. His mother reports that feeding difficulties were noted post-natally, and that Charlie has been taking thickened breast milk through a bottle with a modified nipple.

• What feeding/swallowing difficulties may have prompted these feeding modifications?
• What methods are likely used to thicken breast milk?
• In what way you would you expect the nipple to be modified?
• Discuss how you would approach assessment and treatment of this case

Case # 2

Dominique was born at 30 weeks gestation and required mechanical ventilation during the first ten days following birth. She is now 4 weeks old.

• Why would mechanical ventilation be needed?
• For what medical problems does mechanical ventilation put her at risk?
• What is the impact of mechanical ventilation on feeding (at the time of ventilation, after the ventilator is no longer needed)?
• How will you determine if current feeding behaviors have been impacted by early ventilation?
• If difficulties are noted, what management strategies are likely to apply?

Case #3

John is 4 1/2 months old. His mother reports he was a fussy baby and was never a "good eater", often spitting up after even small meals. The pediatrician has now recommended a feeding evaluation

• What level of feeding skills would John be expected to exhibit at this age?
• What feeding difficulties might you expect John to exhibit given this brief history?
• What diagnostic tests will facilitate a diagnosis?
• What feeding strategies might facilitate more succesful experiences?

Case #4

Sally demonstrated normal development until age 3 when she suffered a head injury. She now coughs when swallowing liquids and refuses many foods she accepted prior to her injury.

• Describe the assessment process you would recommend for Sally
• Identify potential underlying impairments contributing to Sally's feeding difficulties and the management strategies you would recommend for each impairment

Case #5

Jacob is 8 years old and has a complicated medical history including multiple hospitalizations. His development across domains is severely delayed and he is quite medically fragile. He participates in the exceptional children's program throughout the day at his school. His teacher refers him to you because she notices that he has difficulty eating the school lunch.

• How would you respond to this referral?
• What steps would be included when initiating the assessment process?
• Assume the assessment process identifies the need for swallowing treatment - discuss the issues related to providing these services in the school setting.