Kean University



Spring, 2010

Kean University

Union, New Jersey

Pediatric Dysphagia

Course Number: CDD 5265

Semester Hours: 1.5

Limitations on Enrollment: 25

Catalog Description

Evaluation and management of infants and children with oral-motor dysfunction, feeding difficulties and swallowing problems.

N.B. In order to ensure full class participation, any student with a disabling condition requiring special accommodations (e.g., tape recorders, special adaptive equipment, special note-taking or test-taking procedures) is strongly encouraged to contract the professor at the beginning of the course. For the students’ convenience, both the professor’s phone number and e-mail address is listed on the syllabus.

Kean University

Union, New Jersey

CDD 5265: Pediatric Dysphagia

I. Course Objectives: Students will achieve growth toward becoming informed, dynamic professionals by demonstrating proficiency in knowledge (K), skill application (S) and dispositions (D) related to assessment and treatment plans for the infant, child and/or adolescent presenting with oro-phraryngeal swallowing and feeding disorders

.

The student will:

A. understand the significant differences in the physiology and anatomy of the swallowing mechanism of the child and the adult and the nature of development (K).

B. internalize the normal developmental sequence of oro-motor, swallowing and feeding skills (K,S).

C. identify medical conditions/etiologies associated with pediatric dysphagia (K,S).

D. evaluate a wide age range of children from neonates through adolescents with developmental disabilities (K,S).

E. investigate, compare and contrast alternative models of service delivery to meet the individual needs of the child (K,S,D).

F. examine issues related to instrumentation assessment of dysphagia including but not limited to Video-Fluoroscopic Swallow Studies, Ultra Sound, Fiber-Optic Endoscopic Swallowing Assessment, Cervical Auscultation (K,S,D).

G. analyze pediatric dysphagia assessments presented via videotape and case review (K,S,D).

H. integrate methods, materials and procedures used in the treatment of pediatric swallowing disorders (K,S).

I. strategize appropriate habilitative goals for systematic swallowing/feeding development (S,D).

J. design swallowing/feeding intervention programs that address form, content and use issues (S,D).

K. utilize the nomenclature that describes the diagnosis and treatment of pediatric swallowing and feeding disorders (K).

L. identify and correlate the legal and ethical issues currently impacting the professions regarding the assessment and treatment of pediatric dysphagia (K,D).

II. Course Content:

A. The anatomy and physiology of the swallowing mechanism.

1. The structures and musculature involved in swallowing

a. Structural differences between infants and older children

b. Anatomical changes and function

2. The stages of swallowing

a. Anticipatory

b. Oral preparatory

c. Oral Transport

d. Pharyngeal

e. Esophageal

B. Normal development of feeding skills

1. Issues of normal development that influence feeding/swallowing skills

2. A sequential overview of feeding skills

a. Newborns

b. Three- to six-month olds

c. Nine-month olds

d. Twelve-month olds

e. Fifteen-month olds

f. Eighteen-month olds

g. Two-year olds

C. Etiology of pediatric swallowing disorders

1. Prematurity and special diagnostic categories related to prematurity

a. Intercranial Hemorrhage (ICH)

b. Necrotizing Enterocolitis (NEC)

c. Bronchopulmonary Dysplasia (BPD)

d. Congenital Heart Disease

2. Failure to Thrive Syndrome

3. Acquired Immunodeficiency System (AIDS)

4. Cerebral Palsy

5. Traumatic Brain Injury

6. Pierre Robin Sequence/Micrognathia

7. Craniofacial anomalies

8. Tracheo-esophageal fistulae/esophageal atresia

9. Congenital heart disease

10. Gastro-Esophageal Reflux Disease (GERD)

D. Clinical evaluation of pediatric dysphagia

1. Multidisciplinary assessment of feeding/swallowing

2. Case history

a. nutrition and hydration

i. alternate means of feeding

ii. feeding patterns

iii . reported feeding concerns

b. caregiver-child relationship

c. medical, neurological and surgical histories

d. birth and developmental histories

e. sleep and feeding patterns

f. behavioral concerns

3. Assessment/observation

a. Infants

b. Children

4. Distress signals during feeding

5. Breast feeding and the child with feeding disorders

6. State of alertness and response to stimulation

E. Models of service delivery

1. In-patient care

a. Hospital

b. Rehabilitation center

2. Home care

3. Early Intervention (EI)

4. Outpatient clinic

5. Educational settings

F. Instrumentation and technology

1. Videofluoroscopy

2. Cervical Auscultation (CA)

3. Ultrasound

4. Fiberoptic endoscopy (FEES)

5. Manometry

6. Scintigraphy

G. Case reviews

1. Assessment

2. Diagnostic procedures (instrumentation)

3. Treatment applications

H. Treatment principles and perspectives

1. Environmental factors

2. Sensory processing issues

3. Positioning and handling factors

4. Oral-motor treatment

5. Equipment/materials for assessment and treatment

6. Issues of nutrition

7. Specific treatment techniques for:

a. Children who are tube fed

b. Children with cleft palate

c. Children who drool

d. Children with behavioral feeding problems

I. Treatment plan development

1. Parent/caregiver input

2. Goals and objectives

a. Medical model vs. educational model

b. Establishing/prioritizing/writing goals

3. Demonstrating the plan

4. Establishing follow-up

J. Swallowing/feeding intervention programs

1. Creating an environment at mealtime to foster learning and communication utilizing the content, form and use aspects of language

2. Setting priorities

3. Problem-solving during the treatment session

K. The vocabulary of dysphagia

1. Descriptive terms for treatment, e.g., nutritive and non-nutritive sucking, gavage

2. Descriptive terms for observation of feeding/swallowing. e.g., asynchronous pattern, suck-swallow-breathe ratio, grooving, cupping, piecemeal deglutition

3. Terms of medical complication, e.g., apnea, stridor, laryngospasm, reflux induced bronchospasm, atresia, strictures

L. Legal and ethical issues

1. Effects on provision of service

a. In educational setting

b. Health care facilities

c. Home care

d. Early Intervention

2. Professional liability, certification, licensure, supervision.

3. Patient/guardian rights

III. Methods of Instruction

A. Lectures/Guest Lectures

B. Case Study team decisions and discussions

C. Collaborative projects

D. Video presentations

E. Hands-on use of therapeutic equipment

F. Reading assignments

G. Personal research study

IV. Methods of Evaluation

A. Quality and quantity of participation of in-class discussion (S,D)

B. Research project (K,S,D)

C. Case review and submission of therapy plan (K,S,D)

D. Written examination (K,D)

V. Required Texts:

Swigert, Nancy, (2010). The Source for Pediatric Dysphagia, Second Edition. Linguisystems

VI. Bibliography.

Arvedson, J.  & Homer, E. (2006, September 26). Managing Dysphagia in the Schools. The ASHA Leader.

Carrrau, R. & Murry, T. (2007). Comprehensive Management of Swallowing Disorders (2nd ed). San Diego, CA: Singular Publishing Group, Inc.

Dollaghan, D. (2007). The Handbook for Evidence-Based Practice in Communication Disorders. Baltimore, MD: Brookes Publishing Co.

Fraker, C, Fishbein M, Cox S., and Walbert L, (2007)

Food Chaining: The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet. San Diego, CA: Singular Publishing Group.

Leonard & Kendall (2008) Dysphagia assessment and treatment planning, (2nd ed) Plural Publishing.

Twachtman-Reily, J., Amaral SC, and Zebrowski PP. (2008) Research: Addressing Feeding Disorders in Children on the Autism Spectrum in School-Based Settings: Physiological and Behavioral Issues, in Language, Speech and Hearing Services in Schools, Volume 39, Issue 2, p. 2651-272.

Mathers-Schmidt, B. A., & Kurlinski, M. (2003). Dysphagia evaluation practices: Inconsistencies in clinical assessment and instrumental examination decision-making. Dysphagia, 18 (2), 114-125.

Seminal Works:

Abraham, S. S., & Wolf, E. L. (2001). Swallowing physiology of toddlers with long-term tracheostomies: A preliminary study. Dysphagia, 15 (4), 206-212.

Arvedson, J,. & Brodsky, L. (2001). Pediatric swallowing and feeding assessment

and management, San Diego, CA: Singular Publishing Group, Inc.

Arvedson, J.C., & Sheppard, J. J. (2002). Evidence-based practice in the NICU. Swallowing and Swallowing Disorders, 12-15.

Arvedson, J., and Lefton-Greif, M.A. (2000). Pediatric videofluoroscopic swallow studies: A professional manual with caregiver guidelines. San Antonio, TX: The Psychological Corporation.

Arvedson, J. and Brodsky, L., (1993). Pediatric swallowing and feeding assessment and management, San Diego, CA: Singular Publishing Group, Inc.

ASHA. (2001). Special Interest Division 13: Swallowing and swallowing disorders (Dysphagia). Rockville, MD: ASHA.

Bahr, D. C. (2001). Oral motor assessment and treatment: Ages and stages. Needham Heights, MA: Pearson Education Company.

Cherney, L.R. (1994). Clinical management of dysphagia in adults and children, Baltimore, MD: Aspen Publishers.

Fraker, C. and Walbert, L. (2003) Evaluation and Treatment of Pediatric Feeding Disorders: From NICU to Childhood. San Diego, CA: Singular Publishing Group.

Groher, M. E. (1984). Dysphagia: Diagnosis and management Boston, MA: Butterworth-Heinemann.

Hall, K. D. ((2001). Pediatric dysphagia resource guide. San Diego, CA: Singular Publishing Group.

Hartnick, C., Miller, J., Hartley, C., Benjamin, E., & Willging, P. J. (2001). Pediatric fiberoptic endoscopic evaluation of swallowing. Annals of Otology, Rhinology & Laryngology, 109 (11), 996-999.

Kertoy, M. (2002). Children with tracheostomies resource guide. London, UK: Singular Thomson Learning.

Logemann, J. (1983). Evaluation and treatment of swallowing disorders. San Diego, CA: College Hill Press.

Miller, C. K., Burklow, K. A., Santoro, K., Kirby, E., Mason, D., & Rudolph, C. D. (2001). An interdisciplinary team approach to the management of pediatric feeding and swallowing disorders. Children’s Health Care, 30 (3), 201-218.

Morris, S.E., & Klein, M.D. (2001). Pre-feeding skills: A comprehensive resource for mealtime development. San Antonio, TX: The Psychological Corporation.

Newman, L. A. (2001). Anatomy and physiology of the infant swallow. Swallowing and Swallowing Disorders, 3-4.

Newman, L. A., Keckley, C., Petersen, M. C., & Hamner, A. (2001). Swallowing function and medical diagnosis in infants suspected of dysphagia. Pediatrics, 108 (6), 106-116.

Owre, D. W. (2001). A “real world” focus on dysphagia intervention in schools. Swallowing and Swallowing Disorders, 13-15.

Rogers B.(2004). Feeding method and health outcomes of children with cerebral palsy. Journal of Pediatrics, 145(1): 97-112.

Rosenthal, S. (1995). Dysphagia and the child with developmental disabilities: Medical, clinical, and family interventions. San Diego, CA: Singular Publishing Group, Inc.

Schwartz, S. M., Correndor, J., & Fisher-Medena, J. (2001). Diagnosis and treatment of feeding disorders in children with developmental disabilities. Pediatrics, 108 (8), 671-676.

Sheppard, J. J. (2001). School-based management of dysphagia in children with developmental disabilities. Swallowing and Swallowing Disorders, 13-14.

Sheppard, J. J. (2001). Case management challenges in pediatric dysphagia. Dysphagia, 16 (1), 74-80.

Swigert, N.B. (1998). The source for pediatric dysphagia, East Moline, IL: LinguiSystems, Inc.

Wolf, L.F., and Glass, R.P. (1992). Feeding and swallowing disorders in infancy: Assessment and management. San Antonio, TX: Therapy Skill Builders.

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