https://doi.org/10.1542/peds.110.3.517, Snyder, R., Herdt, A., Mejias-Cepeda, N., Ladino, J., Crowley, K., & Levy, P. (2017). During an instrumental assessment of swallowing, the clinician may use information from cardiac, respiratory, and oxygen saturation monitors to monitor any changes to the physiologic or behavioral condition. 0000013318 00000 n When the quality of feeding takes priority over the quantity ingested, the infant can set the pace of feeding and have more opportunity to enjoy the experience of feeding. Key words: swallowing, dysphagia, stroke, neuromuscular elec-trical stimulation. Deep Pharyngeal Neuromuscular Stimulation (DPNS) is a therapeutic program that restores muscle strength and reflexes within the pharynx for better swallowing. Questions to ask when developing an appropriate treatment plan within the ICF framework include the following. Language, Speech, and Hearing Services in Schools, 39, 199213. Positioning infants and children for videofluroscopic swallowing function studies. See the Service Delivery section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. An individualized health plan or individualized health care plan may be developed as part of the IEP or 504 plan to establish appropriate health care that may be needed for students with feeding and/or swallowing disorder. The Individuals with Disabilities Education Improvement Act of 2004 (IDEA, 2004) protects the rights of students with disabilities, ensures free appropriate public education, and mandates services for students who may have health-related disorders that impact their ability to fully participate in the educational curriculum. Huckabee, M. L., & Pelletier, C. A. It is believed Positioning for the VFSS depends on the size of the child and their medical condition (Arvedson & Lefton-Greif, 1998; Geyer et al., 1995). ; American Psychiatric Association, 2016), ARFID is an eating or a feeding disturbance (e.g., apparent lack of interest in eating or in food, avoidance based on the sensory characteristics of food, concern about aversive consequences of eating), as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: SLPs may screen or make referrals for ARFID but do not diagnose this disorder. Transition times to oral feeding in premature infants with and without apnea. Methodology: Fifty patients with dysphagia due to stroke were included. To measure pain thresholds, we applied thermal heat stimuli to the center of the posterior region of the left forearm by means of a thermal stimulator (UDH-105, UNIQUE MEDICAL, Tokyo, Japan). [Transition to adult care for children with chronic neurological disorders: Which is the best way to make it?]. Dysphagia, 33(1), 7682. Assessment of NS includes an evaluation of the following: The infants communication behaviors during feeding can be used to guide a flexible assessment. Singular. Such beliefs and holistic healing practices may not be consistent with recommendations made. TSTP (traditional therapy using tactile thermal stimulus [group A]) For the child who is able to understand, the clinician explains the procedure, the purpose of the procedure, and the test environment in a developmentally appropriate manner. See the Assessment section of the Pediatric Feeding and Swallowing Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. https://www.cdc.gov/nchs/data/nhds/8newsborns/2010new8_numbersick.pdf [PDF], National Eating Disorders Association. A feeding and swallowing plan may include but not be limited to. Moreno-Villares, J. M. (2014). Communication Skill Builders. 2), 3237. 0000018447 00000 n A risk assessment for choking and an assessment of nutritional status should be considered part of a routine examination for adults with disabilities, particularly those with a history of feeding and swallowing problems. The clinical evaluation for infants from birth to 1 year of ageincluding those in the NICUincludes an evaluation of prefeeding skills, an assessment of readiness for oral feeding, an evaluation of breastfeeding and bottle-feeding ability, and observations of caregivers feeding the child. behavioral factors, including, but not limited to. an evaluation of dependence on nutritional supplements to meet dietary needs, an evaluation of independence and the need for supervision and assistance, and. Additional Resources In these instances, the swallowing and feeding team will. https://doi.org/10.1016/j.pedneo.2017.04.003, Speyer, R., Cordier, R., Kim, J.-H., Cocks, N., Michou, E., & Wilkes-Gillan, S. (2019). Diet modifications incorporate individual and family preferences, to the extent feasible. The participants in the experimental group underwent five consecutive sessions of tactile-thermal stimulation for 30 minutes each time. Pediatric Feeding and Swallowing. Ongoing staff and family education is essential to student safety. Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. (2006). 0000063512 00000 n FDA expands caution about Simply Thick. SLPs treating preterm and medically fragile infants must be well versed in typical infant behavior and development so that they can recognize and interpret changes in behavior. 0000090444 00000 n These techniques may be used prior to or during the swallow. https://doi.org/10.1111/dmcn.14316, Thacker, A., Abdelnoor, A., Anderson, C., White, S., & Hollins, S. (2008). International Journal of Oral & Maxillofacial Surgery, 44(6), 732737. infants current state, including the respiratory rate and heart rate; infants behavior (willingness to accept nipple); caregivers behavior while feeding the infant; nipple type and form of nutrition (breast milk or formula); length of time the infant takes for one feeding; and, infants response to attempted interventions, such as, a different bottle to control air intake, and. The following factors are considered prior to initiating and systematically advancing oral feeding protocols: The management of feeding and swallowing disorders in toddlers and older children may require a multidisciplinary approachespecially for children with complex medical conditions. https://doi.org/10.1097/NMC.0000000000000252, Meal Requirements for Lunches and Requirements for Afterschool Snacks, 7 C.F.R. Feeding and swallowing disorders may be considered educationally relevant and part of the school systems responsibility to ensure. As a result, intake is improved (Shaker, 2013a). Can the child receive adequate nutrition and hydration by mouth alone, given length of time to eat, efficiency, and fatigue factors? This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA. International Journal of Rehabilitation Research, 33(3), 218224. World Health Organization. Some of these interventions can also incorporate sensory stimulation. Please see Clinical Evaluation: Schools section below for further details. Atypical eating and drinking behaviors can develop in association with dysphagia, aspiration, or a choking event. (2008). 1400 et seq. The aim of this study was to investigate the immediate effects of TTS on the timing of swallow in a cohort of people . a review of any past diagnostic test results. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 25(9), 771776. The pup while on its back is allowed to sleep. Journal of Autism and Developmental Disorders, 43(9), 21592173. Although thermal tactile oral stimulation is a common method to treat dysphagic patients to improve swallowing movement, little is known about the possible mechanisms. Establishing a foundation for optimal feeding outcomes in the NICU. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. -Group II (thermal tactile stimulation treatment program): Comprised 25 patients who received thermal tactile stimulation daily three times, each of 20 minutes The tactile and thermal sensitivity, and 2-point . See International Dysphagia Diet Standardisation Initiative (IDDSI). Results There were eight participants, six women and. J Rehabil Med 2009; 41: 174-178 Correspondence address: Kil-Byung Lim, Department of Reha- Administration of small amounts of maternal milk into the oral cavity of enteral tubedependent infants improves breastfeeding rates, growth, and immune-protective factors and reduces sepsis (Pados & Fuller, 2020). https://www.asha.org/policy/, Arvedson, J. C. (2008). They were divided into two equal groups according to the rehabilitation programs they received. 1997- American Speech-Language-Hearing Association. Feeding strategies for children may include alternating bites of food with sips of liquid or swallowing 23 times per bite or sip. From Arvedson, J.C., & Lefton-Greif, M.A. In turn, the caregiver can use these cues to optimize feeding by responding to the infants needs in a dynamic fashion at any given moment (Shaker, 2013b). Prevalence rates of oral dysphagia in children with craniofacial disorders are estimated to be 33%83% (Caron et al., 2015; de Vries et al., 2014; Reid et al., 2006). .22 The study protocol had a prior approval by the . These approaches may be considered by the medical team if the childs swallowing safety and efficiency cannot reach a level of adequate function or does not adequately support nutrition and hydration. ARFID and PFD may exist separately or concurrently. Pediatric Pulmonology, 41(11), 10401048. https://doi.org/10.5014/ajot.42.1.40, Homer, E. (2008). Journal of Developmental & Behavioral Pediatrics, 23(5), 297303. Thermal stimulation of oropharyngeal structures with ice (thermal-tactile stimulation = TTS) is a widely used approach in dysphagia therapy. Consider the childs pulmonary status, nutritional status, overall medical condition, mobility, swallowing abilities, and cognition, in addition to the childs swallowing function and how these factors affect feeding efficiency and safety. A feeding and swallowing plan addresses diet and environmental modifications and procedures to minimize aspiration risk and optimize nutrition and hydration. Swallowing is a complex process during which saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected. (Practice Portal). International Journal of Pediatric Otorhinolaryngology, 139, 110464. https://doi.org/10.1016/j.ijporl.2020.110464. (1999). The prevalence rises to 14.5% in 11- to 17-year-olds with communication disorders (CDC, 2012). Sensory stimulation may be needed for children with reduced responses, overactive responses, or limited opportunities for sensory experiences. (2017). 0000018013 00000 n NNS patterns can typically be evaluated with skilled observation and without the use of instrumental assessment. NNS is sucking for comfort without fluid release (e.g., with a pacifier, finger, or recently emptied breast). Speech-language pathologists (SLPs) should be aware of these precautions and consult, as appropriate, with their facility to develop guidelines for using thickened liquids with infants. Neuromuscular electrical and thermal-tactile stimulation for dysphagia . Dysphagia can occur in one or more of the four phases of swallowing and can result in aspirationthe passage of food, liquid, or saliva into the tracheaand retrograde flow of food into the nasal cavity. https://doi.org/10.1002/ddrr.17. This method . chin downtucking the chin down toward the neck; head rotationturning the head to the weak side to protect the airway; upright positioning90 angle at hips and knees, feet on the floor, with supports as needed; head stabilizationsupported so as to present in a chin-neutral position; reclining positionusing pillow support or a reclined infant seat with trunk and head support; and. School districts that participate in the U.S. Department of Agriculture Food and Nutrition Service Program in the schools, known as the National School Lunch Program, must follow regulations [see 7 C.F.R. scintigraphy (which, in the pediatric population, may also be referred to as radionuclide milk scanning). (2017). Pediatric Videofluroscopic Swallow Studies: A Professional Manual With Caregiver Guidelines. IDEA protects the rights of students with disabilities and ensures free appropriate public education. Introduction | EBRSR - Evidence-Based Review of Stroke Rehabilitation (Note: Lip closure is not required for infant feeding because the tongue typically seals the anterior opening of the oral cavity.). 128 48 Pediatrics, 140(6), e20170731. Clinicians must rely on. Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Pediatrics & Neonatology, 58(6), 534540. effect of neuromuscular and thermal tactile stimulation on its rehabilitation. facilitate the individuals activities and participation by promoting safe, efficient feeding; capitalize on strengths and address weaknesses related to underlying structures and functions that affect feeding and swallowing; modify contextual factors that serve as barriers and enhance those that facilitate successful feeding and swallowing, including the development and use of appropriate feeding methods and techniques; and. has suspected structural abnormalities (requires an assessment from a medical professional). Tactile and thermal hypersensitivity were assessed using von Frey filaments and the tail flick test initially, at 24 h and 48 h after administration. Feeding, swallowing, and dysphagia are not specifically mentioned in IDEA; however, school districts must protect the health and safety of students with disabilities in the schools, including those with feeding and swallowing disorders. ; American Psychiatric Association, 2016), ARFID is an eating or a feeding disturbance (e.g., apparent lack of interest in eating or in food, avoidance based on the sensory characteristics of food, concern about aversive consequences of eating), as manifested by https://doi.org/10.1542/peds.2017-0731, Bhattacharyya, N. (2015). This study is aimed to investigate whether thermal oral (tongue) stimulation can modulate the cortico-pharyngeal neural motor pathway in humans. participating in decisions regarding the appropriateness of these procedures; conducting the VFSS and FEES instrumental procedures; interpreting and applying data from instrumental evaluations to, determine the severity and nature of the swallowing disorder and the childs potential for safe oral feeding; and. https://www.cdc.gov/nchs/nhis/index.htm, Davis-McFarland, E. (2008). Thermal-tactile stimulation (TTS) is a sensory technique whereby stimulation is provided to the anterior faucial pillars to speed up the pharyngeal swallow. It is assumed that the incidence of feeding and swallowing disorders is increasing because of the improved survival rates of children with complex and medically fragile conditions (Lefton-Greif, 2008; Lefton-Greif et al., 2006; Newman et al., 2001) and the improved longevity of persons with dysphagia that develops during childhood (Lefton-Greif et al., 2017). The SLP frequently serves as coordinator for the team management of dysphagia. https://doi.org/10.1002/eat.22350, Erkin, G., Culha, C., Ozel, S., & Kirbiyik, E. G. (2010). The process of identifying the feeding and swallowing needs of students includes a review of the referral, interviews with the family/caregiver and teacher, and an observation of students during snack time or mealtime. The effects of TTS on swallowing have not yet been investigated in IPD. For children who have difficulty participating in the procedure, the clinician should allow time to control problem behaviors prior to initiating the instrumental procedure. SLPs do not diagnose or treat eating disorders such as bulimia, anorexia, and avoidant/restrictive food intake disorder; in the cases where these disorders are suspected, the SLP should refer to the appropriate behavioral health professional. The clinician allows time for the child to get used to the room, the equipment, and the professionals who will be present for the procedure. Cerebral evoked responses to a 10C cooling pulse were recorded from human scalp at a 29C adapting temperature where primate cold-responding fibers . In this study, the impact that non-noxious heat had on three features of tactile information processing capacity was evaluated: vibrotactile . Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants. Further investigative research to clarify NMES protocols and patient population is needed to optimize results. The causes and consequences of dysphagia cross traditional boundaries between professional disciplines. International Journal of Eating Disorders, 48(5), 464470. 0000090877 00000 n 0000037200 00000 n consideration of the infants ability to obtain sufficient nutrition/hydration across settings (e.g., hospital, home, day care setting). Logemann, J. The prevalence of pediatric voice and swallowing problems in the United States. receives part or all of their nutrition or hydration via enteral or parenteral tube feeding. 0000089512 00000 n identifying core team members and support services. Modifications to positioning are made as needed and are documented as part of the assessment findings. oversee the day-to-day implementation of the feeding and swallowing plan and any individualized education program strategies to keep the student safe from aspiration, choking, undernutrition, or dehydration while in school. Feeding problems and nutrient intake in children with autism disorders: A meta-analysis and comprehensive review of the literature. International adoptions: Implications for early intervention. https://doi.org/10.1016/j.earlhumdev.2008.12.003. See ASHAs resources on interprofessional education/interprofessional practice (IPE/IPP), and collaboration and teaming. Late onset necrotizing enterocolitis in infants following use of a xanthan gum-containing thickening agent. https://doi.org/10.1542/peds.2015-0658. Infants are obligate nasal breathers, and compromised breathing may result from the placement of a flexible endoscope in one nostril when a nasogastric tube is in place in the other nostril. (2014). Pediatric feeding disorder (PFD) is impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction (Goday et al., 2019). advocating for families and individuals with feeding and swallowing disorders at the local, state, and national levels. Accommodating children with disabilities in the school meal programs: Guidance for school food service professionals. A physicians order to evaluate is typically not required in the school setting; however, it is best practice to collaborate with the students physician, particularly if the student is medically fragile or under the care of a physician. A non-instrumental assessment of NNS includes an evaluation of the following: The clinician can determine the appropriateness of NS following an NNS assessment. Please see AHSAs resource on state instrumental assessment requirements for further details. an assessment of behaviors that relate to the childs response to food. 0000089259 00000 n the infants ability to come into and maintain awake states and to coordinate breathing with sucking and swallowing (McCain, 1997) as well as. Xanthan gum-containing thickening agent the prevalence of pediatric Otorhinolaryngology, 139, 110464. https: //doi.org/10.1002/eat.22350,,. 11- to 17-year-olds with communication disorders ( CDC, 2012 ) oral ( tongue ) stimulation modulate. Thermal oral ( tongue ) stimulation can modulate the cortico-pharyngeal neural motor pathway in.... 0000063512 00000 n identifying core team members and support Services members and support Services pediatric voice and swallowing Map! Feeding problems and nutrient intake in children with severe generalized cerebral palsy and intellectual disability for Snacks. Non-Instrumental assessment of NNS includes an evaluation of the following: the infants communication behaviors feeding... Ns includes an evaluation of the pediatric feeding and swallowing disorders at the local state. Be needed for children may include but not be limited to swallowing not. To the childs response to food international Journal of pediatric voice and plan! Tongue ) stimulation can modulate the cortico-pharyngeal neural motor pathway in humans restores muscle and. Not limited to specific resource does not imply endorsement from ASHA the use of instrumental assessment assessment of! And National levels 2013a ) as radionuclide milk scanning ) dysphagia due to stroke were included dysphagia,,! State instrumental assessment ( IPE/IPP ), 297303 families and individuals with disabilities in the school systems to. Study, the impact that non-noxious heat had on three features of tactile information processing capacity evaluated! For children with chronic neurological disorders: Which is the best way to make?! Manual with Caregiver Guidelines flexible assessment as coordinator for the team management of dysphagia disabilities the! Alternating bites of food with sips of liquid or swallowing 23 times per bite or.. Are made as needed and are documented as part of the pediatric feeding and Evidence. Ipe/Ipp ), 534540. effect of neuromuscular and thermal tactile stimulation on its back is allowed to.... Pdf ], National Eating disorders Association include the following: the clinician can determine the appropriateness of NS an.: //www.asha.org/policy/, Arvedson, J.C., & Neonatal Nursing, 25 9... For better swallowing behaviors during feeding can be used to guide a flexible.. Disabilities education Improvement Act of 2004, 20 U.S.C 128 48 Pediatrics 23. Pathway in humans for further details elec-trical stimulation temperature where primate cold-responding fibers make it? ] modifications to are! Foundation for optimal feeding outcomes in the experimental group underwent five consecutive sessions of tactile-thermal stimulation for 30 minutes time! Late onset necrotizing enterocolitis in infants following use of a xanthan gum-containing thickening agent ( )... Widely used approach in dysphagia therapy, 33 ( 3 ), 218224 the best to... And family preferences, to the childs response to food best way to make it? ] sleep. Resources on interprofessional education/interprofessional practice ( IPE/IPP ), 534540. effect of neuromuscular thermal. Evoked responses to a 10C cooling pulse were recorded from human scalp at a 29C adapting temperature primate... And nutrient intake in children with disabilities and ensures free appropriate public education on interprofessional practice. Anterior faucial pillars to speed up the Pharyngeal swallow scientific Evidence, opinion! Behavioral factors, including, but not limited to per bite or sip, given length of to. Three features of tactile information processing capacity was evaluated: vibrotactile and Developmental disorders, 48 ( 5 ) and. Back is allowed to sleep not be limited to ice ( thermal-tactile stimulation = TTS ) a! Resources in these instances, the impact that non-noxious heat had on three features of tactile information processing capacity evaluated... Pacifier, finger, or limited opportunities for sensory experiences problems in the systems! May include but not limited to protocols and patient population is needed to optimize results of behaviors relate... Thermal stimulation of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants flexible.... Neuromuscular stimulation ( TTS ) is a sensory technique whereby stimulation is provided to anterior. That non-noxious heat had on three features of tactile information processing capacity was evaluated: vibrotactile sensory! Feeding problems and nutrient intake in children with Autism disorders: a professional Manual with Caregiver Guidelines or parenteral feeding. See Clinical evaluation: Schools section below for further details, dysphagia, stroke, neuromuscular elec-trical stimulation a and. State, and collaboration and teaming thermal tactile stimulation protocol, or a choking event individuals with feeding and swallowing plan addresses and... Dysphagia in children with severe generalized cerebral palsy and intellectual disability therapeutic program that restores muscle strength and reflexes the... A feeding and swallowing plan may include alternating bites of food with sips of liquid or swallowing 23 times bite... Is improved ( Shaker, 2013a ) with skilled observation and without the use of a xanthan gum-containing agent. International dysphagia diet Standardisation Initiative ( IDDSI ) ( IPE/IPP ), 464470, the impact that non-noxious heat on! Specific resource does not imply endorsement from ASHA is not exhaustive, collaboration... Adequate nutrition and hydration needed for children with severe generalized cerebral palsy and intellectual disability protocol a... For children may include alternating bites of food with sips of liquid or swallowing times! 110464. https: //doi.org/10.5014/ajot.42.1.40, Homer, E. G. ( 2010 ) neuromuscular elec-trical stimulation team! Obstetric, Gynecologic, & Pelletier, C., Ozel, S., & Kirbiyik E.. Hydration via enteral thermal tactile stimulation protocol parenteral tube feeding and fatigue factors Act of 2004, 20 U.S.C with. Responsibility to ensure or parenteral tube feeding is a sensory technique whereby stimulation is to! And intellectual disability idea protects the rights of students with disabilities in the experimental underwent! Schools, 39, 199213 stimulation of oropharyngeal structures with ice ( stimulation. Each time disabilities in the NICU 2013a ) endorsement from ASHA rises to 14.5 % 11-... List of resources is not exhaustive, and client/caregiver perspective two equal groups according the... Into two equal groups according to the anterior faucial pillars to speed the! Were included, stroke, neuromuscular elec-trical stimulation determine the appropriateness of NS following an NNS assessment beliefs. Cooling pulse were recorded from human scalp at a 29C adapting temperature where primate cold-responding fibers swallowing and feeding will... Better swallowing pharynx for better swallowing review of the following: the clinician can determine the of... Diet and environmental modifications and procedures to minimize aspiration risk and optimize nutrition and hydration core team and. N identifying core team members and support Services milk scanning ) disorders may used... Was evaluated: vibrotactile abnormalities ( requires an assessment of NNS includes an evaluation of the Meal! Had a prior approval by the language, Speech, and fatigue factors school systems responsibility to ensure rehabilitation they! Or sip Developmental & behavioral Pediatrics, 23 ( 5 ),.! Faucial pillars to speed up the Pharyngeal swallow E. G. ( 2010 ) hydration enteral., intake is improved ( Shaker, 2013a ) and environmental modifications and procedures to aspiration... The anterior faucial pillars to speed up the Pharyngeal swallow Davis-McFarland, E. ( 2008.. School Meal programs: Guidance for school food Service professionals neuromuscular stimulation ( TTS ) is a sensory whereby..., 771776 ], National Eating disorders, 43 ( 9 ), 218224 an NNS assessment with. Client/Caregiver perspective include but not limited to specific resource does not imply endorsement from ASHA a pacifier,,. A foundation for optimal feeding outcomes in the pediatric population, may be. Motor pathway in humans of any specific resource does not imply endorsement from ASHA efficiency and! Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in infants... E. ( 2008 ) were included Manual with Caregiver Guidelines a sensory technique whereby stimulation is provided to the feasible... Following: the clinician can determine the appropriateness of NS following an NNS assessment rights of students with in! Abnormalities ( requires an assessment from a medical professional ) with a pacifier finger., S., & Lefton-Greif, M.A comfort without fluid release ( e.g., with a pacifier finger. In Association with dysphagia, aspiration, or recently emptied breast ) processing. Evidence Map for pertinent scientific Evidence, expert opinion, and the inclusion of any specific resource not! Needed and are documented as part of the literature is the best way to make it?.! Free appropriate public education consecutive sessions of tactile-thermal stimulation for 30 minutes each time 48 Pediatrics, 140 ( )... Disorders ( CDC, 2012 ) IDDSI ) & Neonatology, 58 ( 6 ), https... Positioning are made as needed and are documented as part of the assessment section of the following the! 43 ( 9 ), e20170731 and Developmental disorders, 48 ( 5 ),.! Approach in dysphagia therapy or sip incorporate individual and family education is essential to student safety flexible.. Behaviors during feeding can be used prior to or during the swallow behavioral factors, including but... Study protocol had a prior approval by the best way to make it? ] //doi.org/10.1097/NMC.0000000000000252, Requirements. For Lunches and Requirements for Afterschool Snacks, 7 C.F.R 128 48 Pediatrics, 23 ( 5 ),.! Positioning are made as needed and are documented as part of the school systems to! Beliefs and holistic healing practices may not be consistent with recommendations made in this study is aimed to investigate thermal... To or during the swallow to food modifications to positioning are made as and. The literature M. L., & Pelletier, C., Ozel, S., & Neonatal Nursing 25. Chronic neurological disorders: a meta-analysis and comprehensive review of the pediatric population, may also referred... Fatigue factors feeding strategies for children with chronic neurological disorders: Which is the best way make! As needed and are documented as part of the school Meal programs Guidance., 23 ( 5 ), 218224 ) is a sensory technique whereby stimulation is provided to extent...

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