Feeding and Swallowing Difficulties in Infants and …...Feeding and Swallowing Difficulties...
Transcript of Feeding and Swallowing Difficulties in Infants and …...Feeding and Swallowing Difficulties...
Feeding and Swallowing Difficulties in Infants and Children with HIV
Vivienne NormanDivision of Communication Sciences
and DisordersUCT
Feeding and Swallowing Difficulties
• Feeding disorders:
– difficulty with any aspect of eating or drinking
– including caregiver-child interaction, appetite, swallowing, food refusal, food preferences, disruptive mealtimes
• Swallowing difficulties
– problem in 1 or more phases of swallowing
– Including poor sucking, poor co-ordination of swallowing and respiration, aspiration
Feeding and Swallowing Difficulties in HIV 2011Vivienne Norman
Arvedson, 2008
So, what can go wrong?
Oral phase:
• Poor latch
• Absent / weak suck
• Spillage
• Poor bolus formation & control
• Increased oral transit time
• Aversion / hypersensitivity
Feeding and Swallowing Difficulties in HIV 2011Vivienne Norman
Pharyngeal phase
• Delayed / absent swallow response
• Aspiration – material enters airway below vocal cords *
• Nasopharyngeal reflux
Signs of possible problem:
Coughing, choking, spluttering, wet/gurgly
voice, apnoea, hoarse voice
* Aspiration may be silent Feeding and Swallowing Difficulties in HIV 2011Vivienne Norman
Typical reasons for referral
• Absent / weak suck• Suck-swallow incoordination• Coughing associated with
feeds• Gurgly / wet voice during /
after feeds• Vomiting / GOR• Not completing feeds• Increased feeding times• Hoarse voice• Feeding induced apnoea• Excessive spillage• Recurrent LRTI• Excessive gagging
• ?Aspiration• Breathing disruptions• Diagnosis of disorders
associated with dysphagia• Food refusal and FTT• Irritability with feeding• “Behaviour problems” with
feeding• New onset of feeding
problem• Transition from tube to oral
feeds• Delayed feeding milestones /
failure to progress
Arvedson & Brodsky, 2002; Hall, 2001 Feeding and Swallowing Difficulties in HIV 2011Vivienne Norman
Consequences of dysphagia
• Growth faltering
• LRTI / respiratory compromise
(due to aspiration)
• Reduced social interaction & communication
• Increased stress for caregivers
• Pain / discomfort
• Constipation
• Dental problems
Andrew & Sullivan, 2010; Reilly et al., 2011Feeding and Swallowing Difficulties in HIV 2011
Vivienne Norman
Prevalence of feeding & swallowing difficulties
• 20 - 45% typically developing children
• 30 - 40% children with neurological involvement & others report 80%
• 40 - 70% infants / children with chronic medical problems
Arvedson, 2008; Calis et al., 2008; Lefton-Greif & Arvedson, 2007; Reilly et al., 1996; Rudolph & Link, 2002 Feeding and Swallowing Difficulties in HIV 2011
Vivienne Norman
Prevalence in infants and children with HIV and AIDS
USA:• 45% (N=55) – before ARVs
– Pressman & Morrison, 1988
• 20.8% (N=96) – screening only– Pressman, 1992
UK:• 50% (N=42) – feeding problems reported
– Melvyn et al., 1997
SA:• 12.5% (N=446) – of sample of dysphagic caseload
– Unpublished data: Oosthuizen, 2011
Feeding and Swallowing Difficulties in HIV 2011Vivienne Norman
Reported feeding and swallowing difficulties in HIV
• Slow feeding
• Aspiration
• Coughing
• Growth faltering
• Gags with solids / textures
• Odynophagia
• Food refusal
• Behavioural feeding problems
• Delayed feeding milestones
• Nausea & vomiting
• GOR
Pressman, 1992; 2010; Rabie et al., 2007Feeding and Swallowing Difficulties in HIV 2011
Vivienne Norman
Reasons for dysphagia in infants and children with HIV / AIDS
• Feeding difficulties associated with chronic illness
– Psychological and emotional effects on feeding
– Hospitalizations
– Tube feeding
– Caregiver factors
Schwartz & Rothlingova, 2011Feeding and Swallowing Difficulties in HIV 2011
Vivienne Norman
Reasons for dysphagia in infants and children with HIV / AIDS
• HIV-related
– Structure may be affected e.g. oesophageal abnormalities
– Function may be affected e.g. encephalopathy
– Medications may cause nausea, vomiting, and reduce appetite
– Candidiasis (oral, pharyngeal, laryngeal, oesophageal)
– Odynophagia
Halvorsen et al., 2003; Pressman, 2010; Rabie et al., 2007 Feeding and Swallowing Difficulties in HIV 2011
Vivienne Norman
What to look out for…
• Coughing with feeding• Frequently does not complete feeds• Frequently takes longer than 30 minutes to complete feeds• Caregiver reports of feeding difficulty• Tires with feeding• Changes in breathing during feeding• Changes in voice• Excessive drooling • Gags with feeds• Spits out milk / food• Chokes with feeding• Not eating age / developmentally appropriate foods• Complain of pain with swallowing
Feeding and Swallowing Difficulties in HIV 2011Vivienne Norman
Role of Speech-Language Therapist
• Clinical assessment– Skill
– Safety
• Instrumental assessment if indicated e.g. modified barium swallow
• Referral for other investigations if indicated
• Part of team management of feeding and swallowing
Feeding and Swallowing Difficulties in HIV 2011Vivienne Norman
Benefits of MBS• Defines oropharyngeal &
oesophageal anatomy & function
• Determines reason for difficulty e.g. aspiration due to pooling, fatigue
• Assesses treatment strategies e.g. changes to position, consistency, rate, utensils
• Aspiration may be silent or occur with fatigue
• Safest consistency that is developmentally appropriate
• Low clinical reliability in determining aspiration of solids when compared with VFSS
Feeding and Swallowing Difficulties in HIV 2011Vivienne Norman
LIQUID THICKENED FEED
ASPIRATION
NORMAL
Multiple
Strictures
Management of infants and children with dysphagia
• SAFE
• Optimal nutrition
• Facilitates development
• Multidisciplinary team which includes the FAMILY
Andrew & Sullivan, 2010; Reilly et al., 2011Feeding and Swallowing Difficulties in HIV 2011
Vivienne Norman
Management may include
• Consistency modification – NB to remember to thicken medications too in consultation with doctor
• Positioning & seating
• Techniques / programme for oral sensorimotor difficulties
• Utensils
• Supplementing intake
• Caregiver counselling and training
• Alternative feeding e.g. gastrostomy
Arvedson & Brodsky, 2002; Reilly et al., 2011 Feeding and Swallowing Difficulties in HIV 2011Vivienne Norman
GORD and dysphagia
• Frequently co-occur
• Impact of GORD on swallowing
• Intervention may affect feeding and swallowing
• Managed by medical team
Feeding and Swallowing Difficulties in HIV 2011Vivienne Norman
GORD
Feeding and Swallowing Difficulties in HIV 2011Vivienne Norman
Monitoring and review
• SLT should monitor feeding and swallowing in terms of safety and skills
• Determine need for ongoing modifications or new intervention
• Facilitate development of feeding skills
Feeding and Swallowing Difficulties in HIV 2011Vivienne Norman
References
Andrew, M.J. & Sullivan, P.B. (2010). Feeding difficulties in disabled children. Pediatrics and Child Health, 20(7):321-326.
Arvedson, J.C. (2008).Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches. Developmental Disabilities Research Reviews, 14: 118-127.
Arvedson, J.C. and Brodsky, L. (2002). Pediatric Swallowing and Feeding: Assessment and Management (2nd Ed). Singular Thomson Learning, Canada.
Calis, E.A.C., Veugelers, R., Sheppard, J.J., Tibboel, D., Evenhuis, H.M. and Penning, C. (2008). Dysphagia in children with severe generalized cerebral palsy and intellectual disability. Developmental medicine and child neurology, 50:625-630.
Field, D., Garland, M. and Williams, K. (2003). Correlates of Specific Childhood Feeding Problems. Journal of Pediatrics and Child Health, 39:299-304.
Halvorsen, R.A., Moelleken, S.M.C. & Kearney, A.T. (2003). Videofluoroscopic evaluation of HIV/AIDS patients with swallowing dysfunction. Abdom Imaging, 28:244-247.
Lefton-Greif, M. A., and Arvedson, J. C. (2007). Pediatric feeding and swallowing disorders: State of health, population trends, and application of the International Classification of Functioning, Disability, and Health. Seminars in Speech and Language, 28, 161-165.
Melvyn, D., Wright, C. & Goddard, S. (1997). Incidence and nature of feeding problems in young children referred to a paediatric HIV service in London: FEAD screening. Child Care Health & Development, 23(4): 297-313.
Oosthuizen, N. (2011). Unpublished results – Masters Thesis (UCT).
Pressman, H. (1992). Communication disorders and dysphagia in pediatric AIDS. ASHA, 34(1): 45-47.
Pressman, H. (2010). Dysphagia and related assessment and management in children with HIV/AIDS. In Swanepoel, D. & Louw, B. (2010). HIV/AIDS: related communication, hearing, and swallowing disorders. Plural Publishing, San Diego.
Rabie, H., Marais, B.J., Van Toorn, R., Nourse, P., Nel, E.D., Goussard, P., Sellers, N. & Cotton, M.F. (2007). Important HIV-associated conditions in HIV-infected infants and children. SA Fam Pract, 49(4): 19-23.
Reilly, S., Morgan, A. & Wisbeach,A. (2011). The management of feeding in children with neurological problems. In In Southall, A. and Martin, C. (2011). Feeding problems in children: a practical guide (2nd Ed). Radcliffe Publishing, UK.
Rudolph, C.D. and Link, D.T. (2002). Feeding Disorders in Infants and Children. Pediatric Clinics of North America, 49(1):97-12.
Schwartz, A. & Rothlingova, Z. (2011). Management of feeding problems in children with a chronic illness. In In Southall, A. and Martin, C. (2011). Feeding problems in children: a practical guide (2nd Ed). Radcliffe Publishing, UK.