[Dysphagia] pediatric

[scott-dailey at uiowa.edu (Dailey, Scott)]

First question that comes to mind is why he has had an NG for his entire life?  Was her a premature infant, did he have aspiration, etc.
 
I have worked with many children who have received NG or Gtube feedings for long periods for a variety of reasons.  They do not respond well as needed to stopping NG/gtube feedings.  It seems that many have different or no sense of hunger, or have not associated oral intake with decreasing hunger.  If there is a history of GERD or other discomfort with eating, although it may be treated and no longer an issue, infants and children frequently pair negative feelings (discomfort) with oral feeding.  This association continues after the medical issue has been resolved.  For this reason, many kids do not pick up eating just by decreasing NG/Gtube.  We have a team of professionals including Speech Pathologist, Pediatric Psychology, Pediatric Gastroenterologist, Dietitian etc, who help formulate a plan with the parents to work through the transition to oral feeding.  Sometimes behavioral techniques are needed in addition to scheduled feedings (oral).  A delayed swallow by itself should not prevent oral eating, but would only slow the pace of eating.  
 
Scott Dailey, MA CCC-SLP
Speech-Language Pathologist
Unversity of Iowa Hospitals and Clinics

	-----Original Message----- 
	From: dysphagia-bounces@b9.com on behalf of Michelle Snead 
	Sent: Sun 9/18/2005 3:28 PM 
	To: sorriso@adelphia.net; dysphagia@b9.com 
	Cc: 
	Subject: Re: [Dysphagia] the actual cricopharyngeal diet
	
	

	Hello All
	I work with paediatrics and I have a case at the moment that is a bit tricky and has emotional implications as well.  I have a young boy (just over 1 year) who has been fed by NG tube all his life and mum has been very proactive with stimulating him orally and giving him oral feeds as much as he will tolerate.  His oral motor skills are fine however he has a delayed swallow for all consistencies and will often hold food or push it out with his tongue.  His interest in food is nil and he does not show any signs of hunger or desire to take food orally.  We have decided as a team (mum as well) to trial not giving NG feeds for a few days to see whether we can increase his awareness of hunger and oral feeding and ultimately wean him off the tube.  MUm is giving him some food via NG at nights just for reassurance.  He is at a healthy weight at the moment and has gained weight well in the past however mum is very nervous about him not eating and is showing a great deal of anxiety. !
	  Despite this, she is keen to continue with the trial (she really wants him to feed orally) however is looking for some information on other children who have gone through this before.  If anyone can provide information on this it would be GREATLY appreciated.
	Regards
	Michelle Snead
	
	>>> <sorriso@adelphia.net> 16/09/2005 8:14 a.m. >>>
	Here's the "diet" as requested by a member of the ASHA list from the VitalStim people:
	
	Initial Diet for Patients with Cricopharyngeal Dysfunction
	
	The following diet has been shown to be effective to the author (Marcy Freed) for the patients who have a degree of cricopharyngeal dysfunction:
	
	        1.  Crunchy consistency
	                a.  Fritos
	                b.  Potato chips
	                c.  All crackers
	                d.  Pepperidge Farms Bordeaux cookies
	                e.  Toast with butter
	
	
	        2.  Thinned puree consistency
	                a.  Thinned Oatmeal or Cream of Wheat  
	                b.  Yogurt without fruit
	                c.  Strained creamed soups     
	                d.  Mousse
	                e.  Soft drinks
	                f.  Tomato soup or pea soup
	
	        3.  Soft/Slippery consistency
	                a.  Angel hair pasta and olive oil
	                b.  Sweet potatoes with butter or margarine    
	                c.  Soft boiled eggs
	                d.  Poached eggs
	                e.  Squash * butternut or acorn
	                f.  Waffles that are cut into tiny pieces
	                g.  Meat loaf
	                h.  Whipped potatoes
	       
	The patient may progress as the cricopharyngeal problem improves.  Don't mix food and liquid!  First swallow food and then have a drink.
	
	        4.  Foods NEVER tolerated
	                a.  Pudding
	                b.  Applesauce 
	                c.  Pureed foods
	                d.  Mashed potatoes
	                e.  Red meats such as steak
	
	The viscosity of food a,b,c and d contribute to increased vallecular and pyriform sinus retention.  Lower viscosity foods clear more easily.
	
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