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[Dysphagia] pediatric
Children who have functional oral-motor skills often learn to hold food
in the mouth and show a delayed swallow on an MBS because they don't
want to swallow the food. I've seen many of these children treated for
a delayed swallow when the issue really was that the child was
uncomfortable with eating for gastrointestinal or sensory reasons. You
need to sort out the probable reasons for non-swallowing with this
child before you stop the tube feedings. Children who are
disinterested in eating and unaware of hunger typically will not begin
to eat when tube feedings are discontinued. Typically they do not
associate what we call "hunger" sensations with eating. There is no
positive experience to build on. If there has been a history of reflux
or other GI issues, the child may even interpret the hunger signals as
GI discomfort which would signal a non-eating response. There is a
strong need to develop a positive relationship with food and an
interest in exploring the skills used for eating and drinking. You
might consider a wonderful set of videotapes that was developed by
Marsha Dunn Klein, an OT from Tucson AZ. They were designed for
parents and professionals working with infants and young children who
receive tube feedings. They have the following titles:
1. Tube Feedings are Mealtimes Too
2. The Journey from Tube Feeding Towards Oral Feeding
3. Taking Tube Feedings to School
4. The "Get Permission Approach to Mealtime and Oral Motor Treatment
The "Get Permission Approach" is geared more toward therapists and
provides an excellent foundation for encouraging children to work with
parents and therapists in an interactive way. It focuses on the
process of mealtimes and oral motor treatment for both orally-fed and
tube-fed children.
These videotapes are available through the New Visions Mealtimes
catalog by calling 800-606-3665. They can also be purchased from
Mealtime Notions at www.mealtimenotions.com.
Suzanne Evans Morris, Ph.D.
New Visions
1124 Roberts Mountain Rd.
Faber, VA 22938
(434) 361-2285 ext. 5
www.new-vis.com
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> 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
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