This guide can provide more information about the intial evaluation and treatment appointments so you may develop a better understanding of the theraputic process. If you have questions about your appointment, please give our office a call. We are here to help!
For the evaluation, plan on arriving at least 15 minutes prior to your scheduled appointment to check in at the front desk. Prior to the appointment, please review and prepare to bring the items listed on the Feeding Evaluation Checklist to help promote a typical experience for your child. This will offer your therapist a more in-depth understanding of the challenges your child may be experiencing. During the appointment, your attention and participation in the appointment is fundamental to a thorough evaluation.
Infants and children with feeding and swallowing difficulties, or “dysphagia”, may present with a variety of symptoms. This can be overwhelming and sometimes mysterious to families. That’s where we come in.
So what should you expect during the initial evaluation…
During the hour-long initial evaluation, we take time to understand and investigate concerns surrounding feeding and swallowing by conducting a thorough parent interview. We’ll look into medical and family history and ask specific questions that help us understand possible causes and nature of dysphagia. Based on your concerns and observations, we’ll decide what evaluations are necessary. We will complete a clinical evaluation of swallowing during your first visit but may refer you for an instrumental evaluation such as …
- Flexible Endoscopic Evaluation of Swallowing (FEES): A small endoscope is gently placed along the floor of the nose to the back of the child’s throat to visualize the throat from above while swallowing. Various foods and liquids are administered and often dyed with food coloring to allow for greater visualization.
- Modified Barium Swallow Study (MBS) or Pharyngeal Function Study: The MBS is a video X-ray of the swallowing process. The study enables the speech-language pathologist to see what is happening inside your child’s mouth and throat. It can show if food or liquid is going into the airway instead of the stomach, which is called aspiration. It can also help identify which parts of the mouth and throat are not working well.
Depending on the age of the child, we will often play with toys and get to know each other a bit before conducting any examinations.
Ideally, we’ll complete a thorough oral and swallow mechanism examination. That means we’ll “make silly faces” and observe the structures of the mouth, face and throat to determine if there are any abnormalities that may influence swallow function. We’ll look at the tissue under the tongue to rule out “tongue tie”, or ankyloglossia. We may assess upper airway patency by evaluating nasal breathing and looking in their throat for enlarged tonsils.
Next, we’ll observe feeding and swallowing.
For infants, we’ll look at breast or bottle latch, assess coordination of breathing, observe positioning and behavior during feeding, monitor for signs of aspiration and determine the efficiency of feeding.
For older infants, toddlers, and children we’ll observe feeding with preferred food items from home and utensils and cups that they typically use. We’ll look at muscle movements and behaviors during feeding and swallowing. We have a variety of seating options (high chairs, cube chairs, table seating, etc.) to help simulate the home environment so we can capture “typical meal time” at the clinic.
Oftentimes, we’ll begin therapy that day!
After initial observation, we may continue with “dynamic evaluation” and offer preliminary recommendations for strategies, modifications to potentially improve feeding and swallowing. For example, on the first day we may “trial” different postures during breast feeding to decrease physiological demand and improve breath coordination. We may “trial” different maneuvers or strategies with older children to determine what they are capable of doing. For example, if your child is exhibiting tongue thrust swallow pattern we may try to elicit a mature swallow pattern.
After the assessment is completed, we’ll take time to discuss our findings and recommendations for therapy.
Together, we’ll outline goals that are individualized to your child. Each child is unique and our recommendations will depend on their age, specific health condition and results of the assessment. We want families to leave the first visit with clarity and support. Your ST may recommend referrals to ENT specialists or pediatric dentists to address structural abnormalities. We may refer for an instrumental swallow assessment and later help interpret the results. Sometimes dysphagia therapy can be a problem solving journey and we will do our best to support families through this process.
If your therapist has reccomended treatment, the next step is to schedule appointments with our Patient Care Coordinators at the front desk. Some insurance plans may require prior authorization to schedule, in which case we will give you a call once we can proceed.
The nature, frequency and duration of therapy will vary from child to child.
For infants, we focus on parent education and training so that you can implement any recommendations independently. For other children, we may work on direct oral motor and swallowing exercises to improve function for swallowing. We will work with families to help your child progress their oral motor skills in order to tolerate age appropriate textures. Furthermore, your ST will help determine the need for any adaptive equipment to make eating and drinking safe and efficient. Feeding and swallowing therapy can be hard work and it is important that parents are involved throughout therapy.
ONE OF THE BEST WAYS TO OPTIMIZE THERAPY IS TO SHOW UP, BE READY TO LEARN AND GET INVOLVED IN SESSIONS.
Pediatric therapy differs from typical medical professions in the sense that parent involvement within the clinic and home is essential to making progress. Therapy is not only a once a week, 30 minute commitment. In order to truly see progress, it is essential to take home the skills that are practiced in therapy.
After completing a course of treatment, your ST will review the goals and progress made with you.
While it varies for each individual, a course of treatment is up to 12, 30 minute appointments occurring on a weekly basis. During the course of treatment, your ST will review the goals and progress made with you. A break may be indicated at this time to see how your child progresses at home with their home exercise program. You may also bring up new concerns that can be addressed through ST or upgrade goals as necessary.
Ultimately, our goal at Connect the Dots and as ST’s is to help your child achieve their highest potential.