Question
With a very medically and physically involved child that is NPO with limited cognitive resources, what strategies are successful in aiding swallowing of saliva?
Answer
In the medically fragile population, the importance of integrating dysphagia services with other health care providers can not be overstressed. Because of the limited cognitive resources this population may have, the health care provider may be limited in options of treatment/compensatory strategies. Hall (2001) outlined therapy into two strategy types: compensatory and facilitative. There are therapeutic ideas described in the oral stimulation program as outlined in Hall (2001, p. 132) for children who are NPO.
A few strategies that one may use to aid in swallowing of saliva include but are not limited to non-nutritive methods, laryngeal massage, tactile stimulation, and postures.
Considerations with this population include establishing a feeding readiness in the infant as well as identifying and establishing an optimum position for feeding. Of equal importance is the consideration of the child's respiratory status paying particular attention to signs of distress.
In conclusion, we must keep in mind the quote by Hall (2001), "No one way will work with every infant" (p.120). So it is imperative that we continue to research intervention techniques to assist with providing adequate nutrition to this population.
References/Suggested Readings:
Arvedson, J.C. & Brodsky, L.B. (2002). ''Pediatric Nutrition,'' in Pediatric swallowing and feeding: Assessment and management. (2nd Ed.) (pp. 233-282). Albany, NY: Singular Publishing Group, a division of Thomson Learning, Inc.
Hall. K. (2001). ''Therapy for Feeding and Swallowing Problems,'' in Pediatric Dysphagia: Resource Guide. (pp. 119-156). Albany, NY: Singular Publishing Group, a division of Thomson Learning, Inc.
Logeman, J. (1998). Evaluation and Treatment of Swallowing Disorders (2nd ed.). Austin, TX: Pro-Ed.
Swigert, N. (1998). The Source for Pediatric Dysphagia. East Moline, IL: LinguiSystems.
Angela F. Sherman, SLP.D., CCC-SLP has been a speech-language pathologist for over 10 years. She is an Assistant Professor and Clinic Coordinator at Louisiana Tech University in Ruston, LA. Teaching and research areas are in dysphagia, adult language, medically fragile, and professional issues. She has presented at local, state, and national conferences and meetings. She has been elected to the licensure board in Louisiana and has served on the Board of Directors for the Louisiana Speech, Language, and Hearing Association.
