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Pediatric Dysphagia Evidence Map
Treatment

Diet Modification

 


 

External Scientific Evidence

  

Evidence-Based Practice Guidelines

Royal College of Speech & Language Therapists; Department of Health (UK); National Institute for Clinical Excellence (NICE)
 
Royal College of Speech and Language Therapists Clinical Guidelines: 5.8 Disorders of Feeding, Eating, Drinking & Swallowing (Dysphagia)
Taylor-Goh, S., ed. (2005).
RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd
.
Added: July 2011
 
Description
This guideline provides recommendations for the assessment and management of swallowing disorders in children and adults. This guideline is intended for speech-language pathologists. Populations included, but were not limited to, stroke, traumatic brain injury, autism spectrum disorder, cerebral palsy, Parkinson’s disease and head and neck cancer. Each recommendation is graded A (requires at least one randomized controlled trial), B (requires at least one well-conducted clinical study), or C (requires evidence from expert committee reports). 
 
Recommendations
  • “The Speech & Language Therapist will assess the effect of modified presentation of the bolus upon swallow function, in order to identify the method that facilitates the safest and most efficient swallowing” (p. 67).
  • Adjustments to the placement, size, consistency and temperature, taste and texture of the bolus, as well as changes in pacing, utensil, and frequency and timing may be necessary (Level B Evidence) (pp. 67-68).

» See full summary and quality ratings 

 
 
 
Evidence-Based Systematic Reviews
Restriction of Oral Intake of Water for Aspiration Lung Disease in Children
Weir, K., McMahon, S., et al. (2012).
Cochrane Database of Systematic Reviews, 9, CD005303.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: April 2013

Description
This is a systematic review of randomized controlled trials investigating the restriction of oral ingestion of water on the pulmonary status of children identified with aspiration of thin liquids.

Conclusions
"Given the lack of evidence, it is not possible to either recommend total restriction or liberalization of oral water ingestion to ‘protect’ the pulmonary status of children with thin fluid aspiration demonstrated on a modified barium swallow study. Clinicians should be cognizant that water (with a neutral pH) significantly differs from other fluids and this review did not examine the effect of non-water fluids” (p. 6).

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Evidence-Based Review of Moderate to Severe Acquired Brain Injury
Teasell, R., Marshall, S., et al. (2012).
Retrieved from http://www.abiebr.com.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: March 2013

Description
This is a 2012 update of a review published by Teasell et al. (2008). This is a review of prospective and retrospective experimental and non-experimental studies that investigated the effectiveness of rehabilitation for adults and children with moderate to severe acquired brain injury (ABI), including stroke and traumatic brain injury (TBI). This review includes the assessment and management of several aspects of rehabilitation including speech and language treatments. The levels of evidence used to summarize the findings are based on the modified Sackett criteria:

  • Level 1 was applied to randomized controlled trials (RCTs) with a PEDro score greater than 5. 

  • Level 2 was applied to RCTs with a PEDro score less than 6, non-RCTs, and cohort studies.

  • Level 3 was applied to case control studies. 

  • Level 4 was applied to pre-post studies, post-studies, case series, and single intervention group studies.

  • Level 5 was applied to observational studies, case studies, and consensus statements.

Conclusions
"There is Level 5 evidence that food texture and the person feeding are important factors when feeding a person post acquired brain injury" (p. 47).

» See full summary and quality ratings



Feeding Interventions for Children with Cerebral Palsy: A Review of the Evidence
Snider, L., Majnemer, A., et al. (2011).
Physical & Occupational Therapy in Pediatrics, 31(1), 58-77
.
 
This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2011
 
Description
This is a systematic review of studies (all study designs included) investigating the impact of feeding interventions for children with cerebral palsy (CP). Levels of evidence are as follows: 1a (strong; well-designed meta-analysis or two or more “high-quality” randomized controlled trials [RCT]), 1b (moderate; one RCT of “high quality”), 2a (limited; at least one “fair quality” RCT), 2b (limited; at least one “poor quality” RCT), 3 (consensus; expert consensus or a number of pre-post studies with similar findings), 4 (conflict; two or more equally, well-designed studies with conflicting evidence), and 5 (no evidence; no well-designed studies-only case studies, cohort studies, or single-subject studies with no multiple baselines). 
 
Conclusions
  • “[T]here is 2b evidence (limited) demonstrating that providing children with CP with softer food consistencies enhance feeding safety and efficiency. Higher-quality studies (such as [randomized controlled trials] RCTs) investigating this question are currently lacking” (p. 72).
  • “[T]here is level 2b evidence (limited) indicating that feeding devices may not be useful in enhancing feeding efficiency. However, the same level of evidence indicates that adapted equipment may serve to enhance certain oral-motor behaviors and increase independence” (p. 73).
 
 
 
Thickened Liquids as a Treatment for Children With Dysphagia and Associated Adverse Effects: A Systematic Review
Gosa, M., Schooling, T., et al. (2011).
ICAN: Infant, Child, & Adolescent Nutrition, 7 pages.
 
 
This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2011
 
Description
This is a review of peer-reviewed studies investigating the use and adverse effects of thickened liquids in children (under 18) with or without dysphagia. 
 
Conclusions
  • The studies examining the effects of thickened liquids on swallowing physiology or pulmonary health outcomes had significant methodological limitations and reported mixed findings.
  • All of the included studies examining adverse effects focused on children with gastroesophageal reflux and reported no significant increase in adverse effects from the use of thickened liquids.
  • "While no studies in this EBSR (Evidence-based Systematic Review) advised against the use of thickened liquids, experimental research needed to explore thoroughly the beneficial and adverse treatment effects of thickened liquids in children with dysphagia is not currently available" (p. 6).

» See full summary and quality ratings 

 
 
 
Treatment for Swallowing Difficulties (Dysphagia) in Chronic Muscle Disease
Hill, M., Hughes, T., et al. (2004).
Cochrane Database of Systematic Reviews (2).
 
 
This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2011
 
Description
This is a systematic review of randomized trials addressing dysphagia management in people with chronic muscle disease. 
 
Conclusions
This review examined a number of treatment options including dietary modification, swallowing maneuvers, surgical intervention, and enteral feeding. The authors concluded that "no trials have adequately evaluated treatments in the management of dysphagia for chronic muscle disease. It is therefore not possible to decide the most appropriate treatment for a given individual based on current evidence" (p. 1). 
 
 
 
 
 

Clinical Expertise/Expert Opinion

 
Consensus Guidelines  
American Speech-Language-Hearing Association
 
Guidelines for Speech-Language Pathologists Providing Swallowing and Feeding Services in Schools
American Speech-Language-Hearing Association. (2007).
Retrieved from: http://www.asha.org/docs/html/GL2007-00276.html
 
Added: July 2011
 
Description
This ASHA guideline addresses the issues, models, and procedures for management of students with swallowing and feeding disorders in the school setting. 
 
Recommendations
  • “A swallowing and feeding plan typically includes recommendations/guidelines on the following: positioning, equipment, diet/food preparation, feeding plan techniques and precautions (which may include behavioral considerations), and the name and contact information for the dysphagia case manager” (p. 16). 
  • “All diet modifications should consider the nutritional needs of students, and when possible the system should consult with a dietitian. School personnel also need to be able to recognize the signs and symptoms of undernutrition” (p. 9).
 
 
 
American Speech-Language-Hearing Association
 
Preferred Practice Patterns for the Profession of Speech-Language Pathology
American Speech-Language-Hearing Association. (2004).
Retrieved from: http://www.asha.org/docs/html/PP2004-00191.html.
 
 
Added: July 2011
 
Description
This Preferred Practice Patterns for the Profession of Speech-Language Pathology document is a description of recommended practice for many areas of assessment and management in the scope of practice for SLPs. The guiding principles for each clinical service are discussed in terms of service provider, expected outcome, clinical indication, clinical processing, setting, equipment, safety precautions, and documentation. 
 
Recommendations

The results of the assessment dictate the focus of intervention. Intervention may involve alteration of lingual and labial resting postures, muscle retraining, and modification of solids, liquids, and saliva.

 
 
American Speech-Language-Hearing Association
 
Roles of Speech-Language Pathologists in Swallowing and Feeding Disorders: Technical Report
American Speech-Language-Hearing Association. (2001).
Retrieved from: http://www.asha.org/docs/html/TR2001-00150.html.
 
 
Added: July 2011
 
Description
This ASHA position statement provides information regarding the role of the SLP in evaluation and management of children and adults with feeding and swallowing disorders and discusses the scope and rationale for SLP services. 
 
Recommendations
“Infants and young children typically respond to changes in the environment for improving safety and efficiency of feeding. Aspects for change that can affect oral and pharyngeal transit include posture and position, timing and pacing, bolus characteristics (e.g., texture, temperature, taste), and sensory input” (p. 15). 
 
 
 
 

Client/Patient/Caregiver Perspectives

 
No information was found pertaining to client/patient/caregiver perspectives.
 
 
 




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