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in Communication Disorders
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Pediatric Dysphagia Evidence Map
Treatment

Equipment/Utensils

 


 

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
Interventions may involve bolus placement and/or bolus modification, pacing, use of adaptive feeding utensils and/or alternative nutrition.
 
 
 
 
 
 
Evidence-Based Systematic Reviews
Avoidance of Bottles During the Establishment of Breast Feeds in Preterm Infants
Collins, C. T., Makrides, M., et al. (2008).
Cochrane Database of Systematic Reviews (4).

This review meets the criteria for a high-quality evidence-based systematic review.
Added: September 2012

Description
This is a systematic review of randomized or quasi-randomized controlled trials evaluating the impact of avoiding bottles during the establishment of breastfeeding in preterm infants.

Conclusions
“There is evidence of benefit of supplementing breast feeds with cup feeding on breastfeeding rates at discharge; however, this is not sustained beyond discharge and increases length of hospital stay considerably. There is insufficient evidence on which to base recommendations for supplementing breast feeds with a tube alone strategy” (p. 10).

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Utilization of Surface Electromyography During the Feeding of Term and Preterm Infants: A Literature Review
Gomes, C. F., Thomson, Z., et al. (2009).
Developmental Medicine and Child Neurology, 51(12), 936-42.
Added: September 2012

Description
This is a review of research literature investigating muscle activity with the use of surface electromyography during the feeding of term and preterm infants

Conclusions
This review highlights the importance of sEMG as a tool for feeding assessment. Findings indicated that “in term infants the masseter muscle is considered the principal muscle of breastfeeding as well as for preparing the individual for future masticatory function” (p. 941).  There was evidence of similar masseter activity during cup feed and breastfeeding.

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Cup Feeding Versus Other Forms of Supplemental Enteral Feeding for Newborn Infants Unable to Fully Breastfeed
Flint, A., New, K., et al. (2007).
Cochrane Database of Systematic Reviews (2).

This review meets the criteria for a high-quality evidence-based systematic review.
Added: September 2012

Description
This is a review of randomized or quasi-randomized controlled trials investigating the impact of cup feeding as compared to other forms of enteral feeding to supplement breastfeeding in newborn infants.

Conclusions
“Cup feeding cannot be recommended over bottle feeding as a supplement to breastfeeding because it confers no benefit in maintaining breastfeeding beyond hospital discharge and may carry the unacceptable consequence of a longer stay in hospital” (p. 8).

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Feeding Interventions for Growth and Development in Infants with Cleft Lip, Cleft Palate or Cleft Lip and Palate
Bessell, A., Hooper, L. et al. (2011).
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 review of randomized controlled trials investigating the effects of feeding interventions on growth, development and parent satisfaction for infants with cleft lip and palate. 
 
Conclusions
  • Five studies were included which examined various feeding interventions. While there is no evidence to support or refute the type of bottle for best growth outcomes, the authors indicated that squeezable bottles may be easier to use than rigid ones as feeding intervention for infants with cleft lip and/or palate.
  • "This review found some evidence that breastfeeding, when compared to spoon-feeding, may improve weight gain in babies following surgery for cleft lip" for up to 6-weeks post-surgery (p. 12).
 
 
 
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 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). 
 
 
 
 
Nipple Shields: A Review of the Literature
McKechnie, A. C., & Eglash, A. (2010).
Breastfeeding Medicine, 5(6), 309-14.
 
Added: July 2011
 
Description
This is a review of studies investigating the use of nipple shields (NS) for breastfeeding infants. 
 
Conclusions
  • "None of the reviewed studies provided evidence that routine NS use in premature infants is necessary to improve intraoral pressures. Based on these studies, NS use in the premature population should not be routine, but should be considered in cases where infants have demonstrated persistent difficulty with sustained breastfeeding and milk transfer. Milk transfer while using NS should be assessed, and NS use should be discontinued if milk transfer is not good" (p. 313).
  • "The current literature does not support many of the current practices regarding NS use. The available evidence does not demonstrate that NSs are safe in the long term for milk supply, infant weight gain, or duration of breastfeeding. Rather than assuming that NSs are safe until proven otherwise, healthcare providers should consider NSs an unknown risk and limit their duration of use whenever possible, until further evidence demonstrates their long-term safety" (p. 313).

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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).
 
 
American Speech-Language-Hearing Association
 
Roles and Responsibilities of Speech-Language Pathologists in the Neonatal Intensive Care Unit: Guidelines
American Speech-Language-Hearing Association. (2005).
Retrieved from: http://www.asha.org/docs/html/GL2005-00060.html.
 
 
Added: July 2011
 
Description
This is a guideline providing recommendations on the roles and responsibilities of speech-language pathologists (SLPs) providing care in the Neonatal Intensive Care Unit (NICU). Recommendations are provided pertaining to assessment and management of communication, feeding, and swallowing of infants. 
 
Recommendations
  • One set of guidelines suggest that infants should not be expected to demonstrate the ability to suckle and swallow until 32 weeks gestation. “Stable 32-week gestation infants can be put to the breast safely for early feeding experiences, while they may not be ready for bottle-feeding until about 34 weeks gestation” (p. 11).
  • Transitioning challenges may relate to limitations in control of flow rate. “It is important to avoid fast flow nipples (e.g., ‘preemie’ nipples and ‘orthodontic’ nipples) (Vadenberg, 1990b)” (p. 12). Alternatively, the free-flow of formula from the nipples has been proposed. It was found that “preterm infants could divert excess formula flow by drooling as an efficient airway protective behavior” (p. 12). Some evidence also supports cheek and jaw support to enhance suckling efficiency in preterm infants.
  • Mixed results have been demonstrated on the use of various alternatives to the breast when the mother is not present for feeding. These include the use of a cup instead of bottle, NG tube supplements, an orthodontic nipple, and a nipple shield. 
 
 
 
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
"Varied nipples and containers can be tried to find optimal rate of flow (Mathew, 1991; Mathew, Belan, & Thoppil, 1992). Infants have been shown to improve efficiency and reduce duration of nipple feedings with a self-pacing system and vacuum-free bottles (Lau & Schanler, 2000). Individual differences must always be considered, as exceptions to general principles may be needed” (p. 16). 
 
 
 
 

Client/Patient/Caregiver Perspectives

 
Nipple Shields: A Review of the Literature
McKechnie, A. C., & Eglash, A. (2010).
Breastfeeding Medicine, 5(6), 309-14
.
Added: July 2011
 
Description
This is a review of studies investigating the use of nipple shields (NS) for breastfeeding infants. 
 
Conclusions
"...[M]others' subjective reports suggest that they had positive experiences using an NS, with most mothers continuing to nurse after discontinuing NS use. Given the small sample sizes, limited follow-up time, and lack of meaningful statistical measures, these studies should be cautiously interpreted" (p. 313). 
 
 




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