The National Center for Evidence-Based Practice
in Communication Disorders
Home      Pediatric-Dysphagia-Treatment-Positioning-Techniques

Pediatric Dysphagia 
Treatment

Positioning Techniques

 


 

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
  • Body positioning should be identified for optimal swallow function (Level C Evidence) (p. 69). Position of trunk, limbs, shoulder and head support should be considered.
  • Positioning interventions may involve specialized seating equipment (Level C Evidence) (p. 69).

» See full summary and quality ratings 

 
 
 

Evidence-Based Systematic Reviews

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) that positioning has a positive effect on feeding safety and efficiency by decreasing the risk of aspiration and diminishing mealtime. There were no [randomized controlled trials] RCTs found on the effects of positioning on feeding safety and efficiency, and thus, higher levels of evidence are lacking” (p. 71). 
 
 
 
 

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 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).
  • “Postural changes are different among infants, older children, and adults. A semi-reclined position with a neutral head/neck posture and flexion at the hips and knees is classic for the young infant” (pp. 15-16).
 
 
 

Client/Patient/Caregiver Perspectives

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




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