New Handbook Outlines Treatment Strategies for Pediatric Patients with Swallowing Problems

A new handbook to help clinicians determine the best strategies to treat developmentally challenged children who have swallowing problems was developed by a team at Holland Bloorview Kids Rehabilitation Hospital.

The handbook, “Optimizing Feeding and Swallowing in Children with Physical and Developmental Disabilities: A Practical Guide for Clinicians,” is intended to provide a hierarchical and integrated approach to help guide clinicians. It also highlights important considerations they might face in clinical practice.

With more than 4,600 downloads since it was released online in June 2017, the guide is considered a success, and it is now required reading for the University of Montreal‘s occupational therapy course.

“There was a lack of clear summaries of the scientific evidence available across disciplines that presented information in an accessible, efficient way for a broad group of community clinicians who may need to care for children with feeding and swallowing impairments,” Deryk Beal, PhD, an assistant professor in the department of speech language pathology at the University of Toronto and clinician scientist at Bloorview Research Institute, said in a press release.

Results of a survey conducted by the Holland Bloorview staff revealed that many users found the handbook helpful for its clear and relevant guidance. Users cited the guide’s inter-professional focus that can help all members of a clinical team better understand each other’s perspectives and treatment options.

Clinicians also said the guide can be useful as a quick reference when evaluating patients, sharing cases with colleagues, and on-boarding new staff.

Swallowing involves several muscles and nerves in the mouth, throat, and esophagus. Impairments on their function can lead to malnutrition, dehydration, and social isolation, severely impacting quality of life.

Improved ways to detect and treat swallowing difficulties (dysphagia) is of great importance for several patient populations, including children with cerebral palsy and other disorders.

Diagnosing dysphagia in children can be a challenge, in part due to the different conditions that may contribute to the problem. Feeding issues can result from gastrointestinal reflux, sensory problems, muscle weakness, or lack of coordination, cardiac or respiratory conditions, just to name a few. To complicate matters, many strategies used to treat swallowing problems in adults do not work in pediatric patients for developmental reasons.

“We know feeding and swallowing is a specialized area of medical care and a lot of people working in the community may not have received specific training in some elements of the care they’re providing,’’ said Andrea Hoffman, MD, an assistant professor in the department of pediatrics at Toronto and developmental pediatrician at Holland Bloorview. “This handbook helps give them a framework to gather information and determine the important elements of the assessment from a range of disciplines, so they can make the best recommendations and most appropriate referrals to provide optimal care.”

Hoffman and her colleagues have recently published two quick-reference handouts based on the handbook. They are also planning to create client-centered resources for families of patients affected by swallowing problems.