Table 2.
Recommendations for evaluation of dysfunctional swallowing (expert opinion)
| The paediatric neurologist, paediatrician, rehabilitation specialist, speech pathologist, ENT specialist, pedagogue, dentist, nurse practitioner, occupational therapist, physiotherapist, plastic surgeon may be involved in the multidisciplinary swallowing/drooling teams. |
| Assessments: |
| Medical and social–emotional history of the patient. Does the child suffer from intractable seizures? |
| Medication, benzodiazepines or neuroleptic-induced drooling? |
| Respiratory status (cough, wheezing, recurrent pneumonia) → Consider examination by the paediatric pulmonologist. |
| Comment: although common practice, the prophylactic use of antibiotics with suspected or proven aspiration is not recommended. |
| Presence of gastro-oesophageal reflux, which, if severe, can be associated with hyperstimulation of the salivary glands or indirect aspiration → Consider GOR treatment. |
| Nutrition and hydration. Safe feeding programme? Does the feeding result in normal growth? → Consider nasotube feeding, laxative. |
| Comment: see www.LifeExpectancy.org/articles/GrowthCharts.shtml and [9] |
| Neurological examination (consciousness, cranial nerves, general motor skills/posture, and tone) |
| Orofacial examination (nasal breathing, upper airways obstruction) → Consider examination by the ENT specialist. |
| Oral hygiene, occlusion, and dental examination |
| Assessment by a speech pathologist → objective: modify food bolus such as consistency, size and texture, positioning of the patient, and examining compensatory swallow manoeuvres: |
| Posture and head control; mouth closure, lip seal |
| Oral sensorimotor examination (tongue lateralisation, sensation, tone, strength, (pathological) reactions) |
| Oropharyngeal stage of swallowing during eating and drinking (swallow on demand, oral control, frequency/efficiency/safety) |
| Speech (dysarthria/dyspraxia) and communication skills |
| Management of secretions → Consider drooling treatment [31]. |
| VFSS confirms silent aspiration and defines the pathophysiology of oropharyngeal swallow with various types of bolus |
| Comments: VFSS is the study of choice for complete evaluation of the feeding and swallowing process; aspiration is suspected in case of recurrent pneumonia and in children who are prone to gagging and coughing; silent aspirators do not exhibit overt symptoms of aspiration; aspiration risk is increased in non-ambulant children with CP (Gross Motor Functioning Classification System III or higher). See also [2] |