Role of the Speech and Language Therapist in Assessment of Oral Feeding

Gail RobertsonSpecialist Speech and Language Therapist

Terminology

• Dysphagia• Eating, Drinking and

swallowing Difficulties (EDS)

• Swallowing problem• Feeding disorder / difficulty

Phases of swallowing

• Oral Preparatory phase• Oral phase• Pharyngeal phase • Oesophageal phase

Stage One and Stage Two

Stage Three and Stage Four

Effective Swallowing

Safe and effective swallowing is a complex act requiring the coordination of:

• Cranial nerves, the brain stem and cerebral cortex

• 26 muscles of the mouth, pharynx and oesophagus

To assess oral motor skills

Assess eating and drinking

Assess safety of swallowing

To share information and contribute to planning within the Multidisciplinary Team(including parents/carers)

•Medical History

Including birth history, diagnosis particularly neurological conditions, respiratory problems, reflux etc

•Feeding History

Including tube feeding, development, behaviour, nutrition, gagging/choking etc

•Parents/carers views, concerns

Assessment of Oral Motor Skills

• Assess oral structures and control of oral movements for eating , drinking and swallowing including reflex behaviour

• Oro-Facial Exam/Observation

• Ability to control oral secretions

Assessment of Eating and Drinking

• How is child fed?Position, who feeds, self-feeding, utensils

• What is child eating and drinking?Consistency, texture, amount, temperature,

taste

Assessment of Eating and Drinking• How does child deal with food/drink?Sucking, biting, chewing, drinking, abnormal

movements, spillage, indications of poorly coordinated or unsafe swallow

• How long does it take and what happens afterwards?

Coughing, vomiting

Assessing safety of swallowSwallow may be poorly coordinated, delayed

or absentClinical signs indicating an unsafe

swallow/aspiration – cough, choke, colour change, wet voice, refusal, changes in breathing, poor weight gain, frequent chest infections

VFSS – objective assessment (has limitations)Silent aspiration

Videofluroscopic Swallowing Study

• Visualise the swallowing mechanism• Objective evaluation• Present different consistenciesBUT• Positioning• Brief • VariabilityShould not be taken in isolation

Evaluation

• Is the child safe• Does the child have oral skills

required • Can the child achieve and

maintain nutritional requirements • Quality of life for child and carers