Swallowing and Feeding in the Schools Consultant Swallowing and Feeding Disorders in the Schools: Information for para- educators! Emily M. Homer, CCC-SLP Swallowing and Feeding in the Schools Consultant Students Eat Safely

Plan for today is to: Define swallowing and feeding disorders as they occur in a school setting Discuss the signs and symptoms of swallowing and feeding disorders. Identify the students who are at risk for swallowing and feeding disorders Determine what we can do about them in the schools Talk about the para educator’s role in addressing swallowing and feeding

Has anyone in your family experienced swallowing difficulties?

What is a swallowing and feeding disorder? Delays and/or disorders in the development of eating and drinking skills, which are common in the pediatric population. Includes introduction, preparation (oral phase), transfer, and transport of food (pharyngeal phase) and liquid from mouth through esophagus into the stomach (esophageal phase). Management of saliva and oral intake of medications

Video on the Phases of Swallowing: https://www.youtube.com/watch?v=YQm5RCz9Pxc https://www.youtube.com/watch?v=adJHdrQ4CRM&t=28s https://www.youtube.com/watch?v=huZ6ymeKFd4&index=15&list=PLT7oQn1A6Z2PSxqd6wHaQUUHpACpb1S5-

When is it dysphagia (swallowing)? Oral Phase - When the student can not chew food adequately to break it down and form a bolus which can be safely swallowed. Pharyngeal Phase – When structurally there is a problem that interferes with the swallowing mechanism protecting the airway or with food or liquid going directly into the esophagus. Esophageal Phase – The food is swallowing and goes into the esophagus

When is it a feeding disorder? When children need special equipment, positioning, or need to have food modified in order to safely eat their meals then they have a feeding disorder. When children have difficulty using utensils during mealtimes. When children have behaviors or sensory concerns that result in a limitation of the foods that they eat.

Who and What of Swallowing and Feeding Why are we concerned about how a child eats? What can happen if a child is not fed correctly? How do I know if a child is not being fed correctly? Safety is always the first consideration.

Swallowing and Feeding disorders: Safety Concern Under nourishment and dehydration Choking Aspiration and pneumonia

Swallowing and Feeding Swallowing and feeding disorders are addressed using a TEAM APPROACH! The swallowing and feeding team is made up of many professionals in the schools, including the SLP, OT, nurse, teacher, and paraprofessional. The core team, the SLP, OT and nurse, evaluate the student and determine how the student can be fed safely. The case manager, which is usually the SLP writes a swallowing and feeding plan which is followed by the classroom staff members who are responsible for feeding the child.

School-based swallowing and feeding team members Speech/Language Pathologist Occupational Therapist Physical Therapist School Nurse Parent Special Education Teacher Regular Education Teacher Para educator School Administrator Social Worker Physician(s) Hospital Based SLP Dietician Cafeteria Workers

Speech and Language Pathologist Case Manager Speech and Language Pathologist Occupational Therapist Physical Therapist Classroom Teachers Para educator School Administrators Cafeteria Workers School Nurse Medical Team: Physicians Hospital SLP Dietician

What will be reported by parents or what you may observe! Repeated respiratory infections History of recurring pneumonia Weight loss/failure to thrive Difficulty chewing Coughing/choking during or after swallowing Maintains open mouth posture Drooling Food refusal Prolonged feeding times Poor oral motor functioning Nasal regurgitation Wet/gurgle voice/sound after meal Difficulty initiating swallowing

Can you think of a child that you know who has these conditions?

Para educators role with swallowing and feeding: May be asked to participate in the interdisciplinary observation by feeding the student in the manner that is typical at school. Receive training on how to safely follow the Swallowing and Feeding plan. Implement the Swallowing and Feeding plan with fidelity. Receive training on how to prepare the recommended diet modifications. Prepare the student’s cafeteria tray or home supplied food according to the plan.

What is the Swallowing and Feeding Plan? Includes the following: Identifying Information (DOB, Teacher, etc.) Brief History/Special Considerations/Presenting Concerns Feeding recommendations: Positioning Equipment Diet/Food Preparation Feeding plan techniques/precautions Name/number of dysphagia case manager Verification of training Sample Plans

Collaboration: Whether it is helping a student to eat at school safely, or preparing a student’s cafeteria tray, or working on oral motor exercises with a student it comes down to working together! Remember, the goal is student safety during mealtimes at school!

Para educators are essential team members! Communication! If you are not sure what to do…talk to the SLP If you see something you are concerned about…talk to the SLP If you have an idea of something that might work well for the student…talk to the SLP If you disagree with what is being recommended…talk to the SLP If you love what is being recommended…talk to the SLP!!

Questions, Comments, Concerns

For more information contact: Emily M. Homer, M.A., CCC-SLP Swallowing and Feeding in the Schools Consultant www.emilymhomer.com

Signs and Symptoms of Under nutrition Tired, lethargic, irritable, anxious and disoriented. Bruises easily Diarrhea Rashes

Dehydration Thirst Dry, sticky mouth Decreased urine output Few or no tears when crying May be sleepy, complain of a headache, dizziness or lightheadedness.

Parents: essential team members

“Working with students who have dysphagia can certainly be difficult, but understanding the families’ perspectives can prove not only helpful, but in many instances, crucial to developing and implementing effective programming.” (Angel, Bailey, Nicholson, & Stoner, 2009)

Working with Families “School-based professionals should work toward developing an appreciation of the impact that having a child with a developmental disability can have on the family and develop sensitivity for the complexities that families with disabled children face.” (Handleman, 1995)