1. Role of the Speech and Language Therapist in Assessment of Oral Feeding Gail Robertson Specialist Speech and Language Therapist

2. Terminology Dysphagia Eating, Drinking and swallowing Difficulties (EDS) Swallowing problem Feeding disorder / difficulty

3. Phases of swallowing Oral Preparatory phase Oral phase Pharyngeal phase Oesophageal phase

4. Stage One and Stage Two

5. Stage Three and Stage Four

6. 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

7. 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)

8. 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

9. 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

10. 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

11. 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

12. Assessing safety of swallow Swallow may be poorly coordinated, delayed or absent Clinical 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

13. Videofluroscopic Swallowing Study Visualise the swallowing mechanism Objective evaluation Present different consistencies BUT Positioning Brief Variability Should not be taken in isolation

14. 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