A Multidisciplinary Approach to Infants With GERD-Like Symptoms: A New Paradigm.

OBJECTIVES: Infants with gastroesophageal reflux disease (GERD)-like symptoms have been classically defined as having a wide array of symptoms. In these instances, anti-reflux medications are ineffective and overprescribed. Rather these symptoms are more attributable to dysphagia and unsettledness/colic. To address these conditions at our center, both speech language pathologist (SLP) and/or occupational therapist (OT) have contributed to evaluation. We hypothesized that dysphagia and unsettledness/colic are highly prevalent, yet under recognized in this population. METHODS: Full-term infants with typical development and under 6 months of age (N = 174) were included. Infants with suspected dysphagia and/or evident colic/unsettledness were evaluated by SLP and OT, respectively. RESULTS: GERD-like symptoms were present in 109 infants with attributes of dysphagia in n = 46, unsettledness/colic in n = 37, and combined in n = 26. CONCLUSION: A multidisciplinary approach, including SLP and OT, is recommended for the evaluation of infants with GERD-like symptoms.

Tutorial on Clinical Practice for Use of the Fiberoptic Endoscopic Evaluation of Swallowing Procedure With Adult Populations: Part 1.

PURPOSE: Representatives of the American Board of Swallowing and Swallowing Disorders (AB-SSD) and American Speech-Language-Hearing Association (ASHA) Special Interest Group (SIG) 13: Swallowing and Swallowing Disorders (Dysphagia) developed this tutorial to identify and recommend best practice guidelines for speech-language pathologists who conduct and interpret fiberoptic endoscopic evaluation of swallowing (FEES) procedures in adults. This document also includes proposed training needs and methods for achieving competency. Expert opinion is provided regarding indications for performing the FEES exam, potential contraindications, adverse effects and safety, equipment and personal protection, the exam protocol, interpretation and documentation of findings, and training requirements to perform and interpret the exam. CONCLUSIONS: This tutorial by the AB-SSD and SIG 13 represents the first update about the FEES procedure since ASHA's position paper and technical report published in 2004. Creation of this document by members of the AB-SSD and SIG 13 is intended to guide professionals who are training for or practicing FEES in the adult population toward established best practices and the highest standards of care.

A systematic review: The effects of frenotomy on breastfeeding and speech in children with ankyloglossia.

Purpose: The primary objective of this systematic review was to determine if frenotomy for ankyloglossia improves breastfeeding or speech outcomes in infants and children ages birth to 12.Method: Literature selection focussed on the presence of ankyloglossia, reported as either posterior or submucosal, and the impact of surgical treatment. The two populations that were included involve infants who were breastfeeding and children with speech delays. Six search engines were utilised (PubMed, Medline, Cochrane Database, CINHAL Plus, ERIC and PsychINFO). The selected articles critically examined study characteristics, measurement tools, outcome measures, design, and summary of results, and bias.Result: Five articles met the inclusion criteria related to infants who had undergone a frenotomy and who were examining changes in breastfeeding outcomes and two articles met the inclusion criteria for changes in speech production following a frenotomy.Conclusion: Research supports the use of frenotomy in children with ankyloglossia to reduce nipple pain and improve maternal self-efficacy during breastfeeding. The classification of ankyloglossia, assessment tools used, age and timing of frenotomy, in terms of breastfeeding improvements were inconsistent across the studies. Ankyloglossia release for children with speech delays is currently inconclusive due to lack of objective data and research quality. Overall, the review also revealed inconsistent definitions of ankyloglossia severity, standardised outcome measures and research protocols.

Correction to: A Comparison of Measurements of a Pediatric Supplement.

The original version of this article unfortunately contained mistakes.

A Comparison of Measurements of a Pediatric Supplement.

This study evaluated the flow properties of viscosity and flow rate for water and two common pediatric liquids. The flow properties of the test liquids are of interest to create a cup simulation model and "smart" prototype training cup. Two objective methods of determining flow properties were utilized: a rheometer to assess viscosity and a modified version of the International Dysphagia Diet Standardization Initiative (IDDSI) to assess flow rate. Rheometer results concluded that the pediatric supplements were less than 50 cP at all shear rates evaluated and exhibited shear-thinning properties, placing both liquids into the "thin" category. The IDDSI, which was performed according to standardized protocol and also with experimental modifications of varying syringe volumes, determined that all three test liquids had greater than 1 mL/s flow rate across all syringe types/sizes. The experimental modification of the IDDSI with 60 mL syringe volume was found to be the most consistent and applicable with discrete values obtained across all liquids tested. A flow rate factor equation can be determined with the use of a 60 mL syringe, with our laboratory setup, to create the cup simulation model. This computer-generated cup simulation model also aims to integrate engineering with clinical practice to develop a "smart" prototype training cup equipped with software to control flow rate.

Abnormal physiological responses to touch among children with persistent feeding difficulties.

Pediatric feeding/swallowing specialists commonly observe infants and toddlers who present with gagging or significant behavior state changes as a result of touch to oral and body regions. To date, this behavior has not been fully characterized or documented experimentally. This paper describes an exploratory study aimed at filling in these lacunae and providing a possible explanation. The study compares the responses to firm tactile pressure of 40 children between the ages of 3 and 18 months. The experimental group consisted of 20 children (12 males, 8 females) with heterogeneous medical diagnoses, at least 2 weeks of alternative feedings during the first 3 months of life, and a common history of persistent feeding difficulties. The comparison group consisted of 20 children with an unremarkable medical history matched by age and sex to the experimental group. Firm, tactile pressure was applied in a predetermined sequence following dermatome regions from legs to mouth. Response was recorded in terms of presence/absence of gagging and/or behavior state changes. Fifteen of the 20 children in the experimental group showed gagging (14) or inconsolable crying (1) in response to touch. None of the matched comparison group demonstrated either gagging or behavior state changes. The experimental and comparison groups showed significant differences in response to tactile input. Further, the source of these abnormal responses must be sought in similarity of experience across heterogeneous medical diagnoses and interventions. One possible explanation is a history of oral deprivation due to alternative feedings.