Eating, drinking and swallowing disorders: a new regional clinic review

Abstract

Introduction Eating, drinking and swallowing (EDS) disorders can have serious consequences for children which include dehydration, malnutrition, failure to thrive, aspiration pneumonia, choking and possibly death. Adverse feeding behaviour can further perpetuate these problems leading to a cycle of food refusal, further nutritional compromise and considerable stress for the care giver. Background Paediatric feeding disorders have been reported in up to 25% of children. This number increases to 80% in developmentally delayed children. Therefore, disordered feeding should involve assessment by a multidisciplinary team. The problem is seldom limited to the child alone and non-organic factors must also be addressed. Medical treatment, behavioural modification and parental education are some interventions available for these children. Aims The aim of our study was to audit the first 18 months of practice in a new regional EDS clinic from July 2007 to December 2008. Methods Retrospective chart review of clinic reports was carried out. All patients had formal assessment of EDS by a speech and language therapist (SALT) and occupational therapist (OT), a medical review by a doctor and dietetics consult at each clinic visit. Results 28 patients received full assessment. Average age of 1st consult was 4.16 years. 12 patients referred from SALT, seven from local early intervention services, remainder from mixture of healthcare professionals. 27/28 patients had an underling diagnosis, the most common being; genetic disorder (n=7), autism (n=3), cerebral palsy (n=3), Ex-prem (n=3), developmental delay of unknown aetiology (n=3). Diverse reasons for referral included (often >1); issues with coordination of swallow (n=14), perceived behavioural issues (n=6), chronic reflux (n=5), PEG feeding (n=4), aspiration (n=4). 10 had prior video fluoroscopy. 22/28 patients had an abnormal EDS assessment. The two most common interventions initiated were a sensory feeding programme (n=15) or food desensitisation programme (n=4) by SALT/OT. There were nine specific medical interventions of which referral to another physician was the most common (n=5). Conclusion Our EDS clinic has provided further therapeutic intervention for children already with complex medical needs. In conjunction with medical therapy, behavioural and oromotor strategies can be applied successfully even in feeding disorders with an underlying organic cause.