Speech-language pathologists play a central role in the assessment, diagnosis, and treatment of infants and children with swallowing and feeding disorders. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment), prevention and advocacy, education, administration, and research. See ASHA's Scope of Practice in Speech-Language Pathology (ASHA, 2007).
Appropriate roles for SLPs include
- providing prevention information to individuals and groups known to be at risk for pediatric dysphagia and feeding disorders, as well as to individuals working with those at risk;
- educating other professionals on the needs of children with dysphagia and the role of SLPs in diagnosing and managing pediatric dysphagia;
- conducting a comprehensive assessment, including clinical and instrumental evaluation; identifying normal and abnormal swallowing anatomy and physiology; and identifying signs of possible or potential disorders in the upper aerodigestive tract;
- participating in decisions regarding the appropriateness of instrumental evaluation procedures, being included in decision-making about the severity and nature of swallowing deficits, interpreting data and applying results obtained from instrumental assessments to the formulation of dysphagia treatment plans and to the determination of the child's potential for safe and adequate oral intake;
- extracting information about swallowing function from the results of procedures performed by different medical specialists–including procedures such as manofluorography, cervical auscultation, scintigraphy (which in the pediatric population may also be referred to as radionuclide milk scanning), pharyngeal manometry, 24-hour pH monitoring, and esophagoscopy;
- diagnosing pediatric dysphagia;
- referring the patient to other professionals as needed to rule out other conditions, determine etiology, and facilitate patient access to comprehensive services;
- making decisions about management of pediatric dysphagia;
- considering culture as it pertains to food choices, perception of disabilities, and beliefs about intervention (Davis-McFarland, 2008);
- developing treatment plans that incorporate the family's dietary preferences, providing treatment, documenting progress, and determining appropriate dismissal criteria;
- recommending a swallowing and feeding plan for daily management of swallowing and feeding activities that is referenced in the Individualized Education Program (IEP), Individual Family Service Plan (IFSP), or 504 Plan;
- recommending related services when necessary for daily classroom management and therapy;
- counseling children and their families and providing education aimed at preventing further complications related to dysphagia;
- serving as an integral member of an interdisciplinary feeding and swallowing team;
- providing quality control and risk management;
- consulting and collaborating with other professionals, family members, caregivers, and others to facilitate program development and to provide supervision, evaluation, and/or expert testimony, as appropriate;
- remaining informed of research in the area of pediatric dysphagia and helping advance the knowledge base related to the nature and treatment of dysphagia;
- advocating for individuals with dysphagia and their families at the local, state, and national levels.
As indicated in the Code of Ethics, SLPs who serve this population should be specifically educated and appropriately trained to do so. Experience in adult dysphagia does not qualify an individual to provide dysphagia assessment or management services to children. An understanding of adult anatomy and physiology of the swallow provides a good basis for understanding dysphagia in children; however, additional knowledge and skills pertaining to the pediatric dysphagia population are needed.