Session Descriptions for Rethinking Pediatric Feeding and Swallowing

Pre-recorded sessions will be on-demand and last about an hour, so you can watch them whenever time permits! 

Pediatric Feeding and Swallowing: State of the Art and Science in Assessment and Management
Joan C. Arvedson, PhD, CCC-SLP, BCS-S

SLPs who work with infants and children with feeding and swallowing disorders are involved in high-risk patient care. Our knowledge base is broad in some aspects of feeding and swallowing evaluation and management. However, it is critical that we expand our horizons to facilitate the best possible functional outcomes for the whole child and family. This session discusses challenges for the future as a combination of art and science as well as highlights areas of consensus and controversy in the many facets of practice that encompass pediatric feeding and swallowing.

After completing this session, you will be able to:

• state three critical factors in decision-making for infants and children with complex feeding and swallowing disorders
• describe three areas of controversy in management decision-making for infants and children at risk for pulmonary consequences with oral feeding
• apply knowledge of multiple system interrelationships that support consensus in decision-making for infants and children with oropharyngeal dysphagia

From Research to Bedside: Social Determinants of Health and Their Impact on Feeding Development in the Birth-to-Three Population
Brianna Miluk, MS, CCC-SLP, CLC; Kara Fletcher Larson, MS, CCC-SLP; and Emily Zimmerman, PhD, CCC-SLP

This session provides an overview of social determinants of health as they relate to maternal health and child feeding development across a variety of settings. Speakers present research findings on how maternal exposures (e.g., stress, environmental) and maternal factors (psychosocial) can influence sucking and feeding outcomes in infants. The session examines social determinants of health in the neonatal intensive care unit (NICU), home health/community, and outpatient settings for children birth to 3 years old.

After completing this session, you will be able to:

• describe the five domains of social determinants of health
• discuss how exposures in the utero environment (e.g., maternal factors) can influence sucking outcomes soon after birth
• identify at least three ways social determinants of health impact patient and family access to care in their community and homes
• explain how to improve understanding of social determinants of health to support patient access to quality care

Feeding and Swallowing Assessment Considerations for Infants and Toddlers
Pamela Dodrill, PhD, CCC-SLP, BCS-S

The session explores clinical feeding assessment tools that are appropriate for use in various clinical settings with children from birth to 3 years of age with varying etiologies. The speaker discusses pros and cons of various assessment tools as well as the importance of incorporating functional measures into your assessment battery to help guide meaningful management goals.

After completing this session, you will be able to:

• list three indicators of feeding skill dysfunction as outlined in the consensus definition of Pediatric Feeding Disorder (PFD)
• list three examples of feeding assessment items that map to the impairment, activity, and function dimensions of the World Health Organization International Classification of Functioning (ICF) model
• list three indicators of the need for instrumental feeding assessment in children birth to age 3

Distinguishing Physiologic Impairment and Common Developmental Variation in Infant Feeding
Katlyn E. McGrattan, PhD, CCC-SLP

The field of pediatric feeding and swallowing requires clinicians to determine the significance of physiologic aberrations and whether these findings warrant intervention. This session describes the evidence to assist in answering questions like: Is a swallow that initiates in the pyriform sinuses “delayed” and the source of a child’s impairment? Is coughing during a feed a clear sign of aspiration that warrants instrumental assessment and conservative management? What is the significance of stress cues during a feed? This session addresses these types of questions by exploring the literature relating to clinical and fluoroscopic characteristics of how healthy, non-dysphagic infants eat. The session is designed for clinicians with experience in infant feeding and swallowing but also is appropriate for clinicians new to this area of practice.

After completing this session, you will be able to:

• identify which of the following clinical findings is/are commonly observed in healthy, non-dysphagic infants: coughing, turning blue, making gurgling sounds, anterior bolus loss, increased work of breathing, and stress cues
• describe a “normal” response to aspiration during the neonatal period and how this changes with maturation

Interprofessional Practice for Pediatric FEES
Jenny Reynolds, MS, CCC-SLP, CLC, CNT, BCS-S

This session describes the value of interprofessional practice (IPP) on a pediatric FEES (flexible [or fiberoptic] endoscopic evaluation of swallowing) team. The presenter shares FEES case studies that illustrate this collaborative model for dysphagia management; describes the successes and challenges encountered by the IPP team during pediatric FEES; and reviews current FEES literature in the pediatric population.

After completing this session, you will be able to:

• describe the roles and responsibilities of each member on a pediatric FEES team
• identify two barriers and two recommended solutions for effective interprofessional practice when performing a pediatric FEES procedure
• describe two patient populations for which pediatric FEES can be an effective tool for dysphagia management

Videofluoroscopic Swallow Studies for Bottle-Fed Children: Elevating the Standard of Care
Bonnie Martin-Harris, PhD, CCC-SLP, and Maureen A. Lefton-Greif, PhD, CCC-SLP, BCS-S

SLPs make critical decisions for medically complex and fragile children with oropharyngeal dysphagia based on videofluoroscopic swallow studies (VFSS) despite facing challenges due to lack of standardized procedures and valid and reliable measures. SLPs face questions like: How do we conduct studies with high clinical yield that minimize radiation exposure? How should we describe, interpret, and report VFSS findings? How do we translate findings to management? This session explores the practical impact of standardization and how it can be applied to address these common questions, as well as the how the BabyVFSSImP© measurement tool holds potential for elevating the standard of care for babies with oropharyngeal dysphagia.

After completing this session, you will be able to:

• discuss the clinical and safety benefits of standardized and validated videofluoroscopic assessments for bottle-fed children
• describe how standardized and validated videofluoroscopic swallow studies impact clinical decision-making and research

Diet Modification and Pediatric Dysphagia: Controversies and Consensus
Memorie M. Gosa, PhD, CCC-SLP, BCS-S

Diet texture modification—specifically, thickening of liquid consistencies—is often recommended to compensate for dysphagia in pediatric populations due to their physical and cognitive immaturity. This session discusses the evidence in support of this popular management recommendation and explores the many variables that can impact its effectiveness. The speaker presents strategies that SLPs can implement in their clinical practice to mitigate undesirable consequences of texture modification in the pediatric population.

After completing this session, you will be able to:

• describe the physiologic impact of thickened liquids on swallowing function in pediatric populations
• discuss three variables that can influence the thickness of liquid consistencies recommended for managing dysphagia
• name a strategy clinicians can implement to mitigate undesirable consequences of texture modification in the pediatric population

Esophageal Dysphagia & GERD in Infants and Young Children
Laura Brooks, MEd, CCC-SLP, BCS-S

Clinicians working with infants and young children need to understand how the oral, pharyngeal, and esophageal phases of swallowing impact feeding. This session focuses on disorders that impact the esophageal phase of swallowing, and how the clinician can identify and help manage these disorders.

After completing this session, you will be able to:

• describe three disorders that impact the esophageal phase of swallowing in the pediatric population
• describe three interventions for reflux in the pediatric population
• describe three scenarios where the SLP and the gastroenterologist can collaborate to support an infant or young child with esophageal dysphagia

Pediatric Airway Disorders
Laura Brooks, MEd, CCC-SLP, BCS-S

This session reviews prenatal airway development and abnormalities that can impact communication and swallowing. The speaker reviews different levels of respiratory support from low-flow nasal cannula to mechanical ventilation and speaking valve application for patients who are tracheostomy dependent with or without ventilator dependence. The goal of this session is to expand understanding of anatomy and physiology as well as the impact of anomalies on communication and swallowing.

Content disclosure: This session is focused primarily on Passy Muir Valves.

After completing this session, you will be able to:

• account for airway anatomy and physiology considerations during instrumental and clinical swallowing examinations
• account for airway anatomy and physiology considerations during Passy Muir Valve application for tracheostomy dependent patients with or without ventilator dependence

Thinking Outside the Box: Should We Feed Infants on Positive Pressure?
Louisa Ferrara-Gonzalez, PhD, CCC-SLP, BCS-S, CNT, NTMCT, and Kimberly Morris, MS, CCC-SLP, BCS-S, IBCLC

Medically complex neonates often face many challenges as they learn to feed and along the path of transitioning from tube to oral feedings. One of the most perplexing is how to progress oral feedings while the infant is still receiving positive pressure support for respiratory needs. This session explores different approaches to this challenge based on literature, clinical expertise, and multidisciplinary frameworks. The speakers discuss the relevance of the infant’s aerodigestive system when in the NICU vs. in the cardiothoracic ICU. The session shares evidence-based strategies along with novel outcome data so clinicians can feel more equipped to direct the care for these infants in the most supportive and advantageous way.

After completing this session, you will be able to:

• describe the effects of positive pressure support on the neonatal swallowing mechanism and aerodigestive system
• explain the pros and cons of various feeding guidelines as they relate to NICU vs. CTICU infants
• describe the risk-to-benefit ratio when considering advancing oral feedings in infants on positive pressure

Shifting From Survive to Thrive for Infants With Congenital Heart Defects
Karli Negrin, MS, CCC-SLP, and Hema Desai, MS, CCC-SLP, BCS-S, CLE, NTMTC

Infants born with congenital heart defects (CHD) experience unique pre- and post-surgical complications that impact their ability to develop skills to successfully feed orally. This session reviews the disruptions to oral feeding development in infants with CHD and offers strategies to help infants thrive in their feeding skills after surgery. The session addresses the instrumental role the SLP plays on the multidisciplinary team by facilitating oral feeding development after surgery and hospital discharge. This session is intended for advanced clinicians who work with this special population.

After completing this session, you will be able to:

• identify three physiologic differences in cardiac circulation that impact oral feeding development in infants with CHD
• discuss three consequences of surgery that result in delayed oral feeding development
• explain how the gastrointestinal and neurological systems are affected after cardiac surgery
• discuss three strategies for early intervention post-surgery to facilitate oral feeding development in infants with CHD
• identify two strategies to improve maternal mental health post-infant cardiac surgery

Feeding for Infants and Young Children With Cleft Lip, Cleft Palate, and/or Craniofacial Differences
Raquel Garcia, SLPD, CCC-SLP, CNT, BCS-S

Infants and young children with craniofacial differences are inherently at increased risk for feeding and swallowing challenges due to their anatomical variances, medical co-morbidities, and experiences with medical touch. This session explores functional interventions to maximize developmental feeding skills and swallowing safety in children from birth to 3 years old with a history of cleft lip, cleft palate, and/or craniofacial differences. The speaker discusses case studies from infancy and early intervention that utilize the pediatric feeding disorder criteria to guide differential diagnosis and develop an evidence-based functional intervention plan.

After completing this session, you will be able to:

• identify variances in typical feeding/swallowing patterns vs. atypical feeding/swallowing patterns
• discuss the use of adaptive utensils and compensatory strategies to improve oral feeding quality and/or safety
• describe commonly used interventions and the external evidence to support them

Skilled Breastfeeding Support: An Interdisciplinary Approach to Assessment and Treatment of Breastfeeding Challenges
Catherine Watson Genna, BS, IBCLC, and Jamie Mahurin Smith, PhD, CCC-SLP, IBCLC

This session shares effective strategies for SLPs working with infants whose parents’ goal is direct breastfeeding. The session aims to equip SLPs to support families in a safe transition to direct breastfeeding by sharing tools for at-breast assessment and flow-rate modification.

After completing this session, you will be able to:

• identify three assessment strategies suitable for at-breast feeding evaluation
• identify three ways to modulate milk flow during breastfeeding to accommodate infant deficits in suck/swallow/breathe coordination
• identify four ways in which breastfeeding lays a foundation for future well-being across multiple domains (i.e., feeding, cognition, language, speech, immunity)

Partnering to Implement Preferred Practices for Feeding and Nutrition in the NICU
Erin S. Ross, PhD, CCC-SLP

This session explores the challenges presented by the different perspectives on infant feeding among the caregiving team in the neonatal intensive care unit (NICU). The speaker discusses the evidence-based recommendations related to feeding, eating, and nutrition that were recently published by the First Consensus Conference on Standards, Competencies and Best Practices for Infant and Family-Centered Developmental Care in the Intensive Care Unit . The speaker uses a case study to illustrate how the SLP may use these standards and competencies to partner with the family, infant, and care team and improve feeding outcomes.

After completing this session, you will be able to:

• locate and use the Infant and Family-Centered Developmental Care (IFCDC) Standards and Sample Recommendations for Infants in the ICU
• list two standards within the section on feeding, eating, and nutrition delivery
• describe how to use the standards to partner with infants, families, and other professionals to implement infant- and family-centered developmental care feeding practices

Professional Advocacy Within the Interprofessional Practice (IPP) Team
Alyson Ware, MS, CCC-SLP, CLC; Casey Lewis, MS, CCC-SLP, CNT, CLC, NTMTC; and Rebecca Smith, MS, CCC-SLP, CNT, CLC, BCS-S

Advocacy across the continuum of care is critical for improving outcomes in pediatric feeding and swallowing. Although advocacy appears different in each setting, the end goal remains the same: improving the quality of life for the patients and families we serve. This session discusses advocacy in the neonatal intensive care unit (NICU) and early intervention, as well as involvement in professional organizations. Presenters share examples of common issues across the continuum of care and solutions to these challenges through advocacy.

After completing this session, you will be able to:

• describe how state- and national-level advocacy supports patients with pediatric feeding and swallowing disorders
• list three caregiver capacity-building strategies to support their self-advocacy skills
• describe methods of obtaining provider and medical team buy-in regarding feeding/swallowing programs within the NICU, furthering advocacy for patients with pediatric feeding and swallowing disorders

Culturally Responsive Care in Management of Pediatric Feeding and Swallowing Disorders
Megan Richmond, DHA, CCC-SLP, CLC; Dipti Dev, PhD; and Carly Hillburn, MS, RD, LMNT

A culturally responsive approach to support clients and families from all backgrounds begins with understanding and meeting them where they are. This session explores assessing the mealtime emotional climate for group and interpersonal dynamics between family members, supporting family members and young children’s autonomy and self-regulation at mealtimes, and a diagnostic battery that will help produce culturally responsive treatment recommendations and parent education.

After completing this session, you will be able to:

• apply elements of culturally responsive care to management of pediatric feeding and swallowing disorders
• utilize checklists that may be added to a feeding diagnostic battery
• share a key takeaway related to culturally responsive care in the management of pediatric feeding and swallowing disorders via social media

"I loved how there were different perspectives on the same subject. I liked the tips and practical treatment strategies that were provided."