Region IV

Dysphagia Policies & Procedures

It is a team approach

All team members have different responsibilities

All team members need training based on their roles

Parents are a very important member of the team and should be included from the beginning

Region IV

Students identified with dysphagia

Must have a signed doctor order with food and liquid recommendations if any changes are being made to them

Must have an emergency plan for choking/aspiration

Staff must be trained on emergency plan and safe swallow strategies (different for all children)

Region IV

Special Education & Regular Education

Most of the children who are identified with dysphagia are receiving special education services

If they are not; we need to determine if the child has any medical diagnosis related to the feeding problem; (OHI)

Children receiving all regular education services and have dysphagia fall under health services with the nurse

Region IV

Evaluations

All evaluation requests are completed through an ARD

Two types of evaluations: Bedside Swallow Evaluation and a Modified Barium Swallow Study

Evaluations must have parent and physician approval

If a child develops dysphagia or enrolls with a diagnosis; then a temporary emergency plan is followed and completed until an evaluation is completed

Region IV

Normal Anatomy

http://www.radiographicceu.com/article23.html

Signs of Aspiration

Region IV

Michelle

Staff shared concerns with feeding Michelle had diagnosis of Retts Syndrome (a progressive disease)

and takes medication for seizures (some cause sedation) ARD committee recommended a BS (parents & physician agreed) Feeding/Swallowing plan developed with diet of cut solids and

regular liquids The following school year arrived and Michelle was having

difficulty eating again (with concerns enough to call 911) Observations and data collection determine the need for a MBSS MBSS was completed at the campus with parents Michelle demonstrated regression and this was difficult for the

parents to hear and accept New diet recommendations were pureed solids and regular

liquids Michelle is now doing better, eating safely at school, and she is

able to learnRegion IV

Anthony Staff shared concerns with feeding (including refusal of foods,

decreased chewing, and vomiting frequently) ARD committee recommended a BS (parents and physician agreed) Anthony demonstrated severe food aversions and did not chew food Recommendations at review ARD included going to a G.I. to rule out

any medical complications and to have a MBSS MBSS was completed and it showed a severe pathology in the

esophegeal stage of swallowing (esophageal stricture) Esophageal stricture is a narrowing or tightening of the esophagus

that causes swallowing difficulties Diet recommendations were pureed solids and regular liquids Anthony was referred to a GI with the new evaluation results Parents reported that they followed up with the G.I.; no specific

recommendations were required by us A feeding/swallowing plan was developed and the staff was trained Anthony is eating safely at school, and he continues to work on

feedingRegion IV

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Esophageal stricture: Narrowing or tightening of the esophagus that causes swallowing difficulties.

Avery Staff shared concerns with feeding (not

chewing well) Avery had a diagnosis of a hearing impairment

and other medical issues ARD committee recommended a BS (parents

and physician agreed) Feeding/swallowing plan was developed with

diet recommendations of cut/chopped soft foods and regular liquids

Avery had objectives to improve chewing skills At her next annual ARD, Avery made great

progress; she was able to chew solids foods without difficulty

Avery was dismissed from dysphagia support

Region IV

Dysphagia DataYear Trainings Observations Evaluations

08-09 50 52 32

09-10 47 75 42

10-11 34 78 30

11-12 On going 74 35

Region IV

DYSPHAGIA DATA

11/17/08 dysphagia caseload 112 students

2/1/12 dysphagia caseload 150 students

CFISD STATISTICS

84 schools including special facilities 107,995 students

Thank You

In the Cypress-Fairbanks School District students are continually begin monitored by terrific staff and family members. Each member of the dysphagia team is necessary, important, and contributes to the success of the student. Our goal is for students to gain adequate nutrition and hydration safely. This supports their health and educational needs.

Region IV

Resources for Dysphagia

The Source for Dysphagia 3rd Ed. By Nancy B. Swigert (Linguisystems)

The Source for Pediatric Dysphagia 2nd Ed. By Nancy B. Swigert (Linguisystems)

The Source for Oral-Facial Exercises By Debra C. Gangale (Linguisystems)

The Manuel of Paediatric Feeding Practice By Arlene McCurtin (Speechmark)

Just Take A Bite By Lori Ernsperger, Ph.D and Tania Stegen-Hanson, OTR/L (Future Horizons)

Bedside Evaluation Dysphagia By Edward Hardy (Imaginart)

Follow The Swallow By Jo Puntil-Sheltman (Amazon) Pre Feeding Skills By Suzanne Evans Morris (Amazon)