Advocacy in Feeding Disorders

By: Hannah Carey, Madison McDaniel, Haley Conner, Kaitlin Weaver, Maggie Westfall

Introduction:
 
“Imagine what life would be like needing to take 20 minutes away from whatever it is your doing just to take a sip of water… I can’t imagine.”
 
This is the reality for individuals suffering from a disorder known as dysphagia. Dysphagia occurs when there is a disruption in the processes involved in feeding and/or swallowing. Without appropriate intervention, dysphagia can greatly impact an individual's overall quality of life.
 
What are pediatric feeding and swallowing disorders?
 
Feeding disorders are formally defined by the American Speech-Language Hearing Association [ASHA] as, “problems with a range of eating activities that may or may not include problems with swallowing” (ASHA, 2018). This includes problems with actions such as, sucking from a bottle, being fed with a spoon, chewing, and moving the food or drink back toward the throat for swallowing. Swallowing disorders occur when there is a disruption in the “process during which saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected” (ASHA, 2018). Implications of both feeding and swallowing disorders include aversion to different foods, malnutrition, gastrointestinal issues, behavioral issues, social implications, etc. In order to eliminate or minimize the effects of dysphagia, it is imperative that children receive appropriate intervention/therapy.
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What does swallowing intervention look like and SLPs role in treating the patient?
 
Swallowing therapy can be used to restore a person’s normal function, modify behavior without totally restoring function (compensatory strategies), or a combination of either of these. Patients who need swallowing therapy include those who have suffered damage from traumatic brain injuries, multiple muscle-weakening diseases, and many other causes. The amount of treatment necessary is dependent upon the severity of the problems experienced by the person. The role of the speech-language pathologist is dependent upon the specific patient’s needs. First, the SLP will be responsible for giving an assessment and diagnosis of the swallowing or feeding disorder. Once an issue or disorder has been determined, the SLP will then carryout treatment using a variety of techniques: biofeedback (where the patient can see the swallow), diet modifications (making food and liquids a desired consistency), and oral-motor therapy and exercises (asha.org).  
 
 
Why do services for this population matter?
During childhood, the body is growing at a rapid rate. The vitamins and minerals from food helps support the growth and development during this time. The nutrition from food allows the bones, muscles, tendons, joints and organs to develop and work as they should (Seidenberg). Along with the skeletal growth during these stages, good nutrition is needed for brain development. A study done by the CDC found that children who are not receiving the right amount of vitamins and minerals are receiving lower grades than the children that do. According to Dr. Reynaldo Martorell, when a child is receiving a poor diet without the proper nutrients required for growth, it can lead to learning disorders, attentional issues and behavioral/social problems (Brinkman, 2017).
 
What can we change?
Given the prevalence of swallowing disorders, and effects of feeding and swallowing disorders on children, it is critical that insurance companies cover therapy sessions for people with these disorders. Sessions should not be capped, as the focus of the treatment should be on the needs of the child and not on financial costs.
 
Advocate for the number of session they should get. Number of visits should be based on patient’s needs.
 
Every therapy session is going to be different, just like the number of therapy sessions is going to different based on the person and their needs. For instance, a person who has had surgery for a torn ACL is going to have more physical therapy sessions versus someone who is receiving physical therapy who has a sprained ankle. The same effect applies to those receiving swallowing services from the speech-language pathologist. The maximum number of therapy sessions insurances will cover is approximately 20 per year, which is a fairly small number. That being said, it is important to take into consideration the extent and severity of each case, and allow the recommended number of sessions based on what the professional thinks, rather than having insurance companies dictating the amount of sessions they believe a person should receive.
 
References:
 
Seidenberg, Casey. (n.d.). Why it’s so important to feed kids well during growth spurts. https://www.washingtonpost.com/lifestyle/wellness/why-its-so-important-to-feed-teens-well-during-growth-spurts/2018/04/03/c8d2cf98-2c7c-11e8-b0b0-f706877db618_story.html?noredirect=on&utm_term=.cc5c7bf6f31c
 
Brinkman, J. (2017). Why is healthy diet important for child development. https://www.livestrong.com/article/355822-why-is-a-healthy-diet-important-for-child-development/
 
https://www.feedingmatters.org
 
https://pedsfeeds.com
 
https://youtu.be/buwFUkOFipE
 
https://www.youtube.com/watch?v=MrbEUDO6S5U
 
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934965&section=Treatment
 
https://leader.pubs.asha.org/article.aspx?articleid=2289526
 
https://www.asha.org/Practice-Portal/Clinical-Topics/Pediatric-Dysphagia/