Interview with Sarah Hanson on Dysphagia Awareness Month!
Interview with Sarah Hanson on Dysphagia:
Matt: What brought you to the Bluffton area and to LTC?
Sarah: After I graduated from graduate school at the University of Wisconsin-River Falls, I signed on with a national company and they got me hooked up with a school in Ridgeland. After that I worked with Jessi at a previous location and when she opened LTC she offered me a position and I followed her.
Matt: So as you know June is dysphagia awareness month. Can you tell us a little bit about what dysphagia is?
Sarah: Dysphagia consists of feeding and swallowing disorders and can include difficulty with any step in the feeding process. There are 4 different phases in the feeding process that can be affected by dysphagia and your speech and language pathologist can help determine which one is affected. The first stage is the oral preparation phase and this is the phase that we see the most affected by dysphagia at Lowcountry Therapy Center. Then there is the oral transit phase which is when the food is moved back through the oral cavity. The third phase is the pharyngeal phase which is the initiation of the swallow and moving the bolus through the pharynx. The final phase is the esophageal phase which is moving the bolus through the esophagus and down into the stomach.
Matt: How can dysphagia affect children?
Sarah: The main effect that dysphagia has on children is that it prevents them from getting the proper nutrition that they need. If they have pain, choking, problem with textures, or manipulating the bolus in their mouth, they are not going to be getting the proper nutrition that they need for proper growth and brain development.
Matt: What are some of the signs of dysphagia that parents should look for at home?
Sarah: Refusal to eat is a huge sign. Coughing, choking, gagging, and throwing up during meals whether it is with liquid or with food are other signs that parents should watch for. Being a picky eater after the parents have tried everything and the child still refuses certain foods or textures could also be a sign of dysphagia.
Matt: Can dysphagia affect a child’s speech development?
Sarah: Absolutely, especially with oral dysphagia. It means that the muscles are not working appropriately, and if they are not working appropriately to eat chances are they might not be working appropriately to talk and can cause problems such as articulation errors. The other way it can significantly affect speech is that if they are not getting the right nutrition then they cannot thrive to their full potential.
Matt: What are the primary goals of feeding therapy?
Sarah: According to The American Speech and Hearing Association (ASHA), the main goal of feeding therapy is to safely support adequate nutrition and hydration. Also to determine optimum feeding methods and techniques that maximizes swallowing safety. There is a big time collaboration with families. The parents are heavily involved in the session to help give them proper training that they would need at home. We also want to develop the most age appropriate eating skills in a normal setting, and to decrease pulmonary complications such as congestion and aspiration. We also want to prevent future feeding issues with positive feeding oral experiences such as learning thru play.
Matt: Can other therapies help with dysphagia?
Sarah: Yes. Often times I like to involve occupational therapy especially if the child is refusing to eat. If the child is refusing to eat it might be due to a texture aversion, and this can lead to dysphagia. If the child is avoiding certain textures then the mouth is not doing what it is supposed to be doing and so we are not developing our chewing skills. If the texture aversion does not go away, then we do not have the muscle and motor plan to chew certain foods. I have also used physical therapy before in my sessions as well. If the child does not have the core stability or if they have poor positioning the child might not eat. I have seen changes in a child’s eating habits with proper positioning and core strength.
Matt: What should a family do if they have concerns that their child might have dysphagia?
Sarah: Absolutely speak with your pediatrician, and they can steer you in the right direction. They can send you to speech therapy or order some tests such as a modified barium swallow study. This is when they take a video x-ray of the swallow to rule out aspiration. Once that is ruled out speech therapy can work on the oral motor component. If there is aspiration then there needs to be a diet change such as different textures or different chewing techniques.
Here are some links to learn more about dysphagia http://www.asha.org/Practice-Portal/Clinical-Topics/Pediatric-Dysphagia/
http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934965§ion=Treatment
-Matthew D’Antonio, PT, DPT
Pediatric Physical Therapist
