PROVIDING DYSPHAGIA SUPPORT IN THE SCHOOL SETTING

1. PROVIDING DYSPHAGIA SUPPORT IN THE SCHOOL SETTING Region IV

2. 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

3. 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

4. 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

5. 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

6. Normal Anatomy http://www.radiographicceu.com/article23.html

7. Signs of Aspiration • DANGER SIGNS OF ASPIRATION (food or liquid getting into the airway) • WET OR GURGLY VOCAL QUALITY • CHANGE IN VOCAL QUALITY WHEN EATING • FREQUENT THROAT CLEARING AND COUGHING • SIGNIFICANT DIFFICULTY BREATHING • REGURGITATION THROUGH NOSE OR MOUTH • COMPLAINTS OF THROAT PAIN • CHOKING • WATERY EYES • FACIAL REDNESS OR FACIAL GRIMACING • RECURRENT PNEUMONIA • CHRONIC LOW GRADE FEVER Region IV

8. 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 learn Region IV

9. 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 feeding Region IV

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

14. 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

15. Dysphagia Data Region IV

16. 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

17. 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

18. 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)