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Date: | Tue, 27 Mar 2012 03:03:52 -0400 |
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Hi All
I am a SLT/IBCLC who had no specific training other than self learning and a training program that was adult focussed when it comes to
paediatric dysphagia (the most valuable knowledge came from my learning as IBCLC). Not unlike other HCP SLT's come from a place where bottlefeeding has always been the focus of study. It is only recently that more awareness about breastfeeding may be emerging in some centres.
Chin tuck as far as I know is a concept very much related to adult eating drinking swallowing disorders. Neck extension is the very best position
for breathing because the airway is opened up. If the neck is flexed the airway may be closed off in part and therefore less effort will be needed
for airway protection during swallowing but this relates to adults and is a specialised compensatory technique used for adults. I am not aware of any evidence that you can generalise to infants because their anatomy is so different and there is not a lot of evidence based practice in paediatric
dysphagia. For a baby with Pierre Robin sequence extension will be ideal as it will put him in the best position to breathe while also bringing the tongue forward which can occlude the airway in these babies.
I work very closely with a LC in our hospital, which incidentally has the best breastfeeding figures for a secondary hospitals in New Zealand rising from 67% initiation in 2002 to the current 94%. SLTs and LC's can learn so much from each other. When I arrived here in 2002 we hardly ever saw a baby with feeding challenges(cardiac babies, babies with cerebral palsy, syndromes like Downs syndrome, babies with tongue tie etc establishing breastfeeding, now it is becoming much more viable because the basic breastfeeding management is excellent and mothers are more motivated because they get good support. More good news from NZ is that more than 94% of babies are now being born in baby friendly hospitals with 95% of our hospitals now baby friendly.
In my experience many SLT's around the world get a lot of focus on adult dysphagia in their training and then some stuff which is more bottle feeding focussed e.g. the gold standard for dysphagia assessment is the modified barium swallow, totally not breastfeeding friendly.
Regards from NZ
Loraine Hamm
SLT/IBCLC
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