1. Swallowing and Feeding in the Schools Consultant
Swallowing and Feeding Disorders in the Schools: Information for para- educators!
Emily M. Homer, CCC-SLP
Swallowing and Feeding in the Schools Consultant
Students Eat Safely

2. Plan for today is to:
Define swallowing and feeding disorders as they occur in a school setting
Discuss the signs and symptoms of swallowing and feeding disorders.
Identify the students who are at risk for swallowing and feeding disorders
Determine what we can do about them in the schools
Talk about the para educator’s role in addressing swallowing and feeding

3. Has anyone in your family experienced swallowing difficulties?

4. What is a swallowing and feeding disorder?
Delays and/or disorders in the development of eating and drinking skills, which are common in the pediatric population.
Includes introduction, preparation (oral phase), transfer, and transport of food (pharyngeal phase) and liquid from mouth through esophagus into the stomach (esophageal phase).
Management of saliva and oral intake of medications

5. Video on the Phases of Swallowing:

6. When is it dysphagia (swallowing)?
Oral Phase - When the student can not chew food adequately to break it down and form a bolus which can be safely swallowed.
Pharyngeal Phase – When structurally there is a problem that interferes with the swallowing mechanism protecting the airway or with food or liquid going directly into the esophagus.
Esophageal Phase – The food is swallowing and goes into the esophagus

7. When is it a feeding disorder?
When children need special equipment, positioning, or need to have food modified in order to safely eat their meals then they have a feeding disorder.
When children have difficulty using utensils during mealtimes.
When children have behaviors or sensory concerns that result in a limitation of the foods that they eat.

8. Who and What of Swallowing and Feeding
Why are we concerned about how a child eats?
What can happen if a child is not fed correctly?
How do I know if a child is not being fed correctly?
Safety is always the first consideration.

9. Swallowing and Feeding disorders:
Safety Concern
Under nourishment and dehydration
Choking
Aspiration and pneumonia

10. Swallowing and Feeding
Swallowing and feeding disorders are addressed using a TEAM APPROACH!
The swallowing and feeding team is made up of many professionals in the schools, including the SLP, OT, nurse, teacher, and paraprofessional.
The core team, the SLP, OT and nurse, evaluate the student and determine how the student can be fed safely.
The case manager, which is usually the SLP writes a swallowing and feeding plan which is followed by the classroom staff members who are responsible for feeding the child.

11. School-based swallowing and feeding team members
Speech/Language Pathologist
Occupational Therapist
Physical Therapist
School Nurse
Parent
Special Education Teacher
Regular Education Teacher
Para educator
School Administrator
Social Worker
Physician(s)
Hospital Based SLP
Dietician
Cafeteria Workers

12. Speech and Language Pathologist
Case Manager
Speech and Language Pathologist
Occupational Therapist
Physical Therapist
Classroom Teachers Para educator
School Administrators
Cafeteria Workers
School Nurse
Medical Team:
Physicians
Hospital SLP
Dietician

13. What will be reported by parents or what you may observe!
Repeated respiratory infections
History of recurring pneumonia
Weight loss/failure to thrive
Difficulty chewing
Coughing/choking during or after swallowing
Maintains open mouth posture
Drooling
Food refusal
Prolonged feeding times
Poor oral motor functioning
Nasal regurgitation
Wet/gurgle voice/sound after meal
Difficulty initiating swallowing

14. Can you think of a child that you know who has these conditions?

15. Para educators role with swallowing and feeding:
May be asked to participate in the interdisciplinary observation by feeding the student in the manner that is typical at school.
Receive training on how to safely follow the Swallowing and Feeding plan.
Implement the Swallowing and Feeding plan with
fidelity.
Receive training on how to prepare the
recommended diet modifications.
Prepare the student’s cafeteria tray or home
supplied food according to the plan.

16. What is the Swallowing and Feeding Plan?
Includes the following:
Identifying Information (DOB, Teacher, etc.)
Brief History/Special Considerations/Presenting Concerns
Feeding recommendations:
Positioning
Equipment
Diet/Food Preparation
Feeding plan techniques/precautions
Name/number of dysphagia case manager
Verification of training
Sample Plans

17. Collaboration:
Whether it is helping a student to eat at school safely, or preparing a student’s cafeteria tray, or working on oral motor exercises with a student it comes down to working together! Remember, the goal is student safety during mealtimes at school!

18. Para educators are essential team members!
Communication!
If you are not sure what to do…talk to the SLP
If you see something you are concerned about…talk to the SLP
If you have an idea of something that might work well for the student…talk to the SLP
If you disagree with what is being recommended…talk to the SLP
If you love what is being recommended…talk to the SLP!!

19. Questions, Comments, Concerns

20. For more information contact:
Emily M. Homer, M.A., CCC-SLP
Swallowing and Feeding in the Schools Consultant

21. Signs and Symptoms of Under nutrition
Tired, lethargic, irritable, anxious and disoriented.
Bruises easily
Diarrhea
Rashes

22. Dehydration Thirst Dry, sticky mouth Decreased urine output
Few or no tears when crying
May be sleepy, complain of a headache, dizziness or lightheadedness.

23. Parents: essential team members

24. “Working with students who have dysphagia can certainly be difficult, but understanding the families’ perspectives can prove not only helpful, but in many instances, crucial to developing and implementing effective programming.” (Angel, Bailey, Nicholson, & Stoner, 2009)

25. Working with Families
“School-based professionals should work toward developing an appreciation of the impact that having a child with a developmental disability can have on the family and develop sensitivity for the complexities that families with disabled children face.” (Handleman, 1995)