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Simcoe Feeding Assessment and Consultation Services (FACS)

Simcoe Feeding Assessment and Consultation Services (FACS). Liz Day, OT; Bronwen Jones, SLP; Jane Anne Sullivan, RD; Allison Brooker, SLP. Royal Victoria Hospital. SYMPOSIUM 2008 Working Together for Kids & Teens with Disabilities. Simcoe Feeding Assessment and Consultation Services (FACS).

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Simcoe Feeding Assessment and Consultation Services (FACS)

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  1. Simcoe Feeding Assessment and Consultation Services(FACS) Liz Day, OT; Bronwen Jones, SLP; Jane Anne Sullivan, RD; Allison Brooker, SLP Royal Victoria Hospital SYMPOSIUM 2008 Working Together for Kids & Teens with Disabilities

  2. Simcoe Feeding Assessment and Consultation Services(FACS) Enhancing Local Diagnostic and Treatment Capacity

  3. WHO are we? TheSimcoe Feeding Assessment and Consultation Service consists of • Feeding Clinic (Speech/Language Pathologist, an Occupational Therapist and a Dietitian) with consultation from pediatrician, Dr. G. Vomiero • Community Partners – CTG, CCAC, RVH, CTS, Simcoe Preschool Speech and Language Program, SCS, Speech Clinic, physicians, New Path, Kerry’s Place

  4. WHAT do we do? The FACS team sees children with complex feeding problems with regard to chewing and swallowing; nutrition and physical health ; sensory processing and functional feeding skills.

  5. WHAT do we do? • Feeding Clinic • multi-D assessment and problem analysis • trial of intervention strategies • home programming • recommendations/referrals to Local Team Partners • Videflouroscopic Swallow Studies • completed as needed at RVH • approximately 4 spots/month available

  6. WHAT do we do? • Local Team Partners • provide the bulk of community feeding services and refer to feeding clinic when necessary • attend clinic with clients • follow-up with programming and recommendations

  7. WHO do we see? Children from birth to 19 years of age with: • Oral – Motor or Sucking difficulties such as decreased co-ordination of suck swallow breathe; weak suck; decreased chewing; tonic bite; fatigue • Sensory Difficulties such as oral aversion • Severe irritability or behaviour problems during feeds • Extremely Picky Eaters

  8. WHO do we see? • Risk ofaspiration • History of recurrent pneumonia/chest infections • Lethargy or decreased arousal during feeding • Breathing disruptions or apnea during feeding • Excessive gagging or recurrent coughing during feeds

  9. WHO do we see? • Unexplained food refusal • Failure to thrive • Transition from tube feeding to oral feeding • Feeding difficulty related to structural anomalies (cleft palate, high palate, etc.) • Deterioration of feeding and swallowing ability related to disease process (e.g. seizures, MD)

  10. Two Major Areas of Focus in bringing Services Closer to Home… • Providing Videoflouroscopy at RVH • Increasing Feeding Expertise at the Local Level

  11. Videoflouroscopy (VFFS)

  12. Videofluroscopy (VFSS) • Now available at RVH for children in Simcoe • Start up of this service has resulted in shorter wait times and less traveling for families • Children previously seen at BKR & HSC can now be seen closer to home for VFSS

  13. What is VFFS? X-ray study of the child’s swallow to determine safety of oral feeding with regards to choking and aspiration

  14. VFSS

  15. To Videoflo or not to Videoflo? Medical History Highly Suggestive of Aspiration: • Recurrent chest infections • History of aspiration pneumonia • History of increased upper airway sounds or wheezing with oral feeds • Findings on chest x-ray • Positive aspiration on upper GI

  16. Medical History Possibly Suggestive of Aspiration History of bronchiolitis Frequent undiagnosed fevers Recurrent URT infections Perioral cyanosis with feeds Poor secretion control Persistent apnea, bradys, desats Absent gag reflex Poor weight gain To Videoflo or not to Videoflo?

  17. To Videoflo or not to Videoflo? Clinical Evaluation Always do a clinical evaluation before proceeding to videoflo… • VFFS radiation is equal to ~ 30 x-rays • A simple intervention often solves the problem without the need for a videoflo ( e.g. coughing when bottle feeding – often solved by decreasing the flow)

  18. To Videoflo or not to Videoflo Clinically- highly suggestive of aspiration: • Consistent coughing with oral feeds • Increased upper airway sounds and congestions with oral feeds • Sudden, significant drop in O2 sats, heart rate with oral feeds • Increased chest sounds • Change in voice quality

  19. To Videoflo or not to Videoflo Clinically- Possibly suggestive of aspiration: • Distress signs – grimacing, irritability, change in respiration, change of state, etc.

  20. To Videoflo or not to Videoflo… • Provide clinical feeding interventions • thickening • positioning • pacing • addressing GI symptoms • If problems persist, proceed with videoflo

  21. Building Capacity

  22. Capacity at the Local Level:Mentoring • FACS team members are available to provide mentoring when appropriate • CCAC- Closing The Gap has identified mentors (OT Susan Scott & RD Melanie Larkin) to help build expertise in therapists • Organize & provide in-service education & workshops e.g. transitioning from oral to tube feeds • Consultation to therapists with less expertise

  23. Capacity at the Local Level:Extremely Picky Eaters Workshop • Provided by FACS team to community partners • Handouts from the workshop for therapists to give to parents available on SharePoint

  24. Capacity at the Local Level: Resources • Local Hubs – e.g. The Common Roof • Dieticians from Simcoe and York FACS teams have made available Parent Handouts • Feeding equipment and assessment kits at hubs • Educational Materials for therapists and families e.g. Tube Feeding with Love DVD’s

  25. Capacity at the Local Level:Guided Assessment Tool • Created by York and Simcoe FACS team leaders • Resource for therapists - meant to guide their assessment and interventions • Available on SharePoint

  26. Case Example • 9 year old girl with history of meningitis in infancy with global developmental delay, currently a resident of a group home • Presented to Feeding Clinic with swallowing difficulties and inability to self-feed. • Recent history of pneumonia • Taking only purees and thickened liquids

  27. Case Example • Local Team players include CTG OT, RD and PT, paediatrician, group home staff, CAS, school EA’s, • Local team: • seating and positioning • variety of foods/nutrients/calories • thickened liquids

  28. Case Example • Feeding Clinic – clinical assessment suggests risk of aspiration • VFFS - Recommendations • No liquids • thin and thick purees only • Meeting fluid requirements on puree diet • Local team implements and educates caregivers and school EA’s

  29. Simcoe FACS Local Team Feeding Clinic Assessment and VFSS (if nec) Local Team

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