Introduction
One challenge in the assessment and management of infants with tongue tie is the lack of comprehensive assessments to measure tongue structure and function during breast and bottle feeding. As a result clinicians often rely on visual observation to guide decision making. In order to address this challenge, l funding from a Speech Pathology Australia Clinician Researcher Partnership grant is being utilised to collect data on babies with tongue-tie pre and post intervention using the nfant© feeding solution. The nfant© feeding solution provides real-time feedback on sucking performance with objective measures within clinical settings. Normative data is available for full-term and premature infants, but no data exists for infants with tongue-tie.

Aim
To measure tongue structure and function in bottle-fed infants with tongue-tie (newborn to six months) to determine whether objective metrics of sucking are different in infants with tongue-tie compared to normative data of full-term infants.

Methods
A prospective cohort design was used to track infants identified with tongue-tie pre and post-frenotomy (surgery) and 4 to 6 weeks post-surgery to measure maintenance of feeding function the feeding, using objective data to measure oral structure and function. Data collection is currently in progress and a target sample of 22 infants will be recruited.

Results
Preliminary results will be provided for infants from birth to six months for the frequency, peak amplitude, duration, and velocity of infants with tongue-tie and how these compare to typically developing full-term infants on the nfant© feeding solution system.

Conclusions
The results of this study will provide objective data for speech pathologists, reassurance for parents, and assist medical professionals’ decision-making regarding surgical intervention, so surgery is only recommended for infants with observable functional deficits.

Paediatric feeding, food allergies, Paediatric Feeding Disorder, scoping review

This scoping review describes the state of current research regarding feeding in children with food allergies. This work lays the foundation for further research with particular scope directed at evolving a responsive and family-centred clinical pathway. Attendees are encouraged to apply knowledge gained to their paediatric caseloads.

Background:
Food allergy (FA) affects approximately 8% of children, and may be IgE-mediated or non-IgE-mediated. Anecdotally, children with both subtypes of FA present with features of Paediatric Feeding Disorder (PFD), but there is little formal research. The aim of this study was to explore existing research regarding feeding characteristics in children with FA.

Aim:
To determine what is known about feeding behaviours in children with food allergies, and identify areas for future research.

Methods:
A scoping review was conducted using PRISMA-ScR guidelines. Articles that described feeding characteristics in children aged 0-18 with FA or history of FA were included, published between 2001 and 2021. Reported characteristics were mapped onto the recently proposed diagnostic framework for PFD.

Results:
Overall, 38 studies were included. Across all papers, vomiting, abdominal pain, and dysphagia were most commonly reported. In the psychosocial domain, food refusal/aversion, anxiety with eating, and poor intake were most frequently described, regardless of underlying FA type. Less information was reported on the feeding skills domain, although slowness in eating “immature diet”, and delays in oral sensory-motor skills were described. In the nutritional domain, children with non-IgE-mediated FA were more likely to have significant weight/growth concerns. There was a stark difference between the number of papers that reported on non-IgE-mediated FA (n=22), and IgE-mediated FA (n=11), with four papers being non-specified.

Conclusions:
Children with FA present with a range of characteristics across all domains of PFD. Further research is needed regarding feeding development in children with IgE-mediated FA to help inform care.

Background

Thickened feeds may support improved suck-swallow-breath coordination and airway protection in infants with dysphagia. Unfortunately, viscosity for thickened formulas is unpredictable, affected by variables such as time, temperature, and formula/thickener type.

Aim

This study had two aims: (1) To propose a set of ideal Level 1 (slightly thick) recipes for Australian infant formula/thickener combinations, and (2) To test whether these combinations could be batch-prepared.

Methods

A set of powdered, ready-to-feed, and specialised formulas were mixed with two thickening products (Aptamil Feed Thickener® and Supercol®), and tested at 5-, 10-, 15-, 20-, 25-, 30- and 45-minute intervals using the International Dysphagia Diet Standardisation Initiative (IDDSI) Flow Test. Formula/thickener samples were mixed following manufacturer instructions, but recipes were adapted to determine an ideal recipe for Level 1 (slightly thick) consistency that would be maintained over a feed. Samples were refrigerated, reheated after 12 hours, and retested. Each combination was tested six times.

Results

Overall, 1,353 IDDSI Flow Tests were conducted using 14 formula/thickener combinations. In all combinations, recipe alterations meant metric spoon measurements were employed as opposed to the manufacturer-provided scoop. All samples were most variable at the 5-minute timepoint. Formulas thickened with Supercol® reached a more stable consistency by 10 minutes, whereas formulas thickened with Aptamil Feed Thickener® were more stable by 15 minutes. Samples tested after 12 hours were more variable with Aptamil Feed Thickener®.

Discussion/Conclusion

This study provides practical recommendations for clinicians working with thickener for infant feeding management. Further study under controlled laboratory conditions is required.

Key words:

Paediatric feeding, infant feeding, thickened fluids, management, IDDSI

Submission statement

Reflections on use of thickened fluids with infants revealed management inconsistencies, placing infants with dysphagia at risk. This project responded to a need to standardise thickened formula recipes. This session will challenge current practice for delegates, and develop new knowledge regarding best practice recipes.

Cervical auscultation (CA) is the most commonly used adjuvant to the clinical feeding evaluation across the United Kingdom, Ireland and Australia. Recent studies have also shown that specific sound features of swallow and post-swallow breath sounds can accurately differentiate between aspirating and non-aspirating swallows in children based on digital CA. The translation of digital CA into clinical practice is limited by the time-consuming manual segmentation of swallow sounds by trained experts required for analyses. Automated segmentation of swallow sounds via machine learning has the potential to reduce the time required for manual segmentation of swallow sounds and increase acceptability and availability of digital CA in clinical practice. We aimed to evaluate the use of a machine learning technique to automatically extract and segment swallowing sounds from digital CA recordings of thin fluid swallows collected from infants and children with paediatric feeding disorders assessed during a videofluroscopic swallow study (training set, n=19, 275 swallows) and clinical feeding evaluation (validation set, n=15, 246 swallows). Annotation of swallowing segments from audio files of 1 minute duration were completed by a CA trained speech pathologist. Our innovative new machine learning method extracted recurrence plot images from short sliding windows and compared them to a codebook of images. The resulting time series of codes was used to train a long short term memory neural network with corresponding label data on onsets and offsets of swallow events. These codes were then tested with unlabeled data. Results are currently being analysed. Sensitivity and specificity for the automated detection of swallowing events in infants and children from digital CA will be presented.

Recognising respiratory risk is everyone’s role

Introduction:
Respiratory illness is the leading cause of hospital admissions and mortality in children with cerebral palsy (CP) across all age groups. Risk factors for respiratory illness in CP are known, but it is not known whether treating these risk factors can prevent respiratory illness and reduce respiratory-related hospital admissions.

Aims:
To determine the feasibility and acceptability of implementing an individualised multidisciplinary intervention, based on identified risks of respiratory disease for children with CP.

Methods:
This is a feasibility pilot randomised controlled trial (RCT) with two parallel groups (additional care and regular care) with a blinded assessor. Children with CP, aged 0-12 years and at risk of respiratory hospitalisation were included. Twenty children are enrolled and are being followed up for 1 year. The control group are receiving standard care from their treating teams. The intervention group are receiving comprehensive assessments and individualised treatments from physiotherapy, speech therapy, nurse coordination, rehabilitation medicine and respiratory medicine.

Results:
Our pilot RCT is currently underway. We will present a case study from the trial demonstrating the successful application of the model of care in clinical practice, while highlighting service user engagement in our study.

Conclusions:
Our study will determine whether a full RCT to investigate individualised multidisciplinary treatment plans for children at risk of respiratory illness is feasible, to help inform practice and develop clinical care pathways.

Keywords:

Dysphagia
Disability
Respiratory
Multidisciplinary
Collaboration
Prevention

Submission Statement:

Our multidisciplinary team are highly experienced clinicians who have collaborated together for a decade, passionately contributing to research development and knowledge translation in our area of practice. We respect the unique needs of the individuals we support by actively engaging with our consumers to ensure reflective, responsive, evidence based practice.

Introduction
Quality of life and functional outcomes are increasingly being measured in health care settings to improve patient-centred care and satisfaction. Patient-reported outcome measures (PROMS) are tools used to measure the impact of conditions and interventions from the patient’s perspective. In the case of children, often parent/carer-proxy reported outcome measures are used. PROMS are not consistently utilised within the field of paediatric speech pathology, and there is no synthesis of validated PROMS available to guide clinical practice.

Aims
This review aims to identify English validated patient- or proxy/parent- reported outcome measures across paediatic speech pathology practice areas.

Methods
A systematic scoping review methodology was utilised. A comprehensive literature search was performed to identify studies published until 18th February 2022 from MEDLINE, Embase, CINAHL, PsycInfo, Scopus, Cochrane Collaboration and Web of Science. Abstracts and full texts were screened in Covidence. Relevant studies that validated PROMS in the English language were extracted and assessed using the ‘Checklist to operationalise measurement characteristics of patient-reported outcome measures’ (Francis et al 2016) by two independent reviewers.

Results
After abstract and full text screening, preliminary findings identified 50 validated PROMS across six paediatric practice areas of paediatric feeding and swallowing (n=19), language (n=14), speech (n=7), voice (n=6), fluency (n=2) and AAC (n=2). Quality ratings were completed using the Francis et al checklist.

Conclusions
A number of clinically useful validated PROMS were identified to guide speech pathologists in measuring patient and parent/carer perceptions of conditions supported by paediatric speech pathology.


Keywords
Patient Reported Outcome Measures, Speech Pathology, Paediatrics

Submission Statement:
Patient reported outcome measures (PROMS) are increasingly being used in healthcare to improve patient centred care and satisfaction. These tools can support clinicians to reflect on their current practices and service delivery models, demonstrate respect for the health care goals of service users and to respond to service user needs.

Introduction

Simulation is an established education modality that enables practice of new skills in a supportive environment. Largely driven by the pandemic, simulation via telepractice, i.e., telesimulation, has emerged, but little is known about whether outcomes are comparable to in-person simulation.

Aim

This study had two aims: (1) To compare learner outcomes for telesimulation to in-person simulation for infant feeding; and (2) To compare learner outcomes between novice and experienced participants.

Methods

In this pragmatic randomised controlled trial, speech pathologists (SLPs) met eligibility criteria if they a) were qualified; b) had an interest in infant feeding; and c) could travel to the study location. Block randomisation matched participants with <6 months experience to those with >6 months experience (2:1 ratio). Participants completed measures regarding confidence/anxiety, clinical reasoning, and satisfaction pre- and post-simulation.

Results

Overall, 35 SLPs participated (in-person n=17; telesimulation n=18), with 11 experienced and 24 novice learners. There were no significant differences in key variables between telesimulation and in-person groups pre-simulation. Post-simulation, results indicated no significant differences between these groups in self-rated confidence/anxiety and learner satisfaction. Telesimulation participants demonstrated a significant improvement in clinical reasoning scores pre-post (p<0.01, d=0.56), whereas in-person participants did not (p=0.31, d=0.30). Only novice learners demonstrated significant improvements across all measures (p<0.01).

Conclusions

Telesimulation learning outcomes were equal or superior to in-person simulation. This has significant implications for how SLPs can support and maintain skills in new learners. Further exploration into simulation benefits for experienced clinicians is warranted.

Key words

Simulation, paediatric feeding, infant feeding, telepractice

Submission Statement:

Previously, simulation has been valuable in developing clinical skills and confidence, but clinicians have reported limited accessibility. Through this study, our team has responded to these needs by providing simulation in a different medium. Delegates will learn about simulation, and the outcomes of in-person simulation versus telesimulation.

Introduction: Cerebral palsy (CP) is the most common physical disability in childhood and results in impairment of muscle function causing dysphagia for 70-100% of children with CP.
Aim(s): This pilot randomised controlled trial, aimed to 1. assess the feasibility and acceptability of a novel motor-learning feeding intervention program, Intensive Early Active Treatment (I-EAT) and standard care, 2. understand whether dysphagia, reliance on compensatory strategies, and related impairments can be reduced in infants who have CP.
Methods: We compared outcomes for 14 infants with cerebral palsy and dysphagia, randomly allocated to 12-weeks of either I-EAT or standard care. Outcomes included feasibility of interventions, improvement and safety of oral feeding and efficiency, family mealtime stress, infant growth, and health. Results were statistically analysed using descriptive statistics, ANCOVA, and regression analysis has been conducted.
Results: Preliminary results indicate both interventions were feasible and acceptable. Infants in the I-EAT group made greater gains in oral feeding skills, particularly with fluids, were less reliant on compensatory strategies, and their parents reported less mealtime stress after the 12-weeks of intervention. There was no between-group difference in the feeding efficiency, growth, or health, highlighting that a more intensive approach did not negatively impact outcomes or increase safety risks.
Conclusions:
While this is a pilot study with a small sample, the I-EAT program appears to be a more feasible, safe and effective treatment than standard care for infants with cerebral palsy and dysphagia. Further research is needed to determine the strength of its effects.

Keywords:
Dysphagia
Feeding
Infants
Cerebral Palsy
Motor-Learning

Submission statement: Comparison of novel interventions to standard care fosters reflection on and evaluation of efficacy of current practice, showing respect to our patients. Pilot studies are essential to respond to growing research in related fields, such as motor-learning, in a safe and ethical manner before conducting larger-scale studies.

Background
Australian children with life-limiting conditions are at risk of receiving inconsistent or sub-optimal palliative care, especially if they live in regional, rural or remote locations away from specialist paediatric palliative care (PPC) services. Additionally, allied health professionals (AHPs) including Speech Pathologists (SPs), with limited exposure to PPC may feel under-confident or incapable of providing best-practice PPC to children and their families across the phases of palliative care.

Objective
We aimed to explore Queensland AHPs’ perceptions of PPC services, their professional scope of practice, and experiences supporting children and families, in order to develop an online education training package targeted to the regional AHP workforce.

Method
Twenty participants (four SPs) were recruited and assigned to one of five focus groups. Participant demographics and self-reported experience with/exposure to PPC were documented. Focus groups followed a semi-structured interview format, hosted by an experienced facilitator. Participants were given questions and stimulus material prior to focus groups to assist with their preparation. Discussions were recorded, transcribed, de-identified and analyzed using Braun and Clarke’s 6-step guide to thematic analysis. SP responses were extracted for this presentation.

Results/Findings
Three SPs worked in regional hospitals, and one in a tertiary hospital. None had formal training in PPC. Major themes included: i) understanding where the child and family were on the continuum of palliative care (diagnosis, stable, unstable, deteriorating, end-of-life); ii) supporting them and priority setting in a family-centered approach, iii) supporting safe swallowing/mealtimes and parent-child bonding through communication; iv) communicating with the family and finding a way to talk about death and dying; v) helping to support quality of life. SPs accessed support through MDTs and tertiary PPC services.

This presentation reflects current PPC practice, respects challenges experienced by SPs and families, and responds through the development of an SP-specific module and allied health PPC training package.