Manual of Diagnostic and Therapeutic Techniques for Disorders of Deglutition

pp 349-388


Compensatory Strategies and Techniques

  • Claire Kane MillerAffiliated withCincinnati Children’s Hospital Medical Center
  • , J. Paul WillgingAffiliated withCincinnati Children’s Hospital Medical Center Email author 

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Management and treatment of feeding and swallowing ­disorders in infants and children is complex due to the multitude of etiologies and interacting variables that may be present in any given situation. The underlying causes of dysphagia in the pediatric population are both congenital and acquired and include an array of structural, neurologic, cardiorespiratory, genetic, systemic, and metabolic conditions. Feeding and swallowing difficulties may evolve or intensify secondary to medical complications, physiologic abnormalities, or ongoing environmental factors that, singly or in combination, impair progression of normal feeding and swallowing behavior. Inadequate recognition and management of pediatric feeding and swallowing dysfunction has serious implications including potential malnutrition, chronic respiratory disease, disruption of oral motor/feeding skill development, and extended use of nasogastric or gastrostomy tube feedings. Lack of dysphagia treatment, delayed initiation of treatment, or the use of inappropriate treatment approaches may all contribute to prolonged dysphagia and potentially untoward consequences. Thus, thorough dysphagia diagnostic evaluation, accurate identification of oral and pharyngeal swallowing physiology and dysfunction, and appropriate selection of compensatory and rehabilitative interventions is essential to maximize each child’s potential for a satisfactory outcome. A multidisciplinary approach in the differential diagnosis and management of pediatric feeding and swallowing problems is essential in the identification and management of problems that may occur across multiple systems.

The goals of dysphagia therapy in infants and children are thus ­dependent upon the constellation of issues present and are comprised of techniques to modulate responses to sensory stimulation and to facilitate increased oral motor control for successful and safe oral intake. The underlying paradigm of pediatric dysphagia treatment is comprised of direct rehabilitative maneuvers/exercises as discussed in Chap.​ 17 and/or the use of compensatory techniques and strategies. Compensatory strategies include changes in positioning for feeding, sensory stimulation techniques, the use of specialized feeding equipment, and the implementation of specific behavioral approaches focusing on the development of positive and productive feeder/child interactions. Compensatory techniques may be used singly or in combination by the dysphagia clinician at various points in the treatment plan; the use is specific and based on the responses of each patient. The end result of pediatric dysphagia therapy may not always be full oral feeding, and this concept should be discussed and understood early on in the treatment plan by the dysphagia clinician. The following chapter will focus on the application of compensatory strategies and techniques to assist with treatment of oral sensory, oral motor, and pharyngeal phase ­dysfunction. Available evidence to support the use of the compensatory strategies and techniques in the treatment of specific conditions is summarized. Continued research to establish a robust evidence base for the use of treatment approaches in pediatric feeding and swallowing practice is needed to establish best practice guidelines.