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Dysphagia is common in hospitalised children. Clarity regarding its prevalence is required to direct service needs. This review reports oropharyngeal dysphagia prevalence in children admitted to acute and/or critical care, following acute illness, medical or surgical intervention. It also explores patient characteristics significantly associated with oropharyngeal dysphagia in these settings. Five electronic databases (EMBASE, CINAHL, Cochrane, PubMed, Scopus) were searched. Studies identified for inclusion involved children (0-16 years), in acute or critical care settings, where prevalence data for new-onset or worsening oropharyngeal dysphagia was reported. Peer reviewed journal articles, including systematic reviews were included. Data was extracted and synthesised using a purpose designed extraction tool. A total of 7,522 studies were screened and 67 studies met criteria. The most researched populations included congenital heart disease surgeries, posterior fossa tumour resections, stroke and post-extubation dysphagia. Populations with the highest documented dysphagia prevalence were children after posterior fossa tumour resection with a new tracheostomy, children using nasal continuous positive airway pressure, and children following ischemic stroke. Characteristics significantly associated with oropharyngeal dysphagia were younger age, lower weight, longer intubation, upper/middle airway dysfunction (e.g., vocal paresis), and presence of additional comorbidities. This review presents synthesised prevalence data for children in acute and critical care settings with new-onset or worsening oropharyngeal dysphagia. It highlights the broad nature of oropharyngeal dysphagia in hospitalised children and the need for more rigorous research into characteristics associated with increased risk to better support screening and early identification of oropharyngeal dysphagia in these settings., Competing Interests: Declarations. Competing Interests: The authors have no competing interests to declare that are relevant to the content of this article. Consent of publication: This paper’s findings were presented at the Speech Pathology Australia Conference 2024 (Perth). This paper has not been published previously, is not under consideration for publication elsewhere, is approved by all authors and responsible authorities where the work was carried out for publication. If accepted, it will not be published elsewhere in the same form without the written consent of the copyright-holder., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Simulation is an education modality known to support clinical skill development. Unfortunately, access to simulation has been challenging, both prior to and during the pandemic. Simulation via telepractice, i.e., "telesimulation", has emerged, but little is known about whether outcomes are comparable to in-person simulation. This study compared in-person versus telesimulation learner outcomes in an infant feeding scenario. The secondary aim was to compare outcomes between novice and experienced participants.This pragmatic randomized controlled trial included speech pathologists who could attend if randomized to the in-person modality. Block randomization matched participants with < 6 months' infant feeding experience to those with > 6 months experience (2:1 ratio) into telesimulation or in-person simulation. Measures of clinical reasoning, confidence/anxiety, and satisfaction were collected, pre-, post-, and 4-weeks post-simulation.Overall, 39 clinicians completed either in-person simulation (n = 17) or telesimulation training (n = 22), including 16 experienced and 23 novice learners. Both in-person and telesimulation groups achieved significant improvements across time in clinical reasoning, self-reported confidence, and anxiety. The extent of change in clinical reasoning, confidence and anxiety was comparable between the telesimulation and in-person simulation groups. Comparing by experience, novice-level participants reported significantly greater changes in confidence and anxiety than experienced participants. Satisfaction levels were high regardless of simulation modality or experience.Participants in telesimulation and in-person simulation achieved similar improvements in the primary outcome measure of clinical reasoning, had comparable improvements in self-perceived confidence and anxiety, and demonstrated high satisfaction levels. Telesimulation is a promising means to improve clinician access to simulation training in infant feeding., (© 2024. Crown.)

The last two decades have seen increasing use of long-term ventilation (LTV) as an intervention in childhood. Children who use LTV have many risk factors for feeding and swallowing difficulties, including their underlying respiratory and/or neurological etiology, long hospitalizations, medical interventions, and limited exposure to oral feeding experiences. This review aimed to answer two questions: 1) 'What specific swallowing and feeding characteristics do these children experience?'; and 2) 'What impacts do these swallowing and feeding characteristics have on health status and quality of life?'. Texts were identified across bibliographic databases, reference lists, and grey literature. Studies were analyzed according to ventilation, feeding and swallowing, assessment and intervention, and quality of life parameters. Overall, 1919 papers were screened, with 31 papers included in the final data extraction process. A range of feeding and swallowing characteristics were observed, including oral secretion management difficulties, oral aversion, swallowing difficulties, and clinical signs of aspiration. Non-oral feeding was found to be the primary feeding method used. Little information on health status and quality of life was reported in scoping review texts. Children with LTV needs present with a range of feeding and swallowing concerns, and non-oral feeding is common. Further research is needed to understand the feeding and swallowing journey of this population. This will assist in future service planning and delivery, and in turn contribute to improving patient outcomes and quality of life., (© 2024. Crown.)

Project ECHO ® is a virtual, interprofessional, cased-based peer-learning model. To date, no studies have explored ECHO as a model for pediatric feeding education. This study examined the outcomes of establishing a pediatric feeding ECHO network. Using a prospective, mixed-methods design, two cohorts of allied health professionals were recruited. Each cohort participated in eight, 90-min videoconference sessions incorporating a didactic presentation and clinical case presentation. The case was presented by a participant, with questions and recommendations provided by the ECHO network. Participants completed: (1) a learning needs analysis before the ECHO series, (2) a self-reported confidence questionnaire pre, post, and 3-month post, (3) a satisfaction questionnaire after each session, and (4) an overall satisfaction questionnaire post-ECHO series. Time spent by hospital allied health clinicians providing impromptu phone/email feeding support to external clinicians was recorded for 8 weeks prior to and 8 weeks during the ECHO series. Forty-seven participants were included in the study, attending an average of 5.8 sessions. Significant improvements in self-reported confidence were observed across the three time points (p < 0.01) with less experienced participants demonstrating greater improvements. Participants reported high satisfaction with ECHO, with 93% (40/43) wanting continued access to ECHO in future. The multidisciplinary format, interactivity, structure, and case-based nature of ECHO were considered beneficial. A 75% reduction in requests for support from clinicians in the same catchment area was noted during the ECHO series. Results demonstrated that Project ECHO is a viable model for pediatric feeding education for clinicians working in the field. Further research is needed to investigate the long-term effects and impacts on clinical care., (© 2023. Crown.)

Simulation enables learners to practice new skills in a supportive environment. Largely driven by the COVID-19 pandemic, simulation via telepractice, i.e., telesimulation, has emerged. Viable delivery of telesimulation requires consideration of the adaptations needed to conduct simulation via telepractice. The aim of this study was to design and pilot test the feasibility of using telesimulation to provide training in infant feeding management. An iterative process was used across four phases: (1) simulation design, (2) telesimulation adaptations, (3) user testing, feedback, and modifications, and (4) user testing of modified simulation, feedback, and final modifications. During Phases 1 and 2, team members worked together to design and test telepractice adaptations for a simulation experience. During Phases 3 and 4, the telesimulation was pilot tested with a group of speech pathologists, with feedback sought via open-ended survey questions and/or an optional focus group. Manifest content analysis was used to interpret user feedback. In Phase 2, several adaptations were explored to optimize telesimulation delivery and engagement, including Zoom® functions (e.g., 'spotlighting,' digital backgrounds) and supplementary video/auditory files. There were 11 participants across Phases 3 and 4. Specific feedback centered around simulation preparation and structure, session practicalities, supports for realism, Zoom® functions, group dynamics, participants' experiences, and future enhancements. An overall list of recommendations for telesimulation was generated. Telesimulation for feeding management was considered feasible and participant feedback was favorable. Further research is required to investigate if the learner outcomes of telesimulation are comparable to in-person simulation for infant feeding management., (© 2023. Crown.)

Thickened feeds may be useful in supporting improved suck-swallow-breath coordination and airway protection in infants with dysphagia. Unfortunately, the stability of thickened feeds for infant formulas is unpredictable, which makes use of this strategy challenging. This study aimed to propose a set of Level 1 (slightly thick) recipes for Australian infant formulas/thickeners. A secondary aim was to test whether formula could be batch prepared. A set of powdered, ready-to-feed, and specialized formulas were mixed with two thickening products (Aptamil Feed Thickener® and Supercol®) and tested at 5-, 10-, 15-, 20-, 25-, 30-, and 45-min intervals using the International Dysphagia Diet Standardization 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 h, and retested. Each combination was tested six times. Overall, 1,353 IDDSI Flow Tests were conducted using 14 formula/thickener combinations. In all combinations, recipe alterations were made using metric spoon measurements as opposed to the manufacturer-provided scoop. All samples were most variable at the 5-min timepoint. Formulas thickened with Supercol® generally reached a more stable consistency by 10 min, whereas formulas thickened with Aptamil Feed Thickener® were more stable by 15 min. Samples tested after 12 h were more variable with Aptamil Feed Thickener®. This study provides practical recommendations for clinicians working with infants requiring thickened feeds for dysphagia management. Further study under controlled laboratory conditions is required., (© 2023. Crown.)

The COVID-19 pandemic drove rapid and widespread uptake of telepractice across all aspects of healthcare. The delivery of dysphagia care was no exception, with telepractice recognized as a service modality that could support social distancing/infection control, overcome service delivery challenges created by lockdowns/service closures, and address consumer concerns about attending in-person appointments. Now, almost two years since most services first rapidly deployed telepractice, it is time to reflect on the big picture, and consider how telepractice will continue as a service option that is sustained and integrated into mainstream dysphagia care. It is also timely to consider the research agenda needed to support this goal. To this end, in this paper we present 4 discussion topics, which raise key considerations for the current and future use of telepractice within adult and pediatric dysphagia services. These are (1) Dysphagia services must meet consumer and service needs; (2) Aspects of dysphagia services can be safely and reliably provided via telepractice; (3) Telepractice can be used in flexible ways to support the delivery of dysphagia services; and (4) Providing quality dysphagia services via telepractice requires planned implementation and evaluation. Then directions for future research are discussed. These considerations are presented to help shift perspectives away from viewing telepractice as simply a COVID-19 "interim-care solution". Rather, we encourage clinicians, services, and researchers to embrace a future of "integrated care", where traditional dysphagia services are combined with telepractice models, to enhance the quality of care provided to our clients., (© 2022. Crown.)

Feeding disorders can have a significant impact on children and their families. Access to supportive multidisciplinary care is central to improving outcomes; however, there are numerous factors that can impact service access. Using a mixed methods design, the current study examined parents' experiences and satisfaction with accessing a state-wide government-funded tertiary pediatric feeding clinic in Australia. Parents of 37 children (aged 7 weeks to 17 years) participated in the study, residing 6-1435 km from the service. Each completed questionnaires regarding satisfaction (Client Satisfaction Questionnaire-8 Child Services) and costs, and participated in a semi-structured interview. Costs were measured as both direct (e.g., accommodation) and indirect (measured as lost productivity) associated with accessing their feeding appointment. Results revealed parents were highly satisfied with their child's feeding services, but considerable impacts were reported in accessing the service with 85% of the group noting that attending their child's appointment took at least half a day. The total cost per appointment ranged between $53 and $508 Australian dollars. Interviews identified three main barrier themes: distance and travel, impact on daily activities (e.g., work, school), and parent perception of inaccurate representation of their child's feeding skills within the clinic environment. The issues raised were also tempered by an overarching theme of parental willingness to do "whatever was needed" to meet their child's needs, regardless of these barriers. Service providers should be cognizant of the factors that impact access for families and consider alternative service-delivery models where appropriate to help reduce family burden associated with accessing necessary care.

The provision of speech-language pathology (SLP) services via telepractice is expanding. However, little is known about the use of telepractice to deliver pediatric feeding services. The current study aimed to investigate SLPs perceptions, and current use of, telepractice in pediatric feeding. An electronic survey was distributed to SLPs with pediatric feeding experience within Australia. Questions pertained to general demographics, feeding experience, telepractice experience and perceptions of telepractice. Most questions were multiple choice, with some short response questions. Eighty-four complete responses were received. Overall, 41% of the cohort were interested in providing telepractice services but only 20% reported experience delivering pediatric feeding services via telepractice. Most telepractice users reported commencing telepractice services within the last 12 months. Most clinicians identified a range of age groups and feeding services that they believed could be offered via telepractice and a range of benefits to telepractice feeding services were identified. Benefits included natural environment, reduced distance and travel, opportunities to increase services and increased supervision and support. Although most respondents reported access to technology, most had difficulty accessing this on a daily basis to establish regular telepractice services. Clinician concerns regarding the safety and efficacy of conducting pediatric feeding assessments via telepractice were also identified. Overall, although the delivery of pediatric feeding services via telepractice remains limited, many clinicians were interested in using telepractice and had positive perceptions regarding its use. Continued efforts to enhance clinician access to technology and further evidence for the efficacy of this service delivery model for pediatric feeding will aid clinical implementation.