Background: Many infants in developing countries are faced with poverty, poor nutrition, limited access to healthcare, and exposure to communicable diseases that place them at risk for negative developmental consequences. Dysphagia is estimated to occur in 25-40% of normally developing, and 80-90% of infants with disabilities. International studies report the common causes of dysphagia to be of gastro-intestinal and neurological origin, yet limited research exists into the profile of paediatric dysphagia within developing contexts. Objective: To describe the profile of paediatric dysphagia in state hospitals, Gauteng. Methods: By means of a retrospective record review, this study investigated paediatric dysphagia (0-18 months) in state hospitals, Johannesburg. Hospital records of 263 infants with feeding impairments were analysed using descriptive statistics, phi correlations and logistical regression. Results: Findings revealed 214 underlying aetiological combinations whereby 65% (n=171) of infants experienced dysphagia secondary to a systemic illness, predominantly communicable diseases. The health professionals, management strategies and procedures employed in the assessment and intervention of paediatric dysphagia were context specific and related to the aetiological and social factors influencing the infants. Conclusion: Results differ significantly to those reflected in studies from developed countries. Of concern is the fact that 65% of infants experienced dysphagia secondary to a systemic illness, since with adequate nutrition, sanitation and health care, these conditions are potentially preventable. By improving social circumstances, the effects of systemic illnesses may be minimised, and may consequently decrease the number of infants affected by dysphagia. This implies that paediatric dysphagia in South Africa is no longer merely a health dilemma, but one which involves basic human rights.

The number of children with complex medical needs has risen in recent years, due to the increase in medical technology and subsequent increased survival rate of premature infants. This has led to an increasing number of children with complex neurological conditions, such as Cerebral Palsy, being seen by speech-language therapists to address their complex feeding and communication needs in schools (Arvedson 2008). Surface electromyography (sEMG) has been successfully used as a tool to facilitate therapy in adult dysphagia rehabilitation (Huckabee & Cannito 1999), and has been used in studies of dysarthric speech in children with Cerebral Palsy (Marchant, Mc Auliffe & Huckabee 2007). This case series report examines the effect of oral motor control therapy with sEMG biofeedback to increase motor control and inhibit increased muscle tone. Three participants aged 6, 16, and 18 were selected from the population of Kimi Ora Special School. Each of the three participants were offered sixty, twice daily treatment sessions of 30 minutes each focusing on active relaxation, and reducing duration of return to reset after recruitment of the masseter and submental muscles using sEMG biofeedback. After each session each participant was fed a prescribed amount of thin fluid and a range of food textures to encourage generalization of increased control of the submental and masseter muscles during eating and drinking. One participant was withdrawn after 42 sessions, and two participants completed all 60 sessions. Results showed variable improvement in feeding skills, with a notable improvement in anterior food loss. All participants were able to participate fully in the treatment and made significant gains in their ability to control their muscles during treatment sessions which was reflected in the reduction of sEMG amplitudes. This study demonstrated that oral motor control therapy with sEMG is a viable treatment tool, which warrants further larger scale research into its effectiveness.

Background: The prevalence of neonatal dysphagia is increasing, as medical advances contribute to the survival of critically ill and preterm infants. Additional factors such as low birth weight (LBW), gastroesoephageal reflux disorder (GERD), failure to thrive (FTT) and exposure to HIV may increase the complexity of dysphagia symptoms. Knowledge of context-specific risk factors for dysphagia in the neonatal intensive care unit (NICU) may lead to an effective pathway of diagnosis and management in vulnerable neonates. Objective: The objective was to describe the feeding characteristics and categories of underlying medical conditions in 24 to 42 week gestational age infants while still in the NICU and who were referred for feeding and swallowing assessment. Method: The study was a retrospective investigation of 231 purposively selected medical and speech-language therapy records. Participants had a mean stay of 28.5 days in the NICU of a peri-urban public hospital and all had feeding concerns. An existing seven-category framework for the classification of suspected dysphagia was used. Results: Feeding characteristics of the participants demonstrated that 65.0% had previous enteral tube (NGT/OGT) feeding, and only 15.6% were referred for instrumental assessments such as a VFSS by doctors or speech-language therapists (SLTs). The majority of participants used a mixed manner of feeding such as cup and breastfeeding, or cup and syringe feeding. Only 29.7% of participants was able to breastfeed exclusively which was an indication of feeding difficulties as the hospital where the study was conducted promotes exclusive breastfeeding. Results indicated that the majority of participants (90.04%) presented with multiple medical conditions. Underlying neurological conditions (48.48%) and feeding difficulties secondary to systemic illness (65.80%) contributed mostly to suspected dysphagia in the sample. It was found that 70.99% of infants presented with feeding difficulties secondary to other conditions such as LBW and prematurity, highlighting the need for an expanded dysphagia classification framework. Conclusion: The results are in agreement with the outcomes of previous research and confirm the need for a unique classification framework for dysphagia in South Africa. Neonatal dysphagia is a complex condition and frequently associated with multiple risk factors. / Dissertation (M Communication Pathology)--University of Pretoria, 2016. / Speech-Language Pathology and Audiology / MCommunication Pathology / Unrestricted

Background: Feeding and swallowing difficulties (FSD) are found in typically developing children and children with complex medical and developmental conditions. These difficulties may have negative health consequences which can be stressful for caregivers as they are required to provide care for their children in the home environment. The Feeding and Swallowing Impact Survey (FS-IS) is a subjective rating scale used to determine the health-related quality of life (HRQoL) of caregivers of children diagnosed with FSD. However, this scale is not yet available in any of the official South African languages (except for English), and has not yet been culturally or linguistically adapted for the South African context. Research aims: The study aimed to cross culturally adapt and validate the FS-IS for the South African context by 1) describing the content validity of the FS-IS in a South African context; 2) describing the cultural and linguistic appropriateness of the English, isiXhosa and Afrikaans versions of the FS-IS; and 3) describing the experiences caregivers of children have in caring for their child with FSD using the FS-IS, in a pilot study. Methodology: A descriptive exploratory design was used to cross-culturally adapt and pilot the FS-IS, which consists of 3 subsections related to daily activities, worrying and problems with feeding. Five expert speech-language therapist (SLT) participants were identified to review the FS-IS for content validity. The FS-IS was then translated into Afrikaans and isiXhosa using the forward and back translation process. Caregivers (n=15) were identified at feeding clinics to determine the cultural and linguistic appropriateness of the FS-IS in English (n=5), Afrikaans (n=5) and isiXhosa (n=5). Their recommendations were taken into consideration and changes made. The pilot study included caregivers of children with FSD attending feeding clinics at two institutions (n=32) who completed the FS-IS. The participants in the pilot study included parents as primary caregivers (n=28; 88%), grandparents (n=2; 6%), as well as foster parents (n=2; 6%). Thirty-one participants were female with 14 English speaking, 9 isiXhosa and 9 Afrikaans speaking. The caregivers were the primary caregivers of children with a variety of FSD including non-oral feeds, oral feeds with specific modifications and picky or selective eaters. Results: The FS-IS was found to have content validity as experts and caregiver participants judged it to be contextually relevant for the South African context. Caregivers considered the items on the FSIS important, clear and appropriate for speakers of their native language as well as for fellow South African families, with minor changes suggested for the isiXhosa translated version. The tool has high internal consistency (Cronbach's alpha = 0.827) as well as excellent intra and inter-rater reliability (100% agreement). Daily activities that caregiver participants found most difficult included getting help from others (50%, n=16) and leaving their child in the care of others as they are scared to have others feed or take care of their child (62.5%, n=19). The majority of caregiver participants reported concerns related to their child's general health (84%, n=27) and whether they were doing enough to help with their child's FSD (50%, n=16). Few caregivers reported difficulties with feeding, with 87.5% (n=28) reporting no difficulties as a result of the time taken to prepare meals and 72% (n=23) reported no difficulty due to professionals or family having differing opinions about how to feed their child with FSD. Conclusion: The results confirm that the FS-IS is a reliable and valid tool for the identification of caregivers with reduced HRQoL related to caring for their child with FSD in a South African context. The adapted and translated FS-IS can therefore be used to identify caregivers who may need additional support or referral for further management from the multidisciplinary team. The results highlighted the complexity of caring for a child with FSD and the effects of the burden of care on caregivers. Early identification of the HRQoL of caregivers will not only benefit the caregivers but also the child they are caring for as the HRQoL of caregivers impacts on the QoL of the child with FSD.