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 One participant was withdrawn after 42 sessions, and two participants completed all 60 sessions.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.

The primary aim of this thesis was to increase healthcare professionals’ understanding surrounding the emotional distress of paediatric oncology patients prior to reaching five-year survivorship status, to inform resource allocation and evidence-based clinical interventions. Paper 1 systematically reviewed the extant literature that has assessed the emotional distress severity of paediatric oncology patients who had not yet reached five-year survivorship status. Contradictory findings were evident from the 21 studies reviewed. These inconsistencies in findings were discussed in relation to methodological limitations present within the studies and the heterogeneous oncology and control groups studied. The review concluded that further multiple-centre studies, using appropriate self-report and parent-proxy standardised measures, and larger, representative samples comprising patients with CNS and non-CNS malignancies at differing points in their treatment journeys, are needed to identify demographic, illness and treatment variables that leave paediatric oncology patients vulnerable to emotional distress. The empirical paper presented in Paper 2 utilised a rigorous methodology to address this need, and additionally explored modifiable psychological risk factors for emotional distress in this population. 74 paediatric oncology patients (aged 12-18 years), who were within five years of treatment completion, completed self-report measures of emotional distress, self-concept and health related quality of life (HRQOL), whilst their parents provided background information regarding patients’ demographics, diagnoses and treatment protocols. 72 parents also provided ratings surrounding patients’ self-concepts and HRQOL. The mean emotional distress rating indicated that the sample was clinically distressed. Demographic, illness and treatment factors explained little variance in emotional distress, whilst global self-concept, global-generic and cancer-specific HRQOL were significant predictors. Provisional analyses indicated that experiencing pain, illness-related worries, communication difficulties and negative self-views in relation to maths abilities, parent relations and opposite-sex peer relations were specific risk factors in the sample studied. Patient- and parent-reports of patients’ self-concepts and HRQOL were highly consistent. These findings suggest that paediatric oncology patients would benefit from frequent routine screening for emotional distress to allow early identification and intervention. Furthermore, prevention-oriented interventions surrounding emotional distress, and indirect interventions targeting global self-concept and HRQOL could be beneficial. Paper 3 critically appraises the systematic review and empirical paper in terms of their methodologies and clinical contexts. It is acknowledged that some of the results are preliminary in nature and need replicating in larger samples. Nevertheless, this research was successful in exploring demographic, illness, treatment and psychological risk factors for emotional distress for paediatric oncology patients prior to reaching five-year survivorship status, providing guidance for future clinical interventions, and making suggestions for future studies, in terms of their aims and methodologies.

A qualitative descriptive approach was undertaken to explore the experience of eight registered nurses and two hospital play specialists who care for children hospitalised with burn injuries. The research participants were recruited from a paediatric ward that offers centralised specialty care to children with burns. Collected through face-to-face interviews, the participants' stories were tape-recorded and transcribed verbatim using a process for analysis informed by van Manen, (1997b).Emerging out of the data was the over-arching theme of 'passionate dedication' that shows the nurses and hospital play specialists genuine compassion and commitment to meet the needs of the children with burns. The findings of the study reveal that the participant's dedication is shaped and determined by a dynamic process that involves having professional integrity and in-depth knowledge of caring for children and burn management. The nurses and the hospital play specialists have a common understanding of what their role entails and the skills required to provide quality care and support to the children and the children's family. On a personal and professional level the participants encounter several challenges in this care context that are physically and emotionally overwhelming. Despite becoming overwhelmed the participants are revealed as being resourceful and resilient in their aptitude to find ways that enable them to cope and get through.This study supports international literature that suggests that caring for children with burns is equally rewarding, as much as it is physically and emotionally demanding. The implication in this study for the organisation is to seriously consider issues regarding productivity and efficiency of the workforce with acknowledgement that nurses and hospital play specialists cannot do this emotional work without effective systems of support in place. With the help of team leaders, managers and educators, the organisation will need to consider ways to monitor the job satisfaction of their staff. Furthermore, reinforce existing comprehensive measures, such as mentorship and clinical supervision programmes to encourage the retention and well-being of all staff, at all stages of their career on the children's burn ward.

Abstract Background The randomised-controlled trial (RCT) provides the best evidence for evaluating treatment effects and is accepted as a gold standard for clinical and regulatory decision making (1;2). One of the major challenges to the conduct of RCTs is the recruitment of adequate numbers of participants. Inadequate numbers reduce the power of a study to detect statistically significant treatment effects, and may cause delays, increased costs and failure to complete trials. The need for clinical trials in children has been increasingly recognised by the scientific community, resulting in increased demands for the inclusion of children in trials. For several reasons, recruiting children to trials is more challenging than recruiting adults, as consent issues are more difficult because parents make decisions about trial participation on behalf of their child. Despite general professional and community support for paediatric clinical trials, parents and paediatricians express reluctance when their own child or patient is asked to participate. Although researchers working with children commonly experience difficulty with recruiting children to RCTs, little is known about this very important subject. The method by which potential participants are approached for trial participation, the influence of their health care provider and the attitude of potential participants (or their parents, in the case of children), are critical to the understanding of the decision making process for trial participation. This thesis is one of the first major attempts to explore the issues surrounding the recruitment of children to RCTs, and is divided into four studies which address these issues. Methods Recruitment strategies used to encourage participation in randomised controlled trials (systematic review) Eligible experimental and observational studies comparing methods of recruiting participants for RCTs were identified after a comprehensive search of Medline, Embase, the Cochrane Library and reference lists. Independent data extractions were completed by two reviewers who assessed the studies for eligibility and methodological quality. Outcome measures were consent rates, proportion enrolled by each method and cost of recruitment per participant. Summary estimators of effects were calculated using a random effects model and expressed as relative risk with 95% confidence intervals. Heterogeneity was analysed using the Q statistic. Paediatricians� attitudes to children�s participation in randomised controlled trials (focus group research) Qualitative analysis of focus group discussions involving 16 paediatricians and 5 trainees from a paediatric teaching hospital in Sydney was undertaken. Doctors varied in occupation, experience, research activity, age, gender, ethnicity and parenthood experience. A professional facilitator conducted the semi-structured group discussions. Recruitment ceased when informational redundancy was reached, after 4 focus groups involving 21 participants. The transcribed audiotapes were analysed by theme linkage using the constant comparative method. Australian paediatricians� and adult physicians� attitudes to randomised controlled trials (survey) A 44-item questionnaire was sent to 250 paediatricians and 250 adult physicians randomly selected from the membership list of the Royal Australasian College of Physicians. Questions assessing doctors� treatment philosophies and attitudes to trials were compared with demographic and practice variables. Parents� attitudes to children�s participation in randomised controlled trials (focus group research) Qualitative analysis of focus group discussions involving 33 parents from 5 different settings (representing parents of children with a life threatening, chronic or acute illness, with experience in trials and of healthy children) was undertaken. Parents varied in age, gender, ethnicity, level of education, research experience and their child�s health status. The transcribed discussions were analysed by theme linkage using the constant comparative method. Results Recruitment strategies used to encourage participation in randomised controlled trials (systematic review) Fifty papers were included (out of 8602 titles and abstracts searched) which described 8 RCTs, 2 quasi RCTs, 13 prospective cohort studies, 30 retrospective cohort studies and 2 before-after studies. These studies assessed how over 4 million people were approached for RCT participation using 87 different recruitment strategies, with 103,406 people enrolling in RCTs. Health care provider (HCP) referrals had the highest participant consent rates at the time of exposure to trial information (HCP referral versus target mailing: relative risk (RR) 1.84 (95% confidence interval (95%CI) 1.08, 3.13)). They also had the highest consent rates when potential participants respond to the recruitment material by further enquiry about the trial (HCP referral versus community presentation: RR 1.37 (1.06; 1.78); HCP referral versus worksite approach: RR 25.20 (20.19, 31.45); HCP referral versus general community approach: RR 2.53 (0.46, 14.05); HCP referral versus mailing: RR 3.29 (1.26, 8.60); HCP referral versus media: RR 2.66 (1.31, 5.41)). However, by the time potential participants attend eligibility assessment for trial participation, no difference in consent rates could be distinguished by method of recruitment. Higher proportions of study participants were recruited by methods that exposed larger numbers of potential candidates to trial information (despite their lower consent rates). The stated recruitment cost ranged from US$0 to $1108 per participant, with mailing being the most cost-effective method and community methods (such as community presentations, pamphlets and posters displayed at community sites) the least effective. Paediatricians� attitudes to children�s participation in randomised controlled trials (focus group research) From the focus group discussions, paediatricians thought parents balanced perceived gains and risks when deciding about trial participation. They also believed the child�s condition and parents� health beliefs and personal attributes influenced parents� decisions. Other factors thought to be important by paediatricians were the doctors� beliefs and their relationship with the investigators. Paediatricians perceived gains for trial participation including professional benefits for themselves, improved patient care, convenience for the families and themselves and scientific advancement. Perceived risks included inconvenience, inadequate resources and potential harms to the patient and the doctor-patient relationship. Paediatricians with previous research experience were most knowledgeable about RCTs and perceived greatest gains from trial participation. Paediatricians� personal treatment preferences hindered trial support. Australian paediatricians� and adult physicians� attitudes to randomised controlled trials (survey) Response rate from the paediatricians� and adult physicians� survey was 60% (300/500). Australian paediatricians and adult physicians are very similar in their treatment philosophies, and are clinician-oriented rather than research-oriented in their attitudes, with primary allegiance to their patients and preference for selecting treatment rather than referring for trial participation in the face of treatment uncertainty. Professional activities are clinically focused, with limited time assigned for research. Australian doctors perceive little reward for trial participation and claim that the opinions of referring doctors regarding RCTs does not influence them. Predictors of favourable attitudes to trial participation from the survey were time allocation for research, a history of referring patients to trials in the past and younger age (all p values less than 0.0001). Parents� attitudes to children�s participation in randomised controlled trials (focus group research) When parents were interviewed, they acknowledged balancing risks and benefits when deciding about trial participation for their child. Perceived benefits include the offer of hope, better care of their child, the opportunity to access new treatments, healthcare professionals and health information, meeting others in similar circumstances and helping others. Perceived risks include potential side effects, being randomised to ineffective treatments and the inconvenience of participation. The decision for trial participation is also influenced by parental factors (parents� knowledge, beliefs and emotional response), child factors (the child�s health status and preference about participation), trial factors (the use of placebos and the uncertainties of research) and doctor factors (doctor�s recommendations and communication of trial information). Conclusions There are many challenges to the successful conduct of RCTs. Ways of addressing these include: using effective methods of recruiting potential study participants (such as mailing of recruitment material to potential participants) and abandoning ineffective strategies (such as community methods): fostering greater willingness for trial participation by addressing parents� and paediatricians� concerns including enhancing communication between researchers, paediatricians and parents, and improving the gains-hazard balance (by increasing incentives while decreasing inconveniences); and reforming in the health care system to raise the priority placed on clinical research by restructuring clinical research in a clinically predominant workplace and with a clinically predominant workforce. The findings from this study have implications for researchers planning RCTs for children in the future. Careful consideration of the above will enhance RCTs participation for children improving efficiency, lowering costs and ultimately improving the future health care of children.

Introduction: Emergency department usage for non-urgent care has been identified as an issue worldwide. Many health professionals have an opinion as to why parents seek care for their children at an emergency department. In Australia, although it is known that there is increasing usage of paediatric emergency departments for non-urgent care; there is a paucity of research on the reasons for this high usage. Aim: This study aims to provide a better understanding of the motivations and actions of parents of children with non-urgent injury or illness who attend the emergency department (PED) at a tertiary paediatric hospital seeking care. Method: This study was designed as a cross sectional descriptive survey to ascertain information fiom parents about their care-giving and care-seeking behaviours prior to presenting with their child to the paediatric emergency department (PED) for professional assessment and treatment. Demographic characteristics were compared with those of the general population to ensure representativeness. Results: A total of 355 parents were surveyed in the three-month period between May and July 2005. This represented 8% of the parents/carers who had presented to the PED for nonurgent (Australian Triage Score Category 4 and 5) care of their child. Just over half of the children presenting were male (185 (53%)) with an overall mean age of 5.45 years (*SD 4.25). The factors the study identified as seminal as to why parents sought care for their child at the paediatric emergency department are that parents rated their child's condition as moderate to very serious (242 (68%)) and that two thirds of parents (234 (66%)) had sought advice prior to attending PED. Other pertinent factors identified were that 54% of children attended with an injury (137) presented promptly to PED (i-e. within four hours of injury) whereas of those presenting with illness (88 (41.3%)) presented within two to seven days of the onset of the illness. The majority of children attended with an illness (213 (60%)) and of these, 98% had medication administered prior to presentation to PED. The presenting child was most likely to be the youngest sibling. Conclusions: The results of the study highlight the accuracy of 'parental triage', that is that parents assess their child's health, and generally engage in appropriate care-giving and careseeking behaviours before presenting to paediatric PED. This study highlights the deficiencies in current primary care services available to families and the perception that not all cases deemed as non-urgent by the emergency department are able to be dealt with in a primary care setting. In recognising that presentation is multifactorial, an issue that needs to be addressed is that there will always be non-urgent presentations at the paediatric emergency department and service delivery and W i g models need further development to address the increasing paediatric requirements for care. In identifying these multiple factors, this study will provide a solid base for future planning within paediatric hospitals, the emergency department setting and in provision of care in the community.

There is a significant need for research and development into paediatric medicines. The absence of suitable medicines or critical safety and efficacy information, poses significant risks to a particularly vulnerable patient population. The paediatric population is made up of a wide range of individuals of substantially varied physical size, weight and stage of physiological development. Some commonly used excipients may be unsuitable for use in children; and some dosage forms may be undesirable to the paediatric population. There is a need for a dosage form platform that is designed to meet the needs of the paediatric patient. The dosage form should offer dose flexibility, dose accuracy, afford acceptable taste of undesirable tasting drug substances and be suitable for administration to all paediatric sub groups. To ensure affordability and thus enhance access to medicines for children in developing countries or emerging markets, the dosage form should be simple to manufacture without the need for specialised equipment. Spray-drying was investigated to co-process a functional polymer, hypromellose, with a model drug substance, paracetamol, to enhance the functionality of the polymer and to taste mask the paracetamol. Though hypromellose was successfully spray-dried it was not possible to spray-dry hypromellose with paracetamol. The viscosity of aqueous solutions of hypromellose played a key role in determining the grade and concentration of hypromellose that could be successfully spray-dried. Temperature was used to reduce viscosity of hypromellose solutions but careful temperature control is required to avoid reaching the gelation temperature of the hypromellose. The effect of temperature on aqueous hydroxyl propylcellulose (HPC) solutions showed that heating causes a reduction in solubility of HPC in water which results in its precipitation and the formation of liquid crystals. Consequently, the aqueous HPC solutions appear ‘cloudy’ and their viscosity decreases. The temperature at which these changes occur is referred to as the ‘cloud-point’. The effect of temperature on aqueous HPC solutions containing drug is dependent on the properties of the drug. Paracetamol decreased the temperatures of dehydration and onset of precipitation and ranitidine hydrochloride increased the temperatures of dehydration and precipitation. This is probably associated with a salting in effect. HPC was used to form films which disintegrate in <30 seconds but are able to retard dissolution rate of paracetamol. HPC may be used to form films which meet the pharmacopoeial content uniformity criteria typically applied to oral dosage forms. HPC films have application for administering drugs to paediatric or geriatric patients by disintegrating in the mouth and so overcoming swallowing difficulties; potentially providing taste masking and aiding absorption across the oral cavity. HPC films offer significant benefits to the paediatric population. The manufacturing process is simple and transportation is easy as secondary packs are likely to be less bulky than currently used for tablets. The films may also be suitable for administering combinations of drugs in the same dosage form by layering or by combining the drugs at the HPC solution stage. For these reasons the HPC films may have particular application for diseases in the developing world and meet many requirements associated with WHO and other global regulatory guidelines.

This thesis follows a paper based format where papers 1 and 2 are stand-alone papers prepared for submission to the Journal of Pediatric Psychology. The relevant submission guidelines are included in the Appendix. Paper One: The purpose of this systematic review was to assess the effects of family-centred interventions for children and adolescents with Type 1 diabetes and review the bias associated with included studies. The review summarises the outcome measures which consisted of HbA1cs, hospital admissions for diabetic ketoacidosis (DKA), adherence, and family relationships including diabetes-related conflict. Research studies that were randomized controlled trials were selected to maximise the quality of information reviewed. Electronic searches of the OVID database using MEDLINE, PsycINFO, EMBASE, and CENTRAL were searched from their start dates until May 2012. Nine studies were located and assessed with the Cochrane risk of bias tool. Two studies were excluded from further analysis due to serious concerns about bias of their results. The remaining 7 had their findings summarised in a narrative statement, which indicated that family-centred interventions significantly improved HbA1cs, reduced DKA admission rates, improved adherence, and enhanced family relationships including reduced conflict. Family-centred interventions appear to be effective in enhancing health and psychological outcomes. The interventions however, were mainly in clinical settings and delivered by trained professionals. Given the importance of the family relationships in diabetes control, a need exists for interventions to have a more flexible setting and method of delivery, remain viable and demonstrate sustainability. Paper two: Clinic based interventions in type 1 diabetes have shown improvements in family relationships and metabolic control, but have limited reach. Therefore, a self-directed intervention was evaluated. Recruitment occurred through national advertising with diabetes charities, and the randomized controlled trial was conducted via online data collection. Parents of adolescents (aged 11-17) with diabetes were randomized to usual care (n = 37) or intervention (n = 42) using computerised block randomization, with researchers blinded to block size. The 10 week intervention involved the Self-directed Teen Triple P (Positive Parenting Program) workbook (10x1hour modules) and Chronic Illness tip sheet. Primary outcomes of diabetes-related family conflict and parenting stress were assessed pre and post-intervention. Intention-to-treat analysis was undertaken (n = 79), due to increased attrition from the intervention group. Intervention significantly improved diabetes related conflict, but not parental stress, compared to usual care. Followup analyses will assess maintenance effects and impact on metabolic control. Paper three: This paper was a Critical Evaluation, the purpose of which was to consider the findings from both papers, highlight additional and unexpected outcomes, place the research in the wider context, explore limitations of the thesis, and to discuss implications for future work.

Magister Scientiae Dentium - MSc(Dent) / The aim of the study was to compare two doses of intranasal midazolam (INM) 0.3 mg/kg and 0.5 mg/kg in terms of effectiveness and recovery time. Design:-This study was a Randomized Controlled Trial (RCT) and Triple blinded study. Sample and methods A sample of one hundred and eighteen children aged from 4-6 years old were randomly assigned for Intranasal sedation (INS) to either the 0.3 mg/kg group or the 0.5 mg/kg group. Children were taken in fasting and non-fasting conditions. The children were monitored using a pulse-oximeter, the sedation was assessed using Wilson sedation scale and the anxiety and behaviour scales were rated by Venham’s scale throughout the treatment. The facial image Scale (FIS) was also used to assess anxiety and mood of children before and after treatment. Results The mean BMI of children was found to be from 14-16. Intranasal sedation with both 0.3 mg/kg and 0.5 mg/kg midazolam was completed in 100% of the children. The pulse rates were within normal limit but statistically lower in the 0.5 mg/kg group. Oxygen saturation was above 98% in all except for one child who desaturated to 90%. Thirty five percent found this route acceptable in this study; Nine percent had burning sensation from midazolam. The state anxiety between the two groups of 0.3 mg/kg and 0.5 mg/kg were insignificant using Venham’s scale. However, behaviour scores showed statistical significant results of p value (0.03) and (0.04) in the behaviour during LA and behaviour during extractions respectively. The facial images scale (FIS) ratings chosen by the children before and after sedation was insignificant to the anxiety and behaviour ratings. The FIS revealed that 66% chose a happy face at the end of treatment. Fifty percent of the children in the study chose the same image before and after sedation. There were no adverse events encountered during the procedure. Conclusion INS with midazolam using the 0.3 mg/kg or 0.5 mg/kg doses resulted in safe and effective sedation. The 0.5 mg/kg proved to be more effective than the 0.3 mg/kg in providing better behaviour and decreasing anxiety when compared with the 0.3 mg/kg dose. The 0.5 mg/kg dose was found to be safe and the recovery time was slightly more than the 0.3 mg/kg but the difference was not clinically significant.

Magister Pharmaceuticae - MPharm / The objectives of the present study were to describe the type and frequency of prescribing errors and error frequency, to determine the error frequency for different drug classes, to identify potential drug interactions and drug-disease interactions to point out off-label prescribing and to evaluate risk factors of prescribing errors. Methods: This prospective cross sectional study was conducted over a period of 6 months from July 2012 to December 2012 in 2 specialist wards and 2 general medical wards at Red Cross War Memorial Children’s Hospital in Cape Town in South Africa. Only prescriptions generated by doctors in the above mentioned wards were assessed. Convenience sampling was used to select 200 prescription charts for analysis. Information relating to prescribing error, potential drug interaction, potential drug-disease interactions, off-label prescribing and potential risk factors of prescribing error were entered into excel spreadsheet and analysed using STATA versions 11&12. The mass of the patients was converted into weight-for-age z-score (WAZ) using WHO 2006 child growth standards. Univariate analysis and multiple logistic regression were used to identify risk factors of prescribing errors. Results: Of the 200 children on whom prescribing information was analysed, 40 (20%) were severely underweight and a further 25(12.5%) were moderately underweight. A total of 1402 prescribing errors were documented in 1282 drug items prescribed, a rate of 1.09 errors per drug item prescribed. Incomplete prescription information was the most common type of prescribing error, present in 65.6% of all drug items prescribed. The error frequency was high for all drug classes ranging from 57.9% of all respiratory drug items prescribed to 86.4% of all gastro intestinal system drug items prescribed. The number of potential drug-drug interactions was low i.e. 20 potential pharmacodynamics and 49 potential pharmacokinetic drug interactions were identified. The number of potential drug-disease interactions was also low i.e. 39 or 0.03% per drug item prescribed. Furthermore 57 off-label prescribing incidences were recorded. Senior doctors posed a significant risk factor for prescribing errors, an OR 1.95, 95% CI 1.46 – 2.61. Conversely, prescriptions written up in the general wards compared to the specialty wards (an OR 0.65. 95% CI 0.47-0.90) and prescribing during weekends compared to weekdays (an OR 0.71, 95% CI 0.53-0.96) were associated with lower prescribing error risk. Conclusion: This study provided valuable information about prescribing practices in children at RCWMCH. There is a need to improve prescribers’ practice at RCWMCH considering the type of errors observed viz. missing information, use of wrong drug name, abbreviations, legibility concerns and lack of clarity of the prescriptions, among others. Based on this study results further intervention studies are recommended to investigate the level of medical student’s training w.r.t prescribing practice.

There has been a worldwide increase in the number of tracheostomies performed on the paediatric population, particularly during the first year of life, which has also been evident at Red Cross Children’s Hospital in South Africa. Infants and toddlers with tracheostomies present with multiple risk factors for having or developing dysphagia and/or communication difficulties, due to the effects of the tracheostomy on the development of feeding, speech and communication, as well as the underlying medical conditions that necessitated the tracheostomy, and associated medical, social and environmental factors. There is, however, a dearth of literature in the area of paediatric tracheostomies in the South African context, particularly with regard to feeding and communication. The purpose of this study was to determine the incidence and describe the nature of dysphagia and communication difficulties in infants and toddlers with tracheostomies in the South African context, and detail the need for speech-language therapy intervention. It also attempted to determine whether there was an association between the underlying medical condition and the incidence of dysphagia and/or communication difficulties. A retrospective, descriptive survey of the folders of infants and toddlers with tracheostomies within the age range of 0 – 3 years from 2002 – 2004 at Red Cross Children’s Hospital was conducted. A checklist for dysphagia and communication difficulties in infants and toddlers with tracheostomies was developed and used to collect data from participants’ medical records. Results indicated that 80% of the study population presented with dysphagia. Oral phase difficulties were documented in 81.25%, pharyngeal phase difficulties in 60.9% and oesophageal phase difficulties in 79.7% of the dysphagic sample. Communication difficulties were recorded in 94% of the sample population. Speech production difficulties were documented in 78%, receptive language delays in 87% and expressive language delays in 96% of the sample population with communication difficulties. No statistically significant association was established between the underlying medical condition and the incidence of either dysphagia or communication difficulties. The results in the present study support the limited available literature, and the need for early speech-language therapy intervention for infants and toddlers with tracheostomies. / Dissertation (M (Communication Pathology))--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / M (Communication Pathology) / unrestricted