Background: Feeding and swallowing difficulties (FSD) have been found in typically developing children as well as in children with complex medical conditions and developmental disabilities. These difficulties cause negative health consequences such as aspiration pneumonia, chronic lung disease, failure to thrive, prolonged hospital stay and even death. The early identification and management of feeding and swallowing difficulties is important as it prevents the negative effects on health and quality of life. Hence, there is a need for a validated screening tool to use in the general hospitalized paediatric population. Research Aims: The aim of this study was to validate the Feeding and Swallowing Questionnaire as a screening tool, in the paediatric population aged 0 – 2 years admitted to general medical wards. The secondary aim was to describe the FSD presenting in the paediatric population aged 0 - 2 years who are hospitalized in the general medical wards. Methodology: A prospective, descriptive, clinimetric design was utilized. A sample of 107 participants admitted to the general medical wards at Steve Biko Academic Hospital were included in the study. Participants’ feeding and swallowing was screened by a research assistant using the Feeding and Swallowing Questionnaire. After the screening, a clinical feeding and swallowing assessment was conducted for comparison, the assessment was conducted by the student researcher using the Clinical Feeding and Swallowing Assessment Tool. Results: There was a 27% FSD prevalence, with the majority of cases (92%) occurring in children under one year of age. One hundred and three children (63% male; median (IQR) age 5.2 (2.1 – 12.8) months) underwent screening and clinical assessment for feeding and swallowing disorders. The criterion validity of the Feeding and swallowing Questionnaire was established with a sensitivity of 88% and a specificity of 32%. Internal consistency was achieved with an acceptable Cronbach’s alpha of 0.79, and good inter-rater reliability (80%). Participants presented with feeding difficulties in all the phases of swallowing, while some participants had behavioural feeding difficulties. Those who had FSD had the following medical conditions: cardiorespiratory, neurological and gastrointestinal disorders namely acute gastroenteritis and liver disease. Feeding and swallowing difficulties were associated with increased mealtime duration (p=0.005) and supplementary oxygen support (p=0.03). Conclusion: The results confirm that the Feeding and Swallowing Questionnaire shows promising findings as a reliable and valid tool for the identification of FSD in the general hospitalized paediatric population. However, further research in other setting with general paediatric medical wards is required to increase the robustness of the screening tool.

Sväljningssvårigheter förekommer hos personer i alla åldrar, men är vanligast hos de äldre. Konsekvenserna av sväljningssvårigheter i form av undernäring och aspirationspneumonier bidrar till ökad ohälsa och stora samhällskostnader. Sväljningssvårigheter är inte en sjukdom i sig, utan är ett symptom av andra sjukdomar. Eftersom undernäring är vanligt hos personer med sväljningssvårigheter, bör sjuksköterskan ha kännedom om patienters erfarenheter av sväljningssvårigheter. Syftet var att beskriva patienters erfarenheter av att ha sväljningssvårigheter. Genom utförande av en allmän litteraturstudie framkom fyra teman: Erfarenheter av att sväljningssvårigheter ställer upp hinder för måltiden, Erfarenheter av begränsningar i det dagliga livet, Erfarenheter av att hantera vardagen och Den glädjelösa måltiden. Måltiden präglades av hostattacker, kvävningskänslor och att maten fastnade i halsen. Både det sociala livet och familjelivet begränsades. Patienterna hanterade situationen genom att undvika att dela måltider med andra. Patienterna kände ingen glädje av måltiden längre. Vidare forskning gällande allmänhetens attityd gentemot sväljningssvårigheter är av intresse. Ett framtagande av en konsistensanpassad meny för restauranger vore hjälpsamt för patientgruppen. / Swallowing difficulties occur in people of all ages, but is increasingly common in the elderly. Malnourishment and aspiration pneumonia are consequences of swallowing difficulties that lead to increase in ill-health and high costs for society. Swallowing difficulties are not an illness, but a symptom of other diseases. Since malnourishment is common in people with swallowing difficulties nurses should have knowledge of patients with experiences of having swallowing difficulties. The purpose of this study was to describe patients’ experiences of swallowing difficulties. Through the performance of a literature review four themes emerged: Experiences of swallowing difficulties hindering the meal, Experiences of limitations in daily life, Experiences of dealing with everyday life and The joyless meal. The meal was characterized by coughing, feelings of choking and food getting stuck in the throat. Social life and family life alike were limited. Patients handled the situation by avoiding eating with others. Patients no longer experienced joy in eating. Further research on public’s attitude towards swallowing difficulties are of interest. The development of a texture modified menu for restaurants would be helpful for this patient group.

Syftet med denna litteraturstudie var att belysa sväljningssvårigheter hos patienter som genomgått kirurgisk behandling på grund av munhålecancer genom att undersöka vad som bidrar till sväljningssvårigheter, hur patienterna upplever sväljningen samt hur vårdpersonalen kan hjälpa dessa patienter. Studien baserades på 12 vetenskapliga artiklar som söktes fram i databaserna PubMed och Cinahl. Resultatet indelades utifrån vilket metodologiskt tillvägagångssätt som använts i studierna, videofluoroskopi respektive frågeformulär. Förekomst och resektion av tumör i orofarynx, särskilt tungbasen, gav större sväljningsdysfunktion jämfört med orala tumörer i flera av videofluoroskopistudierna. När frågeformulär användes för att undersöka patienternas självupplevda sväljning sågs att strålbehandling var en viktig negativ faktor för sväljningen. I flera av studierna sågs att större resektionstorlek/tumörstorlek eller ett avancerat sjukdomsstadie hade negativ inverkan på sväljningen. Aspekter av munfunktionen rankades som mest betydande av 12 viktiga funktioner i en studie, med sväljningen på fjärde plats. I en studie som undersökt livskvalitet relaterad till sväljningssvårigheter var ”tid för ätande”, ”problem att tugga”, ”problem med mat som fastnar i munnen” de faktorer som gav lägst livskvalitet. Vid sökning efter studier som kunde svara på vilka åtgärder omvårdnadspersonal kan tillämpa för att hjälpa munhålecanceropererade patienter med sväljningssvårigheter framkom ingen relevant studie. / The aim of this literature review was to illuminate swallowing difficulties in oral and oropharyngeal cancer patients treated with surgery by studying which factors contribute to swallowing difficulties, how these patients experience their swallowing and how nursing staff can assist them. The study was based on 12 research articles. The literature search was performed in the PubMed and Cinahl databases. The result was subdevided on the basis of the methods used in the studies, videofluoroscopy and questionnaires. The presence and resection of tumours of the oropharynx, in particular of the base of the tongue, resulted in more severe swallowing dysfunction compared to tumours of the oral cavity in several of the videofluoroscopic studies. Self-assessment questionnaires showed that radiation therapy had a mayor negative effect on swallowing. In several studies large tumours/resections and an advanced stage had a negative impact on swallowing. In one study aspects of mouth function was ranked to be the most important of 12 important issues, swallowing coming in fourth place. One study that evaluated quality of life related to swallowing after surgery, found that the main factors effecting the quality of life were “eating duration”, “problems chewing” and “food sticking in your mouth”. In the search for studies answering the question of what actions nursing staff can apply in caring of oral and oropharyngeal cancer patients with swallowing difficulties after surgery no relevant study was found.

Background: Preterm infants and neonates may present with dysphagia due to immaturity or the presence of medical conditions. Enteral feeds are used to ensure optimal nutrition is achieved while the neonates are developing appropriate oral feeding skills. Varied interventions may be used to transition neonates to full oral feeds as oral feeding is often a prerequisite for discharge from hospital. Aims: The main aim of this study was to summarize, interpret and analyse the literature on the different interventions used for the transition to full oral feeds in preterm infants and neonates to identify research gaps and to inform clinical practice on the best intervention options. A secondary aim was to validate the findings of the scoping review for the South African context. Methods: A scoping review was conducted. Relevant studies were identified by searching six databases, Google and Google scholar. Inclusion criteria included studies written in English, peer reviewed and published between 1998–2018, that described the interventions used to transition preterm infants and neonates to full oral feeds. Data were extracted from the articles using a data charting form and analysed descriptively and thematically. The findings were shared with health care professionals who work with premature infants and neonates who then participated in a semi-structured interview to provide feedback relevant to the South African context. Results: Forty-seven articles were included. Six broad intervention categories were identified: oral-motor, oral-sensory, other senses, timing, cue-based and utensils. Non-nutritive sucking (NNS) interventions were reported most frequently across single and combined interventions. Outcome measures reported included: time taken to full oral feeds, earlier hospital discharge, long-term feeding outcomes, weight and sucking proficiency. Improved outcomes were associated with NNS and NNS with oral stimulation. Nine health care professionals were interviewed. They confirmed using a number of the interventions, with NNS reported the most. Health care professionals also provided insight into the challenges of implementing some interventions due to limited resources and staffing in the South African context. Conclusions: There are a range of interventions reported in the literature and many of them are used in South Africa. Positive outcomes such as earlier transition to full oral feeds; earlier hospital discharge; improved weight gain and improved sucking proficiency have been reported with NNS and combined NNS and Oral Stimulation interventions, however further studies are needed.

No description available.

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.

Coronavirus disease 2019 (covid-19) är en smittsam infektionssjukdom som orsakas av viruset severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Sedan sjukdomens utbrott i december 2019 har viruset spridits globalt och infekterat fler än 270 miljoner människor världen över. Majoriteten av de som insjuknar i covid-19 får lindriga till måttliga besvär, men en liten del blir allvarligt sjuka och behöver sjukhusvård. Bland de patienter som blir allvarligt sjuka i covid-19 diagnostiseras en betydande del i det akuta skedet med sväljsvårigheter, eller dysfagi. Föreliggande studie bestod i en retrospektiv journalgranskning, som en del av ett kvalitetssäkringsarbete inom Region Gävleborg. Syftet med studien var att undersöka hur sväljsvårigheter kan manifesteras hos personer som vårdas på sjukhus till följd av covid-19 och som remitterats till logoped för bedömning och åtgärder. 60 deltagare inkluderades i studien, varav 17 var kvinnor och 43 var män. Resultaten visar att förekomsten av dysfagi var hög i det akuta skedet, där 42 deltagare (70 %) bedömdes ha dysfagi vid första logopedbedömning. Många deltagare återhämtade sig från sin dysfagi under vårdtiden, men 12 deltagare (20 %) hade kvarstående dysfagi vid utskrivning. Behovet av nutritionsstöd och andningsstöd under vårdtiden var stort. Vanliga fynd under de kliniska sväljbedömningarna var hosta, trögutlöst sväljning och nedsatt oral bearbetning. Deltagarna erhöll logopediska rekommendationer främst gällande anpassad kost, sittställning och munvård. Deltagarnas sväljförmåga skattades med Functional Oral Intake Scale (FOIS) vid första logopedbedömning och vid utskrivning. Vid första bedömning rekommenderades en majoritet av deltagarna anpassad kost (FOIS 1–6) och medelvärdet för FOIS var 3,5 ± 2,1. Vid utskrivning hade de flesta återgått till normalkost (FOIS 7) och medelvärdet för FOIS var 6,0 ± 1,8 (p < 0,001). Denna studie visar att en majoritet av de som vårdats på sjukhus till följd av covid-19 i Region Gävleborg och som remitterats till logoped, uppvisade dysfagi i det akuta skedet men kunde vid utskrivning äta normalkost. Behovet av mer forskning och vidare analyser av hur sväljsvårigheter manifesteras och upplevs hos patientgruppen är fortsatt stort. / Coronavirus disease 2019 (COVID-19) is a contagious infectious disease caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the outbreak in December of 2019, the virus has spread globally and infected more than 270 million people worldwide. The majority of people infected with COVID-19 will have mild to moderate symptoms, but some will suffer from severe illness which requires hospital care. Many of those who experience severe illness from COVID-19 are diagnosed with swallowing difficulties, or dysphagia, in the acute stage. This study consisted of a retrospective medical chart review and is part of a review of quality control in Region Gävleborg. The aim of the study was to investigate how swallowing difficulties manifest in people who require hospital care due to COVID-19 and who have been referred to the Speech and Language Therapy department. 60 participants were included in the study, of whom 17 were women and 43 were men. The results show that the prevalence of dysphagia was high in the acute stage, where 42 participants (70%) were diagnosed with dysphagia during the first SLT assessment. Many participants recovered from their dysphagia during their hospital stay, but 12 participants (20%) had persistent dysphagia at discharge. The need for nutritional and respiratory support was high. Common findings from the clinical swallowing assessments were coughing, difficulty initiating swallowing as well as affected oral processing. Common SLT recommendations included modified consistencies, posture and oral care. Swallowing ability was graded with the Functional Oral Intake Scale (FOIS) at first SLT assessment and at discharge. At first SLT assessment a majority of the participants were recommended a modified diet (FOIS 1-6) and the average FOIS was 3.5 ± 2.1. At discharge most participants had returned to a normal diet (FOIS 7) and the average FOIS was 6.0 ± 1.8 (p < 0,001). This study shows that a majority of the people who were hospitalized due to COVID-19 in Region Gävleborg and who were referred for an SLT evaluation, had dysphagia in the acute stage and recovered from their swallowing difficulties before discharge. More research and further analyses of how swallowing difficulties manifest in patients hospitalized due to COVID-19 is still needed.

L’objectif primaire de la présente thèse (appelé OBJECTIF 1) est d’investiguer si, et quand dans la séquence développementale, la présence de difficultés d’alimentation-déglutition est associée à un risque élevé d’apparition concomitante et/ou ultérieure de difficultés langagières à 12, 18 et 24 mois. Ses objectifs secondaires sont de fournir un ensemble de données cliniques sur le développement des habiletés d’alimentation-déglutition entre 8 et 24 mois (OBJECTIF 2) et d’explorer la validité divergente du questionnaire sur l’alimentation-déglutition de McFarland et al. (2020; OBJECTIF 3). Ces objectifs ont mené au recrutement de 140 enfants ayant 8 mois ou approchant 8 mois en âge (c.-à-d. ayant de 7 mois 3 semaines à 8 mois), nés à terme, élevés dans un environnement monolingue francophone et n’ayant pas, à 8 mois, une condition biomédicale associée à l’apparition de difficultés langagières. Leurs habiletés d’alimentation-déglutition et de langage ont été caractérisées à quatre reprises (à 8, 12, 18 et 24 mois) à l’aide du questionnaire sur l’alimentation-déglutition de McFarland et al. (2020) et des Inventaires MacArthur-Bates du développement de la communication (Trudeau et al., 1997a, 1997b, 2008). Les habiletés d’alimentation-déglutition d’un sous-groupe de 30 enfants (parmi les 140 initialement recrutés) ont également été caractérisées à 8 mois à l’aide de l’évaluation clinique standardisée de l’alimentation-déglutition intitulée Schedule for Oral Motor Assessment (Reilly et al., 2000). Pour répondre à l’objectif 1, les réponses parentales aux questionnaires sur l’alimentation-déglutition et aux Inventaires MacArthur-Bates du développement de la communication ont été réduites pour assurer une puissance statistique et codées pour la présence et l’absence de difficultés d’alimentation-déglutition et de langage. Des régressions logistiques ont par la suite été réalisées pour investiguer la relation potentielle entre les variables d’intérêt. À partir des résultats des régressions logistiques, des arbres d’inférence conditionnelle ont également été construits pour visualiser la relation entre les variables d’intérêt. Puisque l’ensemble des enfants présentant un reflux, des allergies alimentaires et/ou des intolérances alimentaires n’avaient pas de difficultés langagières à 18 et 24 mois et que la présence de ces conditions médicales est un variable confondante potentielle, deux régressions logistiques ont été réalisées pour chacun des statuts langagiers : une première avec les données de l’ensemble des enfants de l’échantillon et une deuxième avec les données des enfants de l’échantillon ne présentant pas d’allergies, d’intolérances alimentaires et/ou un reflux. Les résultats révèlent que la présence de difficultés de contrôle salivaire à 18 mois est associée à un risque élevé d’apparition de difficultés langagières à 18 et/ou 24 mois. Ils révèlent également que certains indicateurs de difficultés de mastication et/ou de sélectivité alimentaire n’étant pas attribuables à un reflux, des allergies alimentaires et/ou des intolérances alimentaires et apparaissant à 24 mois (en l’absence de difficultés de contrôle salivaire, de mastication et/ou de sélectivité alimentaire à 18 mois) sont associés à un risque élevé d’apparition de difficultés langagières à 24 mois. Lorsque mise en relation avec la littérature précédemment publiée, ces données suggèrent que la présence de difficultés d’alimentation-déglutition chez les enfants ayant des difficultés langagières reflète un problème au niveau des réseaux neuronaux impliqués dans le développement des habiletés de langage et de l’alimentation-déglutition (Krishnan et al., 2016; McFarland et Tremblay, 2006). Elles fournissent également des indicateurs pouvant être utilisés en clinique pour identifier les enfants qui sont à risque de difficultés langagières. Pour répondre à l’objectif 2, les réponses parentales aux 33 questions du questionnaire sur l’alimentation-déglutition ont été codées pour la présence et l’absence de 33 difficultés d’alimentation-déglutition. Puis, le pourcentage d’enfants ayant au moins une difficulté d’alimentation-déglutition à 8, 12 18 et 24 mois a été calculé et comparé. Les trois difficultés d’alimentation-déglutition (parmi les 33) les plus fréquemment rapportées par les parents à chacune des tranches d’âge ciblées dans l’étude ont également été identifiées. Les résultats montrent que le pourcentage d’enfants ayant au moins une difficulté d’alimentation-déglutition passe de 81% à 8 mois à 54% à 24 mois et que deux indicateurs de sélectivité alimentaire font partie de ceux les plus fréquemment rapportés à trois ou quatre des quatre tranches d’âge ciblées dans la thèse. Ces données contribuent à mieux comprendre le contexte expérimental/clinique dans lequel la relation développementale potentielle entre les sphères de l’alimentation-déglutition et du langage prend place. Pour répondre à l’objectif 3, seules les données recueillies pour le sous-groupe de 30 enfants ayant participé à l’évaluation clinique de l’alimentation-déglutition ont été utilisées. Le pourcentage d’enfants identifiés avec au moins une difficulté d’alimentation-déglutition à l’aide du questionnaire sur l’alimentation-déglutition de McFarland et al. (2020) a été comparé au pourcentage d’enfants identifiés avec un trouble d’alimentation-déglutition à l’aide du Schedule for Oral Motor Assessment (Reilly et al., 2000). Les résultats montrent que le pourcentage d’enfants ayant au moins une difficulté d’alimentation-déglutition est significativement plus élevé que le pourcentage d’enfants identifiés avec un trouble d’alimentation-déglutition. Ces résultats suggèrent que le questionnaire sur l’alimentation-déglutition de McFarland et al. (2020) ne mesure pas les mêmes concepts qu’une évaluation standardisée conçue pour identifier la présence de troubles d’alimentation-déglutition, supportant ainsi son utilisation dans la présente thèse qui investigue la relation potentielle entre la présence de difficultés d’alimentation-déglutition et de langage entre 8 et 24 mois. / The primary objective of this thesis (referred to as OBJECTIVE 1) is to investigate whether, and when in the developmental sequence, the presence of feeding-swallowing difficulties is associated with an increased risk of concomitant and/or subsequent language difficulties at 12, 18, and 24 months. Its secondary objectives are to provide clinical data on the development of feeding-swallowing abilities between 8 and 24 months (OBJECTIVE 2) and to explore the divergent validity of the feeding-swallowing questionnaire developed by McFarland et al. (2020; OBJECTIVE 3). These objectives led to the recruitment of 140 children at 8 months or near 8 months of age (i.e., from 7 months 3 weeks to 8 months), born at term, raised in a monolingual French environment, and without any biomedical condition at 8 months known to be associated with language difficulties. The feeding-swallowing and language abilities of these children were characterized on four occasions (at 8, 12, 18, and 24 months) using the Feeding-Swallowing Questionnaire developed by McFarland et al. (2020) and the MacArthur-Bates Communication Development Inventories (Trudeau et al., 1997a, 1997b, 2008). The feeding-swallowing abilities of a subgroup of 30 children (from the 140 initially recruited) were also characterized at 8 months using the standardized clinical feeding-swallowing assessment entitled Schedule for Oral Motor Assessment (Reilly et al., 2000). To address Objective 1, parental responses to the Feeding-Swallowing Questionnaires and the MacArthur-Bates Communication Development Inventories were reduced for ensuring enough statistical power and coded for the presence and absence of feeding-swallowing and language difficulties. Logistic regressions were subsequently performed to investigate the potential relationship between the variables of interest. Based on the results of the logistic regressions, conditional inference trees were also constructed to visualize the relationship between the variables of interest. Since all children with reflux, food allergies and/or food intolerances did not have language difficulties at 18 and 24 months and these medical conditions are potential confounding variables, two logistic regressions were performed for each of the language statuses: one with data from all children in the sample and a second with data from children in the sample without allergies, food intolerances and/or reflux. The results show that the presence of salivary control difficulties at 18 months is associated with an increased risk of developing language difficulties at 18 and/or 24 months of age. They also revealed that the presence of certain indicators of chewing difficulties and/or food selectivity not attributable to reflux, food allergies and/or food intolerances and appearing at 24 months (in the absence of salivary control, chewing and/or food selectivity difficulties at 18 months) are associated with an increased risk of language difficulties at 24 months. When related to previously published literature, these data suggest that the presence of feeding-swallowing difficulties in children with language difficulties reflects a problem in the neural networks involved in the development of language and feeding-swallowing abilities (Krishnan et al., 2016; McFarland & Tremblay, 2006). They also provide indicators that can be used clinically to identify children who are at risk for language difficulties. To address Objective 2, parental responses to the 33 questions of the Feeding-Swallowing Questionnaire were coded for the presence and absence of 33 feeding-swallowing difficulties. The percentage of children with at least one feeding-swallowing difficulty at 8, 12 18, and 24 months was then calculated and compared. The three (out of 33) feeding-swallowing difficulties most frequently reported by parents at each age studied were also identified. The results show that the percentage of children with at least one feeding-swallowing difficulty decreases from 81% at 8 months to 54% at 24 months and that two indicators of feeding selectivity are among those most frequently reported by parents at three or four of the four ages studied in this thesis. These data increase our understanding of the experimental/clinical context in which the potential developmental relationship between the feeding-swallowing and language spheres takes place. To address Objective 3, only data collected for the subgroup of 30 children who participated in the clinical feeding-swallowing assessment were used. The percentage of children identified with at least one feeding-swallowing difficulty using the Feeding-Swallowing Questionnaire of McFarland et al. (2020) was compared to the percentage of children identified with a feeding-swallowing disorder using the Schedule for Oral Motor Assessment (Reilly et al., 2000). The results show that the percentage of children with at least one feeding-swallowing difficulty is significantly higher than the percentage of children identified with a feeding-swallowing disorder. These results suggest that the Feeding-Swallowing Questionnaire developed by McFarland et al. (2020) does not measure the same constructs as a standardized assessment designed to identify feeding-swallowing disorder. They are therefore supporting its use in this thesis investigating the relationship between the presence of feeding-swallowing and language difficulties between 8 and 24 months.

Normally swallowing occurs completely without effort. Should the act of swallowing for some reason be impaired, it becomes difficult to eat and drink. Dysphagia is the medical term for eating and swallowing disorders. Dysphagia is common in people with dementia, but the prevalence is not yet fully evaluated. The most common cause of death in people with dementia is aspiration pneumonia, which can be caused by dysphagia. In Sweden investigation and treatment of dysphagia are performed by speech and language pathologists (SLPs) but few of them work with dementia care. This study aims to identify the prevalence of dysphagia in people with dementia, living in a nursing home. The screening methods SSA-S and LtL were used to test the swallowing of 38 participants between 68-96 years of age (M = 86 years). To examine the participants’ oral health the risk assessment tool ROAG was used. When tested with the water swallowing test SSA-S 71,1% of the participants showed signs of aspiration, 36,8% had an oral transit time over 5 seconds, measured with LtL and 92% of the participants had an affected oral health, showing one or more symptoms of severity grade 2 according to ROAG. When adding up the results from the two screening tests a total of 86,8% of the participants showed signs of some kind of swallowing difficulty. Correlation analysis did not show any statistically significant correlations between SSA-S, oral transit time, oral health, or age. The present study found that there is a great need for interventions from speech and language pathologists in people with dementia. / Normalt sker sväljning helt utan ansträngning. Skulle sväljningen av någon anledning inte fungera som den ska, blir det svårt att äta och dricka. Den medicinska termen för ät- och sväljsvårigheter är dysfagi. Dysfagi är vanligt hos personer med demens men det är ännu inte helt kartlagt hur vanligt det är. Hos personer med demens är den vanligaste dödsorsaken aspirationspneumoni, vilket kan orsakas av dysfagi. I Sverige är det logopeder som utreder och behandlar dysfagi men det är få som är verksamma inom demensvården. Den här studien syftar till att kartlägga förekomst av dysfagi hos personer med demenssjukdom boende på ett vård- och omsorgsboende. Med screeningmetoderna SSA-S och LtL genomfördes undersökningar av sväljförmågan hos 38 personer mellan 68-96 års ålder (M = 86 år). För att undersöka deltagarnas munhälsa användes riskbedömningsverktyget ROAG. Av deltagarna fick 71,1 % utslag på vattensväljningstestet SSA-S, 36,8 % hade en oral transporttid över 5 sekunder, mätt med LtL och 92 % av deltagarna hade en nedsatt munhälsa med ett eller flera symptom av grad 2 i munhålan, enligt ROAG. Vid sammanräkning av resultaten från de två screeningtesten uppvisade totalt 86,8 % av deltagarna tecken på någon form av sväljsvårighet. Korrelationsberäkningar visade inga statistiskt signifikanta samband mellan resultat på SSA-S, oral transporttid, munhälsa eller ålder. Studien visar på ett stort behov av logopediska insatser hos gruppen personer med demenssjukdom.