Management of dysphagia in a person with developmental disability
The core features of dysphagia management are interventions to reduce the risk of aspiration and improve swallowing. Family members and support workers need training in ways to provide texture-modified foods and safe mealtime assistance.
Review medications regularly to ensure necessary drugs are in an appropriate formulation and are able to be taken, and to minimise exacerbation of dysphagia; see also Drug-related dysphagia.
A multidisciplinary person-centred approach using an ethical decision-making framework is recommended for complex management interventions (eg enteral nutrition) for dysphagia in people with developmental disability (see Person-centred framework for assessing and managing dysphagia). The general practitioner (GP) has an important role in ensuring that the patient has access to specialist health professionals to inform dysphagia assessment, and advise on treatment options. This framework guides clinicians in weighing up the risk of dysphagia with the potential harms and benefits of all treatment options. See also Consent, capacity and decision making for people with developmental disability.
The National Disability Insurance Scheme (NDIS) may provide funding for relevant supports for people with dysphagia to support participation and inclusion. Comprehensive management of dysphagia (including assessment, interventions) and training of carers and family members should be requested in the NDIS funding plan.
Healthdirect has information about dysphagia (difficulty swallowing) for people with dysphagia, their family and carers.
Identify:
- the clinical presentation (eg swallowing difficulty, choking on saliva, respiratory symptoms, being underweight)
- the people involved—consider the person, family, carers, substitute decision maker (if relevant), healthcare professionals
- who can give consent for intervention(s).
- associated medical conditions, medications
- communication
- complications of dysphagia
- impact of dysphagia on the person, family and carers
- nutrition
- oral and dental health
- quantities and pacing of safe food intake
- seating and positioning for eating and drinking
- assistive technologies for use during meals
- swallowing.
Include clinical assessments (eg speech pathologist, dietitian, respiratory physician, gastroenterologist, occupational therapist) and investigations, as indicated.
Consider all possible management interventions, including the:
- risks, benefits and harms
- ethical and legal implications
- practical implications
- values, beliefs and attitudes of the person, family and carers.
Adopt a collaborative approach when choosing management interventions; discuss with the person and relevant parties (eg parents, carers, other healthcare professionals).
Management of dysphagia is ongoing, and includes:
- involving the person, parents and carers
- developing a plan to implement the chosen interventions
- implementing the plan
- monitoring, reviewing and amending the plan as appropriate.