Pediatric Dysphagia 

Student will independently take smaller bites and use effortful swallowing to facilitate bolus clearance in 9 out of 10 opportunities during feeding/swallowing therapy by mid-year as observed by SLP data.

Compensatory postures or swallow maneuvers are useful both for introducing immediate improvement in the safety or efficiency of the swallow and for identifying potentially beneficial therapy strategies (Groher & Crary, 2016).

• Effortful swallow- Posterior tongue base movement is increased to facilitate bolus clearance.

How to: “As you swallow, squeeze hard with all of your muscles.”

• Mendelsohn maneuver- Elevation of the larynx is voluntarily prolonged at the peak of the swallow to help the bolus pass more efficiently through the pharynx and to prevent food/liquid from falling into the airway.

How to: Maintain hyolaryngeal elevation during the swallow for a count of at least 2 seconds. 

• Supraglottic swallow- Vocal folds are closed by voluntarily holding one’s breath before and during the swallow in order to protect the airway.

How to: Hold breath before, during and after swallow. 

• Super-supraglottic swallow- An effortful breath hold tilts the arytenoid forward, which closes the airway entrance before and during the swallow.

How to: More effortful breath-hold than supraglottic swallow and requires volitional cough to follow. 

1. Instruct the client to take a breath in

2. Hold the breath

3. Take a mouthful of food/drink

4. Keep holding their breath and swallow

5. Then cough

Include: 

Observation of client performance, expected outcomes that were and were not achieved, and difficulties encountered or symptoms reported by the client during the task.

Include the following:

– Name of maneuver

– Number of repetitions, sets and duration of hold completed 

– Any difficulties experienced and/or monitoring requirements

– Required re-positioning, assistance or any equipment used while eating/drinking

– Observed signs of aspiration, oral pooling, or choking and action taken

– Ability to clear the oral cavity and any strategies required

(Queensland health, 2019)