The Institute for Child Development (ICD) has gained a national and international reputation for providing superior diagnostic and treatment services to children with special needs. Our mission is to help children with neurodevelopmental and behavioral disorders and complex medical needs achieve their maximum potential while providing guidance and support to their families, as well as education and community outreach.
The ICD’s developmental pediatricians provide consultative services for local school districts in Bergen County and, along with other allied health professional staff members, offer educational presentations on topics of current interest through the Hackensack University Medical Center Speakers Bureau.
Pediatric residents, interns, and medical students benefit from education and observation opportunities provided by the ICD’s medical and clinical staff. Students in training in the fields of physical, occupational, and speech therapy are also offered the opportunity to participate in supervised clinical practice. For the past 29 years, the ICD has sponsored an annual national conference spotlighting current research and trends in both general and developmental/behavioral pediatrics.
The ICD is a dynamic organization responding to the changes and the challenges of the 21st century. In 2008, the ICD was recognized by the Governor’s Council of New Jersey as a Center of Excellence in the diagnosis and treatment of children with autism.
To ensure that our staff at the Institute for Child Development has the information necessary to help you and your child, please click on the links below to download the ICD packets. These packets include information pertaining to registration, directions to the ICD, and forms to be completed and returned. For information or to make an appointment call 551-996-5555.
New patient packet
Returning patient packet
Developmental and Behavioral Services
Our board-certified developmental and behavioral pediatricians serve as key members of our interdisciplinary team, and they act as liaisons with patients’ primary care physicians and other medical specialists. Our developmental and behavioral pediatricians provide:
comprehensive developmental, medical, and behavioral histories
extensive neurodevelopmental examinations
education for parents and professionals regarding various medical/developmental diagnoses
medical management of attention deficit/hyperactivity disorder (ADHD) and related disorders
community outreach to parents, schools, and medical specialists
Randye F. Huron, M.D.
Punam Kashyap, M.D.
Jasmin Furman, M.D.
Rita Benezra-Obeiter, M.D.
Eileen A. Dolan, M.D.
The JUDY Center for Down Syndrome
The JUDY Center for Down Syndrome is a consultative service to families, the community, and other pediatric healthcare professionals at The Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center. The center is dedicated to the management of the complex health care needs of its patients. Our team of healthcare professionals utilizes a comprehensive range of services to maximize the quality and lives of our patients. We care for individuals with Down syndrome through young adulthood at any age, and partner with the community, schools, and other agencies to promote the best health outcomes. While our focus is on Down syndrome, individuals with other lifelong illnesses can also be helped.
The initial consultation and admission process generally takes approximately three hours and may involve two separate visits. Follow-up visits are usually shorter. Information derived from these visits is provided to the family and the individual’s physicians. The JUDY Center follows the guidelines from the American Academy of Pediatrics and the National Down Syndrome Congress. With the consent of the individual or family, our healthcare professionals can meet with other agencies and health professionals to discuss the treatment and care of our mutual clients.
The JUDY Center has ongoing programs open to the community that involve healthcare professionals in Child Life Services, educational sessions for families managing Down syndrome, and outreach to medical professionals.
Some of the services we provide are:
Medical services to manage specific problems associated with Down syndrome
Individual and family counseling aimed at enhancing coping and adaptation
Outpatient parent support groups
Referrals to community resources to ensure continuity of care throughout the lifespan
Educational services that help families have smooth transitions along the educational pathway
Recreation, wellness, and sports services that encompass a spectrum of activities ranging from recreational activities to wellness exercise programs
Special services that include speech-language therapy, physical therapy, occupational therapy, audiological enhancements, and others
Long-term planning services that provide an advocacy support system to assist families with projected long-term needs
Fred Hirschenfang, M.D.
National Down Syndrome Society: 800-221-4602 http://www.ndss.org/
National Down Syndrome Congress: 800-232- NDSC http://www.ndsccenter.org/
National Association for Down Syndrome: NADS http://www.nads.org/
National Info Center for Children & Youth w/ Disabilities: 800-695-0285 http://www.nichcy.org/
Down Syndrome: Health Issues: http://www.ds-health.com/
The Arc of New Jersey: 732-0246-2525 www.arcnj.org
Division on Developmental Disabilities: 8000-832-9173 www.state.nj.us/humanservices.ddd
Supplemental Security Disability Insurance: 800-772-1213 http://www.ssa.gov/
New Jersey Early Intervention System: 609-777-7734 www.nj.gov/health
NJ Dept. of Education www.state.nj.us/education:609-292-4469
Exceptional Parent Resource Guide: 800-E-Parent http://www.eparent.com/
NJEISFamilies@yahoogroups.com Early Intervention Parent to Parent Listserve
NJ Division of Vocational Rehabilitation Services: www.state.nj.us/labor/dvrs/vrsindex.html
Network 21: http://www.dsnetwork21.org/
NJ Council of Developmental Disabilities: http://www.njddc.org/
High-Risk Infant Follow-Up Program
Babies who are born prematurely are at a high risk for a developmental delay. An assessment of an infant's skills in motor coordination, play, social awareness, and communication is available through the High-Risk Infant Follow-Up Program. A developmental/behavioral pediatrician performs a neurodevelopmental evaluation. She also provides parent education regarding the acquisition of these skills and referrals for recommended services or further evaluation and treatment, if needed.
The Institute for Child Development’s Medication Program provides services to families whose children would benefit from medication management of developmental and/or behavioral disorders.
The conditions treated include attention deficit-hyperactivity disorder, autism spectrum disorders, and other behavioral disorders. Treatment plans are tailored to the individual needs of the child and family, and are provided by board-certified developmental and behavioral pediatricians and a registered nurse. Recommendations may include referrals to community-based resources for individual/parent psychotherapy, behavior management programs, and social skills training. Education of the child and family, as well as acting as a liaison to the school and to other professionals, is ongoing. To make an appointment, call 551-996-5254.
Frequently Asked Questions
What happens during an initial Medication Program appointment?
During an initial Medication Program appointment, you will meet with a developmental pediatrician/registered nurse to discuss a treatment plan. Medication options will be addressed, including the effects and side effects of medication, as well as additional services that may be needed. Your child’s medical history and significant family medical history will be reviewed, at which time medical recommendations, i.e. blood tests and/or referral to other medical professionals will be made as needed. Your child’s growth parameters and vital signs will be obtained. You will be given the opportunity to ask questions and discuss your concerns before making a decision as to whether to begin treatment with medication. If medication treatment is chosen, program protocol will be explained and a follow-up plan will be made. Educational materials and website information will be provided.
What should we expect during a follow-up Medication Program appointment?
Your family will meet with a developmental pediatrician/registered nurse to discuss the effectiveness of your child’s treatment plan. Any side effects will be addressed, and the medication regimen will be adjusted accordingly to provide the best effect of medication with the least side effects. Your child’s growth parameters and vital signs will be monitored. A plan will be made for follow up, which is dependent upon your child’s/family’s needs.
How do I get refill prescriptions between visits? I
f the medication used to treat your child is classified as a controlled substance, it cannot be called into the pharmacy. When you are getting close to finishing your current prescription, you will call the program secretary, who will have a refill prescription written by your physician. You will not get a return call regarding the prescription, unless there is a question or concern. Please be clear when you are leaving a message, stating your child’s name, date of birth, and the medication that you are requesting. You can ask for the prescription to be mailed or you can pick it up.
How often does my child need to be followed in the Medication Program?
Depending on the effectiveness of the medication, follow-up visits may vary in frequency. At the start of treatment, the visits may be more frequent, as the medication may need to be adjusted to achieve the best effect. We will discuss your child’s follow-up plan with you at each visit.
The Registered Nurse(s) at the Institute for Child Development is an essential member of the interdisciplinary team and provides:
Coordination of services in Medication Program to include: ongoing monitoring of effectiveness and side effects of medication, education of parent/child regarding medication and treatment plan, liaison with the school/other related services, referral to outside services which may include diagnostic testing and other medical/specialty services.
Works closely with the Developmental Pediatricians to evaluate children with various developmental disorders. Provides support to families when seeking additional medical/behavioral services and makes referrals, as needed.
Serves as a resource to other ICD/CH department members, as well as to families, schools and the community.
Sonya Stankovci-Finno, RN
Occupational Therapy assists people in developing the “skills for the job of living that are necessary for independent and satisfying lives”. Occupational therapy helps children learn skills and participate in play, family and school activities.
The American Occupational Therapy Association defines Occupational Therapy (OT) as “skilled treatment that helps individuals achieve independence in all facets of their lives”.
Occupational therapists at ICD are licensed professionals and specialize in the treatment of children. Services are available for infants and children of all ages with a variety of diagnoses including low muscle tone/weakness, brachial plexus injury and other nerve injuries, orthopedic injuries/conditions, prematurity, cerebral palsy including hemi paresis, quadriplegia and diplegia, Down syndrome and other chromosomal disorders, seizure disorders, rheumatologic conditions, developmental delays and Autism Spectrum Disorders. Individualized therapy programs help:
Increase function, strength and mobility through play activities and exercise programs.
Improve body awareness and motor planning for motor skills that require higher level coordination.
Improve fine motor skills.
Improve eye hand coordination and perceptual motor skills
Improve pre writing and handwriting skills.
Increase independence in self care skills including self feeding and dressing.
Learn adaptations for sensory processing difficulties
Frequently Asked Questions
What happens during an OT evaluation?
Your child will be asked to do activities to test his/ her coordination, upper extremity strength, fine motor skills, visual perceptual skills and visual motor abilities, and activities of daily living in order to ascertain if their skills are age appropriate. If concerns in the sensory areas are reported or noted a Sensory Screening will be completed. Standardized assessments are used as appropriate.
You will be allowed to come into the evaluation with your child. However, once your child is school age and is willing to separate from you, your child may perform better if they attend the evaluation by themselves. In this case you will be brought into the evaluation room once your child has completed the evaluation to go over the preliminary findings. If an area of weakness is found, suggestions for activities to begin at home to help your child will also be given by the evaluator. A written report will be sent to you within two weeks of the evaluation. If you have not received the report within two weeks of the evaluation, please call the ICD Records Room (551-996- 5253) at ICD to request a copy of the report.
What Is The Duration And Frequency Of Each Occupational Therapy Session?
Children who have medically based conditions are prioritized for therapy such as; childhood cancers and blood disorders, Cerebral Palsy, Down syndrome, Autistic Spectrum Disorders, brachial plexus injuries and seizure disorders. When children are referred to ICD for occupational therapy and are currently already receiving occupational therapy in early intervention or school, the evaluating therapist will determine the appropriateness for additional therapy.
If your child is recommended for therapy at ICD after completing an OT evaluation, a treatment plan and goals will be developed that is individualized for your child. ICD focuses on educating families and caregivers to carry over the treatment techniques at home in order for your child to make the most improvement in their areas of weakness. When families and caregivers carry over suggestions and recommendations, it optimizes progress and independence. Home programs are provided to families and caregivers either verbally or through written materials.
Typically occupational therapy sessions are 45 minutes long and the parent attends the sessions with their child. If the child is older and distracted by having the parent/guardian in the room, the parent / guardian will often be asked to come into the last 10 minutes of the session. In this way the therapist can communicate events that occurred in the session as well as activities to encourage at home. In all cases a parent or guardian must stay at ICD while their child attends therapy.
Why Would Short Term Occupational Therapy Be Recommended?
Often if children are already receiving school based therapy or therapy in the home, the need for additional therapy is not warranted on a long term basis. Therefore, short term therapy may be more appropriate to supplement your child’s current program. Once children become school age, they may need to come back for re evaluations each year to determine progress or change in their condition and if additional short term therapy is needed to update their home programs or supplement their school therapy program.
What Should My Child Bring To Therapy?
Children who use glasses or hearing aides should wear them to each therapy session for optimal participation.
Children should wear comfortable clothing and sneakers.
Children may be requested to bring homework or communication logs from teachers to each session.
Therapists often give activities to complete at home and will request that assignments be returned the following week.
Children who need help with self help skills such as self feeding and dressing, may be requested to bring in eating utensils, snacks, clothing or tie shoes to their OT session.
How Will I Know If My Insurance Plan Will Cover Occupational Therapy?
Once your child’s evaluation is completed and therapy is recommended at ICD, your insurance company will be contacted to ascertain your Occupational therapy benefit. Many times authorization is required before therapy can be initiated and only certain diagnoses are covered by certain plans. There also may be a limitation in the number of visits per year depending on your child’s condition and your insurance benefits. If pre authorization is required for therapy, the OT evaluation report must be faxed to the insurance company for approval. This causes a delay in initiating therapy.
Can The Occupational Therapist Contact Other Professionals Involved With My Child?
Frequently the therapist will recommend coordination of services with other professionals involved in your child’s care. This may include teachers, early intervention or school therapists, or any other ,,professionals working with your child.
Why would therapy be recommended only for school and not at ICD?
ICD provides occupational therapy that is medically based. When children reach school age, the educational environment is often the most appropriate setting for occupational therapy. Occupational Therapy is recommended in the school setting when your child’s area of weakness is primarily educationally related. In this way Occupational Therapy can be provided in the child’s natural environment within the routine of your child’s school day as educational needs should be met in the school setting. Additionally, school therapy optimizes communication with educational staff and the school therapist.
Examples where occupational therapy in the school would be recommended include but are not limited to ; a child who has difficulty organizing their back pack or schoolwork, difficult with handwriting or difficulty focusing during school activities such as circle time.
Occupational Therapy Staff
Senior Occupational Therapist
Irma Arndt, MA, OTR
Jenny Shatzel, MA, OTR
Sara Silverstein, MA, OTR
Linda Lieter, MA, OTR
The American Physical Therapy Association describes physical therapists as experts in "the science of healing and the art of caring." Licensed pediatric physical therapists help children to reach their maximum potential for functional independence, play and recreational activities through examination, evaluation, consultation, and intervention.
At the Institute for Child Development, our physical therapists provide professional care in a safe and fun clinical setting. ICD’s physical therapists are specifically trained in pediatrics to provide evaluation and therapeutic services for children of all ages with problems with gross motor (large muscle) development due to orthopedic, developmental, and/or neurological disorders. Your child will have access to a variety of therapeutic equipment to help him/her achieve his/her goals and address your concerns. Our physical therapists collaborate with other medical, educational, developmental, and rehabilitation specialists to provide the best supports for your child.
Our physical therapists provide the following services:
exercise programs for strengthening, range of motion, balance, and coordination
functional mobility skill training, including walking and using assistive devices
ongoing family education through home exercise programs
consultation and evaluation services for schools
adaptive equipment consultation
Yoga and/or therapeutic exercise groups for children 5 and up
Our physical therapy services help children of all ages to:
improve weakness, function and mobility deficits due to orthopedic, neurological, oncologic, or blood disorders, such as: torticollis and/or plagiocephaly, positional foot deformities, poor posture and balance, low/high muscle tone, weakness, brachial plexus injury, seizure disorders, bone and joint injuries, prematurity, cerebral palsy (hemiplegia, diplegia and quadriplegia), Down syndrome and other chromosomal disorders.
achieve motor milestones, such as holding head upright, rolling, sitting up, moving in and out of positions, standing and walking with good balance and control;
reduce pain, Improve mobility and functional motor skills due to disorders such as complex regional pain syndrome (RSD), rheumatologic conditions, and other bone and joint injuries.
improve overall coordination and balance necessary for higher level motor skills such as running, jumping, hopping, stair climbing, ball skills, etc.
Physical Therapy Staff
Section Chief of Physical and Occupational Therapy
Patricia Ryan, PT, MBA
Senior Physical Therapist
Susan Lastra, PT, MPA
Jocelyn Alex, PT, DPT
Michelle Calabrese, PT, MSPT
Jaclyn Gonzalez, PT, MSPT
Jennifer Jenco, PT, DPT
Danit Macklin, PT, DPT
Tara Wach, PT, DPT
Frequently Asked Questions
What happens at a physical therapy examination?
Your child will be asked to perform activities to test his/ her functional mobility skills, joint mobility, strength, coordination, and balance. You will be allowed to come into the evaluation with your child. However, once your child is school-aged and is willing to separate from you, your child may perform better if he/she attends the evaluation by himself/herself. In this case you will be brought into the evaluation room once your child has completed the evaluation to go over the preliminary findings. If an area of weakness is found, suggestions for activities to begin at home to help your child will also be given to you by the evaluator. A written report will be sent to you within two weeks of the evaluation. If you have not received the report within two weeks of the evaluation, please call the ICD Records Room (551-996- 5253) to request a copy of the report.
What is the duration and frequency of each physical therapy session?
Children who have medically based conditions are prioritized for therapy, including childhood cancers and blood disorders, complex pain syndromes, juvenile rheumatoid arthritis, cerebral palsy, Down syndrome and other chromosomal disorders, autism spectrum disorders, brachial plexus injuries, seizure disorders, and orthopedic surgery or injuries. When children are referred to the ICD for physical therapy and are currently already receiving physical therapy services through early intervention or in school, the evaluating therapist will determine the appropriateness for additional therapy.
If your child is recommended for therapy at the ICD after completing a physical therapy evaluation, a treatment plan and goals will be developed that are individualized for your child. The ICD focuses on educating families and caregivers to carry over the treatment techniques at home in order for your child to make the most improvement in his/her areas of weakness. We have found that when families and caregivers carry over suggestions and recommendations, it optimizes progress and independence. Home programs are provided to families and caregivers, either verbally or through written materials.
Physical therapy sessions are typically 30 to 45 minutes long, and the parent attends the sessions with the child. If the child is older and/or is distracted by having the parent/guardian in the room, the parent/guardian will often be asked to come into the last 10 minutes of the session. In this way the therapist can communicate events that occurred in the session as well as activities to encourage at home. In all cases a parent or guardian must stay at the ICD while his/her child attends therapy.
Why would short-term physical therapy be recommended?
Often if children are already receiving school-based therapy or therapy in the home, the need for additional therapy is not warranted on a long-term basis. Rather, short-term therapy may be more appropriate to supplement your child’s current program. Once children become school age, they may need to come back for re-evaluations each year to determine progress or changes in their condition and/or if additional short-term therapy is needed to update their home programs.
What should my child bring to the therapy session?
Your child should wear comfortable clothing and sneakers (sandals, boots or flip-flops are not appropriate footwear for physical therapy). Children who have orthotics, glasses, or hearing aids should wear them to to the evaluation and for each therapy session for optimal participation.
What role does the family play?
The family plays an integral role in enhancing the development of the child. At the ICD, our physical therapists educate and instruct the family to implement individualized home exercise programs with the child. Since your child is only in therapy one to two times per week, it is important that your family be able to carry over activities at home. The support requested by the family may include positioning of the child, arranging environment to promote mobility, safe and effective usage of adaptive equipment, and performing exercises to help with strengthening and mobility.
How do I know if my insurance will cover physical therapy?
Once your child’s evaluation is completed and therapy is recommended at the ICD, your insurance company will be contacted to ascertain your physical therapy benefits. Often, authorization is required before therapy can be initiated and only certain diagnoses are covered by certain plans. Many times if your child’s condition is considered to be a “delay” in development or solely a “developmental” issue, therapy may not be covered by your insurance plan. There may also be a limitation in the number of visits covered per year depending on your child’s condition and your insurance benefits. If pre-authorization is required for therapy, the physical therapy evaluation report will be faxed to the insurance company for approval, which causes a delay in initiating therapy.
Can the physical therapist contact other professionals involved in the care of my child?
Frequently the therapist will recommend coordination of services with other professionals involved in your child’s care. This may include physicians, teachers, early intervention or school therapists, or any other professionals working with your child.
What if my child’s school program will no longer provide physical therapy, will you provide it at the ICD or can your report recommend that therapy be continued at school?
Once children reach elementary school age their physical therapy needs often change. Their program may be one that is considered maintenance, and weekly physical therapy is often no longer appropriate. Instead your child should have a yearly evaluation to ascertain changes in his/her status and to make appropriate recommendations in any area of concern. Short- term physical therapy may be recommended at the ICD to update your child’s home programs, monitor orthotics, or assist with adaptive equipment. The ICD can make a recommendation that school therapy is appropriate only if your child’s physical limitations affect his/her ability to learn in his/her school environment. The ICD does not make recommendations of frequency for school therapists. The appropriateness and frequency of school therapy is determined by the physical therapy professional of your child’s child study team.
Licensed and American Speech-Language-Hearing Association-certified speech-language pathologists provide evaluations and therapeutic recommendations for children experiencing:
receptive and expressive language disorders
motor speech disorders (dysarthria and apraxia)
autistic spectrum disorders
post-traumatic brain injury
voice disorders (nodules, vocal strain, chronic hoarseness)
paradoxical vocal fold dysfunction
cleft palate and/or resonance disorders
hearing impairment (including cochlear implant)
dysphagia (eating and swallowing disorders)
modified barium swallow studies performed in collaboration with our pediatric radiologists
Speech/language/dysphagia therapy may be available for:
any child under the age of 3 years
children of any age whose speech/language or swallowing disorder requires skilled, medically based treatment
Therapy requests for preschool and school-aged children with a diagnosis of autistic spectrum disorder are reviewed on an individualized basis. Therapy may be offered at the ICD when a goal is identified that is either not addressed by the current individualized education plan (IEP) or better addressed in a medical setting.
Chief, Pediatric Speech Pathology
Hildy S. Lipner MA, CCC/SLP
Senior Speech-Language Pathologist
Eileen J. McGuire MS, CCC/SLP
Dana Rosen MS, CCC/SLP
Lauren G. Gitstein MA, CCC/SLP
Stephanie Harding MA, CCC/SLP
Frequently Asked Questions About Speech/Language/Dysphagia Evaluation and Therapy
Why does my child need to have a hearing test before the speech-language evaluation?
An evaluation by an audiologist is considered a best practice and is required as part of our speech-language evaluation to formally document hearing status and to rule out hearing loss as a contributing factor to the presence of a speech or language deficit. Even the smallest or a fluctuating hearing loss caused by multiple middle ear infections can negatively impact speech-language development. Milder hearing losses are more difficult to identify during the course of everyday activity and can more often go undetected.
What does a speech-language evaluation include?
Our evaluation includes a parent interview, formal testing, and informal assessment procedures, which can include play, along with a review of incoming records and outside evaluations, as appropriate. The evaluation process progresses more quickly and smoothly when the pre-evaluation parent questionnaire and any relevant outside reports are available for examiner review prior to the date of your child’s evaluation. Preliminary results and diagnoses will be discussed with you at the completion of the evaluation. Depending upon your child’s age, the complete evaluation including discussion of results and recommendations can take from 1.5 to 2 hours.
Why do I have to give you copies of my child’s previous evaluations?
All formal tests cannot be administered more than once in a 12-month period. Repeated administration of the same testing instrument invalidates the result. Review of all previous reports and test results also helps us tailor our evaluation procedures to your child’s individual needs in order to best address your questions and give you a useful second opinion.
When can I expect a copy of my child’s evaluation report?
Following completion of the evaluation, a formal evaluation report is generated, which includes a summary of your child’s performance, all diagnoses, recommendations, and referral information for community resources directly discussed with you upon completion of the evaluation. It typically takes several weeks to finalize testing results and provide a report that accurately reflects your child’s performance and individualized recommendations. Please contact your evaluating speech-language pathologist directly and provide the earliest possible notice if you will be requesting your child’s evaluation report to be available for a specific date so you may bring it with you to a scheduled school meeting or early intervention or private therapy appointment. We will do our best to meet your needs and accommodate requests made within a reasonable timeframe.
Will my health insurance pay for therapy?
Health insurance providers will pay for what they determine is medically necessary speech-language and dysphagia therapy. Every insurance policy contains written language defining the policy’s interpretation of medical necessity. A representative from our hospital finance department will call your insurance company prior to initiation of treatment to determine whether speech/language/dysphagia therapy benefits are available given your child’s diagnosis, the limits of your benefits, and your financial responsibility in the form of co-payment. This will all be discussed with you prior to initiating treatment. We can provide you with information to assist you should you wish to appeal any denial of therapy benefits.
How long is a typical speech-language or dysphagia therapy session?
Sessions are typically scheduled for 40 minutes. This includes direct treatment, parent education, and information on home carryover activities. Your child’s therapist will divide session time to best meet his/her individualized treatment needs and goals.
How will I know what to practice at home with my child?
When appropriate, a home program is provided and reviewed with the parent. Depending upon your child’s age and/or ability level, when written homework or printed worksheets are not appropriate, techniques to improve your child’s speech/language skills are reviewed in detail and often modeled during direct treatment in order to assist parents in carrying over skills within the home environment.
Parents are an integral part of feeding therapy sessions and are given specific strategies and targets to carry over into the mealtime setting within the home. All therapeutic techniques are modeled for the parent during direct treatment. Successes and barriers to implementation of techniques and strategies are reviewed during the initial portion of each subsequent session.
Will contact be made with other professionals involved with my child?
Often the therapist will require coordination of services with other outside professionals already involved in your child’s care. This may include another speech-language pathologist, a doctor, or any other professional who works directly with your child. At times the treating therapist may suggest additional referrals to a medical specialist or other allied health professionals. Sharing of confidential diagnostic and treatment information can only be done with the permission of the parent or legal guardian.
What does an oral-motor/dysphagia evaluation include?
Our evaluation includes a parent interview, diet history, oral structure and functional assessment and direct observation of eating skills and behaviors. It is most helpful for you to bring the child’s bottle/nipple, cup, and spoon along with familiar food items from your own home that include a variety of preferred items as well as items that may currently present an eating challenge for your child. We have access to a microwave oven for foods that may require warming. Participation in eating is expected so please manipulate your child’s mealtime schedule so that at the time of the scheduled evaluation, infants will be ready for a feeding and children are ready and interested in eating a snack. The evaluation process is enhanced when the pre-evaluation parent questionnaire and any relevant outside reports from your pediatrician or medical specialists are available for examiner review prior to your appointment date. Results and recommendations will be discussed with you at the conclusion of the evaluation. The complete evaluation including discussion of results and recommendations can take from 1.5 to 2 hours.
What happens during a modified barium swallow study?
A modified barium swallow study is a moving X-ray study of the process of swallowing. The movement of liquid and food can be watched starting in the mouth through entrance into the stomach. Modified barium swallow studies are recommended when there are concerns about how well your child swallows and how well the airway is protected during swallowing. The purpose of the study is to image as typical a swallow as possible. The child’s bottle and/or feeding utensils should be brought for use during the study. Liquids and foods offered to your child during testing will be mixed with contrast material (most typically barium) in order to become identifiable on the X-ray. This will alter their taste, but by utilizing flavorings and selecting foods with more intense and preferred flavors we are able to avoid a significantly unpleasant taste experience. Holding off on giving your child any food or liquid for a few hours immediately prior to the study can also help to optimize cooperation. You will have an opportunity to discuss particular concerns and preparation procedures related to your individual child when scheduling your appointment. Modified barium swallow studies are conducted with our pediatric radiologist and take place in Pediatric Radiology on the first floor of the Children’s Hospital. Modified barium swallow studies always require a prescription from your pediatrician or referring medical specialist, which must be brought with you to the hospital on the day of the study.
Preliminary results and recommendations are discussed at the conclusion of the study. The study is recorded on DVD so it can be carefully reviewed by the speech-language pathologist and radiologist prior to finalizing a formal radiology report, which is made available to your child’s referring physician. Based upon study results, specific recommendations for changes in diet -- including how best to introduce food and liquids and what might need to be avoided -- along with therapeutic recommendations will be made as appropriate by the speech-language pathologist.