The Dysphagia Service provides specialist expertise in the assessment and management of complex feeding and swallowing problems in children.The clinic aims to work with local services to support these children and their families within the community.
Who we see
The Neurodisability Dysphagia Service accepts new referrals of children up to the age of 16 years with severe difficulties with eating and drinking arising from confirmed or suspected neurological impairment. At referral children may be orally fed and/or fed by tube.
Referrals should be made by the child’s Paediatrician and include details of current local Speech Therapy advice and support, feeding recommendations and previous assessments regarding their feeding presentation. Previous reports from the child’s SLT team and/or dietitian would be helpful. GP referrals are not accepted. The clinic works in partnership with children’s local paediatricians and speech and language therapy teams and it is anticipated that children will remain under the care of their local teams whilst input from the Dysphagia Service is ongoing.
Referrals should be addressed as below but referrers are encouraged to send referrals securely via email to:
The Wolfson Neurodisability Service
Level 10 Main Nurses’ Home
Great Ormond Street Hospital
Great Ormond Street
London WC1N 3JH
New referrals of children aged 17-18 may be considered if there is no other service locally which can provide the specialist assessment requested; before such referrals can be accepted the Dysphagia Team will need to request permission from the Medical Director at Great Ormond Street Hospital.
Initial assessment may lead to recommendations for further investigations and treatment; modifications in feeding may be recommended.
Review will be offered to ensure that investigations are completed and discussed, and to review the effectiveness of any treatment of problems identified and suggested modifications to feeding practice. Recommendations for treatment or management of other aspects of the child’s medical problems may be made, but not undertaken directly within the clinic.
A child will be discharged back to local follow up once their swallow function is well understood, with a clear management plan in place and with local support identified.
At the Appointment
The first appointment may take up to two hours.
There are usually three parts to the appointment:
Assessment: this involves taking a full case history, focussing on feeding skills, medical history and developmental skills as relevant. Physical examination including weight and height and neurological examination is completed.
Observation: we will need to observe the child’s feeding and swallowing skills. Families are requested to bring familiar food, drink and utensils along to the appointment in order to create a realistic feeding experience. Seating should also represent the child’s typical feeding experience as far as is possible. The feeding assessment may be videoed, with the family’s permission.
Feedback: Once the assessment is complete the team will formulate a management plan which is discussed with parents. Further investigations may be recommended which will take place on a later date.
Liaison with local services is an integral part of the assessment process.
After the appointment
A full written report is despatched within three weeks; liaison with local services is integral to recommendations made.
Follow up appointments
Families may be offered a follow-up appointment to review the findings from any planned investigations and to review progress with feeding. Follow up appointments last up to one hour. Children will be discharged from the Neurodisability Dysphagia Service once the original referral questions have been answered.
Members of the Team
The team comprises a Consultant Paediatrician in Paediatric Neurodisability or Neurology and a Specialist Speech and Language Therapist with specific expertise in Dysphagia. The team has access to Occupational Therapy advice if this is required.
Other professionals may be invited to take part in the assessment process where specific questions have been asked.
Please click on the links listed below to access several relevant and helpful pages linking to the Dysphagia Service across Great Ormond Street Hospital website:
You can contact the Dysphagia Clinic on 020 7405 9200 ext 1198