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CLINICAL INDICATORS OR "RED FLAGS" TO ASSIST IN DECISION MAKING AND IDENTIFICATION  OF "AT RISK" INFANTS (Birth-Three years)

FEEDING - SWALLOWING = ORAL/MOTOR

Coughing or choking during swallowing

Inability to handle oral secretions

Noisy "wet" upper airway sounds after individual swallow or increase noisiness over course of feeding

Multiple swallows to clear a single bolus

Apnea during swallow

Changes in oxygen saturation levels during feeding

History of frequent upper respiratory infections or pneumonia

Chronic fatigue or failing asleep during a feeding

Difficult feeding transitions (puree to semi-solid to solid etc.)

Difficulty initiating a suck

Excessive time to consume a bottle (longer than 30 min per 8oz  bottle

Poor coordination of suck-swallow-breath  sequence

History of frequent nipple changes and alterations

Disorganization of sucking in middle of feeding

Slow or fast sucking rate

Uneven sucking rhythm

Excessive gagging

Very particular about nipple, pacifier, bottle etc.

History of tube feeding and/or invasive oral-pharyngeal procedures

Extreme negative behavioral responses to variety of tastes, textures, temperatures etc.

Report of being a "very picky' eater

 RESPIRATION -  PHONATION

Strained, "strangled" vocal quality

Inadequate intensity of phonation

Atypical vocal pitch

Inability to combine more than one sound on one breathe or decreased duration of phonation

Intercostal retraction in preparation for phonation

Postural "fixation" in preparation for phonation

Arrhythmic breathing rate

Audible breathing (on inhalation or exhalation)

History of cleft palate repair

History of tracheotomy 

History of respirator and/or NG/OG  tube feeding

History of laryngeal paralysis

 LANGUAGE COMPREHENSION -  LANGUAGE EXPRESSION

Limited attention to speech, speaker, music, etc.

Poor response to commands presented without gestural cueing

Easily distracted when challenged linguistically

Negative behavioral outbursts in conjunction with increasing language complexity

LANGUAGE COMPREHENSION - LANGUAGE EXPRESSION

Limited or no anticipation of play activities

Limited or no participation in reciprocal interaction and games

Limited communicative intent (i.e.: How does the child communicate their needs? Does child easily  "give up" when message is not received?)

Limited spontaneous production of variety of consonant-vowel combinations

Drooling

Limited spontaneous sound play (lip smacks, tongue clicks, etc.)

Poor imitation of oral-motor movement

Oral-motor "searching" when asked to imitate a sound

Increased frustration associated with an inability to be understood

Parent report of being "stubborn", "not listening", "always ignores"

Inability to perform commands that are not part of daily routine

Widely varying performance from one setting to another and/or one person to another

 NOTE:    A thorough understanding of normal and abnormal development is necessary to effectively utilize these clinical indicators as some of the items listed may be considered normal based ion the chronological age of the child

Prepared by Patricia Poillon Schwarz M.S. CCC/Sp. 

 Reference: Feeding and Swallowing Disorders in infancy; by L. Wolf and R. Glass

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