The Feeding Clinic provides a targeted service to children who have complex feeding difficulties and concerns around weight gain and nutritional status that require input from dietetics. These difficulties may arise from oral motor, swallowing, sensory difficulties or from various medical conditions such as cardiac, renal and mild to moderate disability. The appointment may include a multidisciplinary feeding clinic or an individual appointment. A written referral from a paediatrician and/or specialists associated with John Hunter Children’s Hospital is required.

The clinic offers assessment of feeding and nutrition with involvement from a dietician, speech pathologist and/or occupational therapist, ongoing management and review and referral back to local services as necessary. Reasons for referral may include:

• Failure to thrive
• Poor or limited oral intake
• Food refusal
• Choking or coughing during feeding
• Oral motor and sensory problems
• Swallowing incoordination
• Excessive feeding times

A Videofluoroscopic Swallow Study (VFSS) also known as a Modified Barium Swallow (MBS) is an examination using a moving x-ray that shows the mouth and oesophagus during swallowing. It involves swallowing food or fluid mixed with a white liquid that can be seen with x-rays. This liquid is known as barium.

A VFSS is recommended when there is concerns about how well your child swallows, how well the airway is protected during swallowing and/or how well food moves from the mouth through the oesophagus. A written referral is required from your child’s treating medical professional or can be requested by your child’s local speech pathologist however this must be accompanied by a letter from your child’s doctor.

Acquired brain injury (ABI) is when the brain is damaged due to something that happens after birth. This may be due to falls, traffic accidents, sports accidents, infections, stroke or lack of oxygen to brain. The effects can very as it depends on the part of the brain that was affected and the amount of damage caused. You may notice some changes in your child’s physical function, cognition, personality, behaviour and communication.

Children with an ABI are often treated by a rehabilitation team which may consist of doctors, nurse, occupational therapists, physiotherapists, social workers, speech pathologists, and psychologists. A speech pathologist can work with your child and family to maximise communication skills and help them return to school and their community.

Your child’s communication goals may include:

• Speech skills which involves saying the sounds in words so people can understand what is being said
• Language skills which involves the understanding and expression of ideas using words, usually in spoken or written form
• Alternate/augmented communication (AAC) which involve using an external item to aid communication (e.g. object symbols, communication boards, books, speech generating device, mobiles, computers)

A cleft lip/palate is a structural anomaly where the normal lip and palatal structures do not close during development. A cleft can be unilateral (one side) or bilateral (both sides). Approximately 1 in 700 children is born with a cleft lip and palate in Australia. Sometimes there is a family history of cleft however most often cleft is sporadic with no history or known cause. A cleft lip may be able to be identified during antenatal scans. Babies with cleft palate tend to be diagnosed once they are born. Babies will be referred to the Cleft Palate Team who will provide longitudinal care across the child’s lifespan. This will generally involve surgery, speech therapy, audiology and orthodontics.

Most children who have had a cleft palate repair will have speech which is normal or very close to normal. Some children who had had their palate repaired will have velopharyngeal insufficiency (VPI). This occurs when the soft palate is not long enough to reach the back of the throat to make a firm seal. It allows air to escape through the nose during speech and makes it difficult for the child to make certain speech sounds, especially those that require the palate to be in a closed position. Speech may sound nasally and soft, have extra airflow or be produced in way that are not typical of their native language (e.g. in the throat). A speech pathologist will work with your child to help develop the specific sounds required and remediate any errors in your child’s speech. The speech pathologist will also identify whether further surgery may be indicated due to the nature of the speech errors present.

The speech pathology team at John Hunter Children’s Hospital provides a consultative tertiary service to babies, children and adolescents with cleft lip/palate. This service encompasses assessment of speech, resonance and nasal airflow, collaborative decision making with the cleft palate team, and consultation with your child’s local therapist. Therapy for speech, and any other aspects of communication, is conducted at the local community level, either through Community Health Services or private speech pathology services.

Velopharyngeal disorders is a general term used to describe different dysfunctions of the soft palate. These include:

• Velopharyngeal insufficiency (VPI) which involves abnormal structure
• Velopharyngeal incompetence (VPI) which involves abnormal movement
• Velopharyngeal mislearning which involves abnormal speech sound production

Velopharyngeal disorders causes a leak of sound and/or air into the nose during speech - this is commonly known as ‘nasal speech’. Your child may have trouble making sounds with making individual sounds or putting sounds together or have speech that sounds like they have a cold. ‘Nasal speech’ may include:

• Hypernasality where there is too much sound in the nose during speech
• Hyponasality where there is not enough sound in the nose during speech
• Nasal air emission where the air exits from the nose instead of the mouth

The treatment of velopharyngeal disorders depends on the type and cause of the disorder. A palato-videofluoroscopy (PVF) procedure may be offered to your child to help determine the type and cause of the disorder. This is an examination of the velopharyngeal structure using a moving x-ray and shows the function of these structures. Surgery may be required for the treatment of abnormal structures and movements however this does not change the way your child has already learnt to talk. Speech therapy is usually needed after the operation to help your child learn how to make the sounds correctly and aims to eliminate abnormal speech patterns. If no surgery is required then speech therapy alone will correct the abnormal speech.

The speech pathology team at John Hunter Children’s Hospital provides a tertiary outpatient service which involves a specialist assessment, diagnosis, review and a consultative service with the child’s local speech pathologist who will provide treatment. A written referral is required from your child treating medical professional or can be requested by your child’s local speech pathologist.