Browsing by Author "Norman, Vivienne"

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    An exploration of the facilitators and barriers experienced by Rehabilitation Care Workers in the provision of Speech-Language Therapy related services
    (2018) Higgs, Salma; Harty, Michal; Norman, Vivienne
    Background: South Africa experiences a severe shortage of speech-language therapists (SLTs) which results in individuals requiring Speech-Language Therapy (SLT) services having to travel long distances or being placed on long waiting lists to access services. Rehabilitation Care Workers can assist with bringing this service closer to the communities they serve. It is important to explore the experiences of these individuals to ensure that they are adequately supported and skilled. The University of Cape Town (UCT) has been training Rehabilitation Care Workers (RCWs) since 2012, however to there is currently no empirical data documenting the facilitators and barriers experienced by RCWs in their work. Aim: To explore RCWs (in the Mitchells Plain/Klipfontein sub-structure) perceptions of the facilitators and barriers in providing SLT related activities in their work context. Methods: A descriptive exploratory study was conducted. Eighteen RCWs were approached and 13 participated in 2 focus groups. Data was transcribed and analysed using thematic analysis. An inductive approach was used to develop meaningful themes and sub-themes. Results: The plot of “vital role players” best synthesized the 3 main themes namely scope of practice, RCW position and value as an intrinsic motivator and challenges. : The scope of practice theme included 4 sub-themes namely, RCW activities; awareness of broad scope; understanding family needs; including family as stakeholders in patient management. RCW position and value as an intrinsic motivator - included 4 sub-themes namely, integral members of the team; agents for change; community servants; go between formal structures and the community. Finally the theme challenges –included 4 sub-themes namely, training gaps; safety; lack of resources; feeling undervalued. The facilitators and barriers identified by the RCW’s aligned with perceptions of other mid-level health care workers as reported in the literature. Implications: RCWs work within a family centred care approach and see themselves as community servants who bring vital rehabilitation services into homes by transferring their skills to families and communities through education, support and advocacy. Despite their value and passion, RCWs feel undervalued by those around them, including management structures and the Department of Health (DOH). Conclusion: RCWs can bring much needed rehabilitation services into the homes of communities in Cape Town. For this reason, it is imperative to consider the facilitators and barriers experienced by these individuals in order to harness their natural skills and strengthen the current RCW service and solidify their roles within the Multidisciplinary Team (MDT).
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    Are we there yet? on a journey towards more contextually relevant resources in speech-language therapy and audiology
    (AOSIS Publishing, 2013) Pascoe, Michelle; Rogers, Christine; Norman, Vivienne
    Audiologists and speech-language therapists working in developing contexts like South Africa have the opportunity to address a range of needs through their research. One of these needs is the development of assessments and therapy materials that are appropriate for their clients’particular language needs and cultural background. This editorial paper aims to introduce original research in speech-language therapy and audiology, which has been carried out in South Africa and other developing contexts and is presented in this volume of the journal. In addition we suggest that while the focus of much research is on the destination or end product that is developed, there is a need to share the methodologies that are used to reach that goal so that more research can be carried out by a wider pool of students, researchers and clinicians. We describe some of the methods that we have used in our research – often in small scale projects with budgetary constraints, which would be feasible for clinicians in their routine clinical contexts. Our hope is that others can build on these approaches, critique and share their own strategies for the ultimate advancement of the professions in southern Africa.
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    Caregivers? perceptions of caregiver burden, quality of life and support needs in caring for a child with cerebral palsy with feeding and/or swallowing difficulties within the context of the Western Cape, South Africa
    (2023) Le Roux, Raquel; Norman, Vivienne; Harty Michal
    Background: Children with cerebral palsy often present with feeding and/or swallowing difficulties and are reliant on family caregivers for long-term care, particularly in resource-constrained countries like South Africa. This can result in caregiver burden and decreased quality of life for both caregiver and child. The planning and implementation of supportive services and interventions depend on the availability of knowledge relating to caregivers' perceptions of burden and the impact on their quality of life, as well as their specific support needs. Research Aim: To describe caregivers' perceptions of caregiver burden, quality of life and support needs in caring for a child with cerebral palsy who has feeding and/or swallowing difficulties, in the context of the Western Cape, South Africa. Methods: A qualitative, descriptive, case study design was utilised to describe the perceptions of eight mothers caring for children with cerebral palsy who have feeding and/or swallowing difficulties, who were between the ages of two and eight years (mean=4.63). Participants, aged between 25 and 42 years (mean = 29.25), were recruited from a hospital's cerebral palsy clinic. Semi-structured telephonic interviews, using an interview guide of seven open-ended questions and probes, were conducted and recorded. Four interviews were conducted in English and the remaining four were conducted in isiXhosa. To ensure trustworthiness and rigor, the study used various measures such as pilot testing, informal member checking, verbatim transcription, re- evaluation of data, triangulation of analysts and sources, debriefing and reflexivity. The data were analysed using thematic analysis to generate themes and sub-themes. Results: Caregiver perceptions were captured in seven key themes, namely: ‘Worry'; ‘Feeding is everything'; ‘Identified support needs'; ‘What helps me cope?'; ‘Cost of caregiving'; ‘Hopeful caregiving'; and ‘Shortfalls of healthcare system and society'. The themes reflect the stress and anxiety of caregiving, the centrality of feeding, specific needs for support, resilience and coping, multifaceted strain, hope and positivity, and failures of healthcare and society in supporting caregivers. Conclusions: The results of this study give voice to caregivers of children with cerebral palsy who have feeding and/or swallowing difficulties, in South Africa. The caregivers highlighted challenges they face in terms of the burden of caregiving and the impact on their quality of life. These caregivers also described the support that was helpful and support that is needed. This knowledge contributes to a broader knowledge base and informs the development of contextually relevant support services for caregivers of children with cerebral palsy who have feeding and/or swallowing difficulties in the Western Cape – and similar contexts – to improve the caregiving experience and quality of life outcomes for caregivers and their children.
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    Configurations of self-identity formations of adults who stutter
    (2010) Kathard, Harsha; Norman, Vivienne; Pillay, Mershen
    The aims of this paper are twofold: Firstly, to describe the configuration of self-identity formations evident across and within research stories of adults living with stuttering; and secondly, to discuss the clinical implications of these findings. The study on which this paper is based used life history narratives to describe the types, processes and configurations of self-identity formations of adults who stuttered since childhood. Through open-ended, in-depth interviews 7 participants shared their experiences of living with stuttering. The interviews were analysed at a first level using narrative analysis and at a second level to further describe the types, processes and configurations of self-identity formations evident in the stories. The findings on configurations of self-identity formations were that the two types of self-identity formations Able and DisOther were present in singular and dual configurations. The dual self-identity formations occurred in co-existing, competing and coalescing relationships within particular time periods in their stories. The clinical implications of the findings are discussed.
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    Contextually relevant resources in speech-language therapy and audiology in South Africa-are there any?
    (AOSIS, 2011) Pascoe, Michelle; Norman, Vivienne
    In this editorial introduction we aim to explore the notion of contextually-relevant resources. We argue that it is the responsibility of Speech Language Therapists (SLTs) and Audiologists (As) working in South Africa to develop contextually relevant resources, and not to rely on the countries or cultures where the professions originated to do so. Language is often cited as the main barrier to contextually relevant resources: most SLTs and As are aware of the need for more resources in the indigenous local languages. However, the issue is not as straightforward as translating resources from English into other languages. The challenges related to culture, e.g. formal education, familiarity with the test situation, have to be considered; as well as the population on which norms were obtained; the nature of vocabulary or picture items. This paper introduces four original research papers that follow in this edition of the journal, and showcases them as examples of innovative development in our field. At the same time we call for the further development of assessment materials, intervention resources, and contributions to the evidence base in our context. We emphasise the importance of local knowledge to drive the development of these resources in innovative and perhaps unexpected ways, and suggest that all clinicians have an important role to play in this process.
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    Dysphagia in children (0-12 years) recovering from tuberculosis meningitis (TBM)
    (2015) Makanza, Wadzanai Michel; Norman, Vivienne; Singh, Shajila
    Background information: Tuberculous meningitis (TBM) is the most severe extra-pulmonary complication of tuberculosis (TB) and also the most common bacterial meningitis in the Western Cape. The consequences of childhood TBM include poor motor and neurological outcomes which could lead to dysphagia. Aims: The aim of the study was to describe dysphagia in children (0-12 years) recovering from TBM at Red Cross War Memorial Children's Hospital (RCWMCH) in the Western Cape, South Africa. The purpose of the study was to determine the occurrence and describe the nature of dysphagia as well as to investigate whether any associations existed between dysphagia and the severity of TBM, neurological sequelae, age, and radiological findings.
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    Effectiveness of the classroom communication resource in changing primary school learners' attitudes towards children who stutter after one month: A feasibility study
    (2015) Walters, Freda Aletta; Kathard, Harsha; Norman, Vivienne
    Children who stutter are bullied and teased by their peers, especially in the primary schooling years. The Classroom Communication resource (CCR) was developed as a teacher-administered classroom-based education programme aiming to improve peers' attitudes towards CWS. The focus of this feasibility study was to determine the initial treatment effect of the CCR to improve peers' attitudes towards CWS and the feasibility for a larger scale cluster randomised trial (CRT) in future. Peer attitudes were determined via a Likert scale questionnaire, the Stuttering Resource Outcomes Measure (SROM), completed by primary school learners. Aim one was to establish if the SROM was a valid and reliable outcomes measure. Aim two utilized a quantitative, CRT design with a control group to describe the direction and magnitude of changes in 196 Grade 7 peers' attitudes towards CWS following the administration of the CCR. It also determined whether the changes were linked to gender or having exposure to a person who stutters. The evidence confirmed that the SROM was a valid and reliable outcomes measure. Attitude changes after the administration of the CCR were analysed through inferential statistics. A significant positive change in SROM scores was found in the experimental group (p=0.005) when compared to the control group (p=0.41). Females had a greater magnitude of change in SROM scores after the administration of the CCR compared to males. Participants with prior exposure to a person who stutters held more positive attitudes towards CWS at pre-test. The magnitude of positive change in SROM was greater in participants who did not have prior exposure to a person who stutters (p=0.007). The study indicated initial positive treatment effect of the CCR and implications for the feasibility of a larger CRT is discussed.
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    Health practitioners' practices, perceptions, and experiences regarding gastronomy placement in a paediatic setting
    (2018) Coetzee, Samantha Fae-Lee; Singh, Shajila; Norman, Vivienne
    Background Since its introduction in the 1980s, reports show an increase in the placement of gastrostomies in children, particularly in those with disabilities, due to its many benefits. To date, little has been reported on the practices, perceptions and experiences of the health care practitioners when engaging in the management of children with gastrostomies. Research aims This study aims to provide insight into the practices as well as the perceptions and experiences of the health care practitioners working with gastrostomies in a paediatric setting. Method A qualitative interpretative design was used. Eighteen healthcare practitioners, who form part of the multidisciplinary team working with paediatric gastrostomies, from one of the two prominent tertiary institutions in Cape Town, South Africa were recruited for this study. Semi structured interviews were conducted after which data analysis took place. Results Four themes emerged from the data collected; experience of better patient health evolving post gastrostomy despite complications, health care practitioners’ perceived change to a family’s quality of life, the gastrostomy process: just as you think it’s going right then something goes wrong; and experiencing multidisciplinary team work, and its influences on the management of patients with gastrostomies. Conclusion The health care practitioners reflected on their practices, perceptions and experiences of gastrostomy management as being a process. During the different stages of the process, they engaged with the advantages and disadvantages the gastrostomy has on the health of a child; the positive and negative influences on the quality of life for families and identified the importance of but also the lacking in the provision of education and ongoing support for caregivers. An effective multidisciplinary team is a requirement for the management of the gastrostomy; inadequacies within the team contributed to undesirable service delivery and poor health outcomes for the child. This study highlights the importance of and the need for the implementation of best practice guidelines for gastrostomy decision-making, placement and management in the paediatric setting.
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    Interventions used by health care professionals to transition preterm infants and neonates from enteral feeds to full-oral feeds: A Scoping review
    (2021) Rabbipal, Yajna; Norman, Vivienne; Pascoe, Michelle
    Background: Preterm infants and neonates may present with dysphagia due to immaturity or the presence of medical conditions. Enteral feeds are used to ensure optimal nutrition is achieved while the neonates are developing appropriate oral feeding skills. Varied interventions may be used to transition neonates to full oral feeds as oral feeding is often a prerequisite for discharge from hospital. Aims: The main aim of this study was to summarize, interpret and analyse the literature on the different interventions used for the transition to full oral feeds in preterm infants and neonates to identify research gaps and to inform clinical practice on the best intervention options. A secondary aim was to validate the findings of the scoping review for the South African context. Methods: A scoping review was conducted. Relevant studies were identified by searching six databases, Google and Google scholar. Inclusion criteria included studies written in English, peer reviewed and published between 1998–2018, that described the interventions used to transition preterm infants and neonates to full oral feeds. Data were extracted from the articles using a data charting form and analysed descriptively and thematically. The findings were shared with health care professionals who work with premature infants and neonates who then participated in a semi-structured interview to provide feedback relevant to the South African context. Results: Forty-seven articles were included. Six broad intervention categories were identified: oral-motor, oral-sensory, other senses, timing, cue-based and utensils. Non-nutritive sucking (NNS) interventions were reported most frequently across single and combined interventions. Outcome measures reported included: time taken to full oral feeds, earlier hospital discharge, long-term feeding outcomes, weight and sucking proficiency. Improved outcomes were associated with NNS and NNS with oral stimulation. Nine health care professionals were interviewed. They confirmed using a number of the interventions, with NNS reported the most. Health care professionals also provided insight into the challenges of implementing some interventions due to limited resources and staffing in the South African context. Conclusions: There are a range of interventions reported in the literature and many of them are used in South Africa. Positive outcomes such as earlier transition to full oral feeds; earlier hospital discharge; improved weight gain and improved sucking proficiency have been reported with NNS and combined NNS and Oral Stimulation interventions, however further studies are needed.
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    The nature of feeding and swallowing difficulties in the paediatric cerebral palsy population who have had videofluoroscopic swallow studies
    (2014) Le Roux, Lezanne; Norman, Vivienne; Singh, Shajila
    Includes abstract. Includes bibliographical references.
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    A profile of a paediatric population with feeding and swallowing difficulties at a tertiary hospital in the Western Cape
    (2012) Oosthuizen, Nicolene; Norman, Vivienne; Singh, Shajila
    Feeding and/or swallowing difficulties (FSD) have been associated with some of the leading causes of infant and child mortality in South Africa. Preventable conditions such as lower respiratory tract infections (LRTI) and under-nutrition may be caused by FSD. FSD are frequently reported in paediatric populations and may occur with various medical co-morbidities. The nature of FSD is however under described and information specific to developing countries is scarce. Furthermore, limited information regarding the service delivery requirements of the paediatric population with FSD is available. To describe in a paediatric population: the nature and frequency of FSD, the nature of FSD in different medical conditions or participant characteristics, and the nature of the services and interventions received by infants and children with FSD. A descriptive, retrospective survey design was used to examine the medical records of 446 infantsand children aged less than 13 years who accessed services for FSD at a paediatric tertiary hospital from January 2007 to December 2009. Seventy percent of participants were under the age of 2 years at the time of first assessment. The nature of participants’ FSD, the medical conditions present, and services/interventions received were recorded. The data were described and associations were analysed statistically. Infants and children with FSD often presented with various medical co-morbidities affecting multiple organ systems with neurologic and gastro-intestinal tract conditions occurring most frequently. A third (34%) of the participants had confirmed aspiration on instrumental assessment. Participants with confirmed aspiration presented with statistically significantly more aspiration pneumonia (x2 = 26.4314, p <; .001) and unspecified LRTI (x2 = 21.2757, p <; .001) than those without aspiration. Participants required a range of services for FSD from Speech-Language Therapists (SLT) as well as medical intervention, and surgical procedures. Most participants (91%) received intervention for FSD for an average of 6 months with a mean of 6 SLT consultations. Forty-three percent of participants completed intervention while 20% continued to receive intervention. The present study profiled paediatric FSD in the Western Cape, South Africa. Infants and children with FSD presented with varied and multiple underlying medical conditions. The safety of swallowing was often (34%) compromised in this population which may have affected respiratory health negatively. Infants and children with FSD frequently presented with LRTI and growth faltering/under-nutrition, two of the leading causes of death in children under the age of 5 years. There is a need for dysphagia services at primary and district levels of health care in the Western Cape to detect and prevent paediatric FSD. While the management of FSD requires the collaboration of many health care professionals, the inclusion of SLTs and dieticians into primary and district level teams may assist with the identification of FSD for early intervention and may prevent FSD-related LRTI and undernutrition in infants and children with FSD
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    The feeding and swallowing impact survey (FS-IS): cross-cultural adaptation for the South African context
    (2021) Bestenbier, Candice; Norman, Vivienne; Pascoe, Michelle
    Background: Feeding and swallowing difficulties (FSD) are found in typically developing children and children with complex medical and developmental conditions. These difficulties may have negative health consequences which can be stressful for caregivers as they are required to provide care for their children in the home environment. The Feeding and Swallowing Impact Survey (FS-IS) is a subjective rating scale used to determine the health-related quality of life (HRQoL) of caregivers of children diagnosed with FSD. However, this scale is not yet available in any of the official South African languages (except for English), and has not yet been culturally or linguistically adapted for the South African context. Research aims: The study aimed to cross culturally adapt and validate the FS-IS for the South African context by 1) describing the content validity of the FS-IS in a South African context; 2) describing the cultural and linguistic appropriateness of the English, isiXhosa and Afrikaans versions of the FS-IS; and 3) describing the experiences caregivers of children have in caring for their child with FSD using the FS-IS, in a pilot study. Methodology: A descriptive exploratory design was used to cross-culturally adapt and pilot the FS-IS, which consists of 3 subsections related to daily activities, worrying and problems with feeding. Five expert speech-language therapist (SLT) participants were identified to review the FS-IS for content validity. The FS-IS was then translated into Afrikaans and isiXhosa using the forward and back translation process. Caregivers (n=15) were identified at feeding clinics to determine the cultural and linguistic appropriateness of the FS-IS in English (n=5), Afrikaans (n=5) and isiXhosa (n=5). Their recommendations were taken into consideration and changes made. The pilot study included caregivers of children with FSD attending feeding clinics at two institutions (n=32) who completed the FS-IS. The participants in the pilot study included parents as primary caregivers (n=28; 88%), grandparents (n=2; 6%), as well as foster parents (n=2; 6%). Thirty-one participants were female with 14 English speaking, 9 isiXhosa and 9 Afrikaans speaking. The caregivers were the primary caregivers of children with a variety of FSD including non-oral feeds, oral feeds with specific modifications and picky or selective eaters. Results: The FS-IS was found to have content validity as experts and caregiver participants judged it to be contextually relevant for the South African context. Caregivers considered the items on the FSIS important, clear and appropriate for speakers of their native language as well as for fellow South African families, with minor changes suggested for the isiXhosa translated version. The tool has high internal consistency (Cronbach's alpha = 0.827) as well as excellent intra and inter-rater reliability (100% agreement). Daily activities that caregiver participants found most difficult included getting help from others (50%, n=16) and leaving their child in the care of others as they are scared to have others feed or take care of their child (62.5%, n=19). The majority of caregiver participants reported concerns related to their child's general health (84%, n=27) and whether they were doing enough to help with their child's FSD (50%, n=16). Few caregivers reported difficulties with feeding, with 87.5% (n=28) reporting no difficulties as a result of the time taken to prepare meals and 72% (n=23) reported no difficulty due to professionals or family having differing opinions about how to feed their child with FSD. Conclusion: The results confirm that the FS-IS is a reliable and valid tool for the identification of caregivers with reduced HRQoL related to caring for their child with FSD in a South African context. The adapted and translated FS-IS can therefore be used to identify caregivers who may need additional support or referral for further management from the multidisciplinary team. The results highlighted the complexity of caring for a child with FSD and the effects of the burden of care on caregivers. Early identification of the HRQoL of caregivers will not only benefit the caregivers but also the child they are caring for as the HRQoL of caregivers impacts on the QoL of the child with FSD.
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    The validation of a screening tool for the identification of feeding and swallowing difficulties in the paediatric population aged 0-2 years admitted to general medical wards
    (2019) Sibanda, Cynthia; Norman, Vivienne; Morrow, Brenda
    Background: Feeding and swallowing difficulties (FSD) have been found in typically developing children as well as in children with complex medical conditions and developmental disabilities. These difficulties cause negative health consequences such as aspiration pneumonia, chronic lung disease, failure to thrive, prolonged hospital stay and even death. The early identification and management of feeding and swallowing difficulties is important as it prevents the negative effects on health and quality of life. Hence, there is a need for a validated screening tool to use in the general hospitalized paediatric population. Research Aims: The aim of this study was to validate the Feeding and Swallowing Questionnaire as a screening tool, in the paediatric population aged 0 – 2 years admitted to general medical wards. The secondary aim was to describe the FSD presenting in the paediatric population aged 0 - 2 years who are hospitalized in the general medical wards. Methodology: A prospective, descriptive, clinimetric design was utilized. A sample of 107 participants admitted to the general medical wards at Steve Biko Academic Hospital were included in the study. Participants’ feeding and swallowing was screened by a research assistant using the Feeding and Swallowing Questionnaire. After the screening, a clinical feeding and swallowing assessment was conducted for comparison, the assessment was conducted by the student researcher using the Clinical Feeding and Swallowing Assessment Tool. Results: There was a 27% FSD prevalence, with the majority of cases (92%) occurring in children under one year of age. One hundred and three children (63% male; median (IQR) age 5.2 (2.1 – 12.8) months) underwent screening and clinical assessment for feeding and swallowing disorders. The criterion validity of the Feeding and swallowing Questionnaire was established with a sensitivity of 88% and a specificity of 32%. Internal consistency was achieved with an acceptable Cronbach’s alpha of 0.79, and good inter-rater reliability (80%). Participants presented with feeding difficulties in all the phases of swallowing, while some participants had behavioural feeding difficulties. Those who had FSD had the following medical conditions: cardiorespiratory, neurological and gastrointestinal disorders namely acute gastroenteritis and liver disease. Feeding and swallowing difficulties were associated with increased mealtime duration (p=0.005) and supplementary oxygen support (p=0.03). Conclusion: The results confirm that the Feeding and Swallowing Questionnaire shows promising findings as a reliable and valid tool for the identification of FSD in the general hospitalized paediatric population. However, further research in other setting with general paediatric medical wards is required to increase the robustness of the screening tool.
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    The validation of a screening tool for the identification of dysphagia in the paediatric population with HIV/AIDS
    (2015) Vermeulen, Suzanne; Norman, Vivienne; Eley, Brian
    Background: The paediatric population with HIV is at higher risk for feeding and swallowing difficulties (FSD) than the general paediatric population, which may contribute to increased morbidity and mortality. Consequences of dysphagia may include insufficient nutritional intake leading to growth faltering, decreased quality of life, and risk of aspiration which may cause respiratory complications and permanent lung damage. Currently, no validated screening measures exist for the identification of FSD in infants and children with HIV/AIDS. Early identification and appropriate management of dysphagia is essential to prevent further complications and negative health outcomes. Research Aims: To determine the validity and reliability of a caregiver questionnaire as a FSD screening tool in infants and children with HIV/AIDS. As a sub-aim, the nature of FSD and the relationship between FSD and other factors, such as age, lower respiratory tract infection, undernutrition and HIV-related factors were also described. Method: A prospective, descriptive clinimetric research design was utilised. Three experts in the field of paediatric FSD were consulted to determine face and content validity of the tool. Key informant interviews were conducted with 15 caregivers of children with HIV, to determine the linguistic appropriates of the tool. Sixty-six participants with HIV/AIDS under the age of 13 years were recruited from the Infectious Diseases Clinic at Red Cross War Memorial Children's Hospital. The screening tool and a comprehensive feeding and swallowing evaluation were conducted with all participants. Additional medical information, such as HIV data, anthropometry information and history of respiratory illness were recorded. Results: The screening tool - the Feeding and Swallowing Questionnaire - was found to have face and content validity. Criterion validity was established with sensitivity of 92% and specificity of 59%. The tool has high internal consistency (Cronbach's alpha = 0.78) and excellent inter-rater reliability (100% agreement). Twenty-five (38%; N=66) participants presented with FSD. Difficulties were noted in all phases of swallowing, as well as behavioural feeding difficulties and delays in reaching age-appropriate feeding and swallowing milestones. FSD were significantly inversely associated with age (p =.008) and length of time on antiretroviral therapy (p =.014) i.e. younger children and children on ART for a short period of time were most likely to have FSD. Conclusions: The results confirm that the Feeding and Swallowing Questionnaire is a reliable and valid tool for the identification of FSD in infants and children with HIV. This tool identifies children likely to have FSD, thereby indicating referral for comprehensive assessment of feeding and swallowing, as well as the necessary management of any FSD. The results highlight the multifaceted nature of FSD in this population. Early identification of FSD may not only benefit the child, but may decrease the associated social and economic burden of frequent hospitalisation related to FSD.