1.

Stethoscope
Although cervical auscultation (listening to swallowing sounds) is not an independent diagnostic tool it is a cheap, quick and non-invasive method of augmenting existing dysphagia assessments. Subtle difficulties with initiation of swallowing, effectiveness of swallow and coordination with respiration can - with practice - be identified. There are numerous courses now run (see the Royal College of Speech & Language Therapists Bulletin) but I would encourage therapists to practise listening to normal swallows as much as possible and then trial on abnormal swallows until your confidence increases. Litmann paediatric stethoscopes can be purchased for around 55-60. Austin, J. (Royal College of Speech & Language Therapists Bulletin, August 2000) has devised a useful checklist for speech and language therapists who are new to using auscultation. Zenner, P. (1995) The use of cervical auscultation in the clinical dysphagia examination in long term care. Dysphagia 10, 27-31.

MY TOP RESOURCES
6. Other professionals
I am very fortunate in that I have good access to physiotherapy, occupational therapy, dietetics and psychology but I appreciate most therapists are not as fortunate. Joint assessment with a physiotherapist is invaluable when working with children with neurological impairment as optimal position can be achieved prior to trial swallows. Occupational therapists have a wealth of experience on how best to seat a child and what utensils are appropriate if independent feeding is being encouraged. Working with a dietitian when weaning a child off enteral feeding means oral feeding is more likely to be achieved. And where would I be without a psychologist who provides the objective view of mealtime behaviors that, as a parent, it is easy to lose sight of?

Rebecca Howarth is a senior specialist speech and language therapist in Manchester She works both in a specialist acute Childrens Hospital as well as providing a community service to preschool children with feeding and swallowing difficulties as part of a multidisciplinary team Rebecca has specialised in paediatric dysphagia for the last six years

2. Feeding and Nutrition for the Child with Special Needs

This collection of handouts on feeding and nutrition includes topics such as cup drinking oral-motor strategies family mealtime interactions desensitisation. All handouts are photocopiable but can also be customised by adding specific advice in the special instructions section. The ring bound version of this book is more practical and more likely to withstand the rigours of photocopying. By Marsha Dunn Klein and Tracy A. Delaney, 98 from The Psychological Corporation, www.tpc-international.com.

7. Blue food dye

As I am often asked to assess swallowing in children with tracheostomies I will usually begin with a blue dye test. This is a quick, non-invasive bedside assessment which can detect aspiration. Although I am aware of the concerns of some therapists as to the reliability of this test I personally find it very useful as a starting point from which to plan further assessment (including videofluoroscopy if a negative result is obtained). Thompson-Henry, S. & Braddock, B. (1995) The modified Evans blue dye procedure fails to detect aspiration. Dysphagia 10 (3), 172-174. Leder, S.B. (1995) Comment on Thompson-Henry & Braddock. Dysphagia 11 (1), 80-81.

8. Feeding and swallowing disorders in infancy: Assessment and Management

Although this book can be heavy going at times it covers everything from anatomy/physiology to assessment and is also a framework for problem solving. It is probably not ideal as a starting point but is worth a read/dip into once you have developed some knowledge and experience. By Lynn S. Wolf and Robin P. Glass, 62 from The Psychological Corporation, www.tpc-international.com.

3. Doidy cup / Kapi cups

These specially designed cups enable fluids to be presented at a slower rate and reduce the amount of neck extension required. I order them in bulk and then sell on to families as this works out cheaper than the family buying them individually. Their only drawback is the narrow handles that are difficult for physically disabled children to use. Doidy cups are available from Bikkipegs at 3.50 each (01224 790626) Kapi cups from Kapitex Healthcare at 13.50 for a set of 5 (01937 580211).

9. Bottles and teats

Having a selection of these available for parents/nurses to try is always useful and it is amazing in some cases what impact a different teat or bottle can make. My personal favorites are NUK products as they have a good range of sizes as well as teats and dummies for premature babies and products for youngsters with cleft lip and palate. Available from selected branches of Boots or direct from MM distributors (01438-351341).

4. My own child!
There is no better way to learn about normal feeding development than by having your own personal research project in front of you day to day. Watching a baby progress from a bundle of reflexes into an independent and sophisticated feeder is truly fascinating. It also gives you an appreciation of some of the everyday issues that parents are often faced with. (NB: This may seem a drastic measure to take to learn about feeding development so, if this is not for you, the dysphagia courses at Manchester Metropolitan University are an acceptable alternative. Contact Manchester Metropolitan University on 0161-247-2535.)

10. The care of children with long term tracheostomies

This useful and easy to read book gives a sound introduction to both assessment and implications of tracheostomy, as well as the basics of ventilation, and should be foundation reading for therapists who are managing children with tracheostomies. There is a particularly useful glossary of terms (although you have to cope with the Americanisms) if you should come across any unfamiliar jargon. The contents of the book include feeding difficulties, behavioural issues, social support, and training. By K. Bleile (1994), ISBN 1565930940, Singular, 37.

5. Skips/Quavers/Wotsits
No paediatric dysphagia therapist is complete without a pocketful of crisps both as a bribery tool and also as an assessment tool for examining biting and chewing safely. (I also like these crisps myself so theres no chance of any waste.)