Date of Award


Document Type



Edith Cowan University

Degree Name

Bachelor of Speech Pathology Honours


School of Psychology and Social Science


Faculty of Health, Engineering and Science

First Supervisor

Dr Charn Nang

Second Supervisor

Ms Abigail Lewis


Background and purpose: Dysphagia can be described as difficulty within the oral, pharyngeal and/or oesophageal phases of deglutition and occurs in approximately 80% of children with developmental disabilities, according to the American Speech and Hearing Association (2015). It occurs when there is impairment to the motor and/or sensory aspects of swallowing, due to a range of disorders affecting the voluntary and reflexive components of deglutition. The ability to swallow safely is essential in preventing medical complications, sustaining life and maintaining social participation. Paediatric interventions can be categorized into three broad approaches; direct, indirect and mixed. At present, two systematic reviews have examined the efficacy of direct interventions. Despite a large body of evidence supporting the efficacy and safety of indirect paediatric dysphagia interventions, no studies have systematically grouped and compared the relative effectiveness of indirect interventions, across all paediatric ages and conditions.

Methods and procedure: Following a comprehensive search of 19 databases by two independent searches and using an identical search strategy, a systematic review appraised 13 randomized and non-randomized control studies relating to indirect paediatric dysphagia interventions. Based on retrieved results, indirect interventions included modified equipment, environmental changes and altered rate of food and liquid presentation. Articles included in the analysis were rated for quality on two separate appraisal scales; The Cochrane Risk of Bias Tool and the Pedro Scale. Additionally, effect size calculations and forest plots were derived to standardize and compare the effects of individual intervention types.

Outcomes and results: The review demonstrated that whilst a lack of high quality evidence exists in the field of paediatric dysphagia, the available RCTs are of high methodological quality. Overall, effect size calculations demonstrate a positive trend towards improved feeding, anthropometric measures and length of hospital stay outcomes for interventions involving modified equipment, environmental changes and altered rate of presentation.

Conclusions: The available RCT evidence involving indirect interventions are of high methodological quality. As effects of these interventions demonstrate positive outcomes, Speech Pathologists should continue to implement these interventions within everyday practice. To further validate the effects of indirect management approaches, additional high quality research is required.