Mealtime interventions for carers of school-aged children who have oropharyngeal dysphagia: A systematic review

Oropharyngeal dysphagia (eating, drinking, and swallowing difficulties) in children with neurodisability impacts their whole life. Speech-language pathologists optimise safe, efficient, and enjoyable mealtimes by providing interventions that require carers to adapt their mealtime assistance behaviours. This systematic review identifies and evaluates peer-reviewed mealtime interventions evidence, including content, child, and carer outcomes targeted and effectiveness. Eleven database and manual searches were completed (January 2024). Eligible studies reported on school-aged children with neurodisability and oropharyngeal dysphagia carer mealtime interventions in any setting against any comparator. Data extraction and quality assessment were completed leading to narrative synthesis. From 9627 reports, 29 studies (34 reports) were included in this review. Studies had variable designs, only one randomised controlled trial. There were 941 child and 457 carer participants, variably described. Multiple mealtime interventions by varied healthcare professionals targeted different carer behaviours. Twenty-four studies met quality criteria for synthesis with data too heterogeneous for meta-analysis. Studies demonstrated positive outcomes for child and carer mealtime safety, efficiency, and enjoyment using multiple measures. Mealtime interventions appear better than none. Study evidence is low quality and heterogeneous, with no optimum approach evident. Good quality studies using consistent participant descriptions and core outcome set are required.