[Dysphagia] question

[neversayuncle at sbcglobal.net (Amy Jamison)]

Hey guys,
  It's the newbie lurker here and I have a question. 
  I am wanting suggestions of what I could do with a new client to our clinic. This is only my fourth week of practice, and I have already encountered things with peds that I was never exposed to in our program. I'm a little overwhelmed, but am eager to learn.
  This client is 2 years 9months. She lived her first two years in The Arkansas Children's Hospital. She is pegged, trached, on vent at night (just got off the vent during the daytime). Socioeconomic issues and parent education presents a problem, but father appears eager to learn. 
  Cognition is low, though to difficult to ascertain, of course. Physically she is very frail...maybe weighs 10 pounds. Against medical advice, parents are feeding the child orally. 
  Trach care is yuck, vision poor but she does at least see forms to identify favorite toys. She can grasp items fairly well. She can wave hi and bye. She cries with displeasure when not allowed to have what she wants. The extent of her play skills are just shaking rattles or putting things in her mouth. 
  I want to maximize my time with this child. WHere do I begin? Or prioritize?
  Trach care? 
  Oral Motor or Sensory?
  Augmentative? (had our first PECS session today and she did well)
  We NEVER learned how to clean trachs at the U of A.... decide to when to get Passy Muir, etc. Please give me all the advice you can. I have called various therapists, but am wanting all the advice I can get. 
  Thanks so much, 
  Amy


"There are years that ask questions and years
   that answer."  - Zora Neale Hurston