Complete refusal to feed Due to ongoing... - Medical issues - Gastro-intestinal distress - Traumatic experiences

6.1 Infant Dysphagia Flashcards by Jamie Bevill

What is a Feeding Disorder?

Persistent failure to eat adequately for a period of at least one month

Results in significant loss of weight or failure to gain weight

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When do Feeding Disorders tend to manifest?

Prior to six years

Onset is usually in first year of life

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What are symptoms of a Feeding Disorder?

Unsafe or inefficient swallowing

Growth delay

Lack of tolerance to different textures and tastes

Poor appetite regulation

Rigid eating patterns

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What is a Swallowing Disorder?

Specific type of feeding disorder in which child exhibits unsafe or inefficient swallowing pattern that undermines feeding process

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What is Swallowing?

The act of moving a substance (bolus) from the oral cavity to the esophagus

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What are those with Swallowing Disorders at risk for?

Penetration

Aspiration

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What may put a child at risk for a Swallowing Disorder?

Several syndromes that feature low muscle tone, delayed motor development, and physical deformities

Cerebral Palsy

Significant anomalies of oral structures

Chronic or recurrent respiratory problems

Cardiopulmonary diseases

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What do children with Cerebral Palsy exhibit problems with during their first year of life?

(4)

Sucking

Swallowing

Malnutrition

Failure to Thrive (FTT)

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What 8 conditions can lead to feeding/swallowing disorders?

Low birth weight

Developmental disabilities (Down syndrome, autism, and cerebral palsy)

Prematurity (Born at or before 37 weeks)

Prenatal drug exposure (Alcohol, tobacco, cocaine, heroin, etc.)

Diet restrictions (due to diabetes, PKU, etc. - may result in feeding challenges and resistance to eating)

Lip or tongue tie

Cleft lip/palate

Cardiac problems

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What are some negative parent behaviors that may contribute to feeding/swallowing disorders?

(5)

Over-stimulating

Under-stimulating

Rigid + demanding

Chaotic + frenzied

Overly concerned + anxious

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What do INFANTS need for a positive feeding time?

Positive

Alert

Calm

Show readable cues for hunger + fullness

Willingness to try to tastes and textures

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What do TODDLERS need for a positive feeding time?

Interest in eating

Ability to indicate hunger and fullness

Predictable meal schedule

Positive behaviors

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What are undesirable or disruptive behaviors children might exhibit during mealtimes that inhibits successful feeding?

(6)

Screaming

Spitting

Throwing

Hitting

Drop food on the floor

Eating at inappropriate rates (too slow or too fast)

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What can happen if a child eats too slow?

Nutritional deficiencies

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What can happen if a child eats too fast?

Choking

Aspiration

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What are the 4 types of Feeding and Swallowing Disorders?

Inefficiency

Over selectivity

Refusal

Feeding Delay

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What is Inefficiency?

Inability to meet caloric and nutritional needs

Due to unproductive feeding and swallowing

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What is Overselectivity?

1+4

Restrictions in food…

Taste
Type
Texture
Volume

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What is Refusal?

2+3

Complete refusal to feed

Due to ongoing…

Medical issues
Gastro-intestinal distress
Traumatic experiences

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What is Feeding Delay?

Delayed development of feeding skill milestones

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What is Enteral or Tube Feeding?

Liquid nutrition is delivered through a tube

can be sole avenue for nutrition or supplemental to oral intake

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What type of Tube Feeding is used for short-term treatment?

Nasogastric tube

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What type of Tube Feeding is used for longer-term treatment?

2 names

Gastronomy tube

Jejunostomy tube

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Special support also is given to caregiver-child feeding ______ and to promoting _______ even when not used for feeding

Relationship

Oral abilities

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What is In-Utero Swallowing important for? | 2

Regulation of amniotic fluid volume Maturation of the fetal digestive tract

When has Pharyngeal Swallowing developed in most fetuses? When are they constantly swallowing?

By 15 weeks gestation By 22 to 24 weeks

When do oral motor movements and suckling typically begin?

Around 10-14 weeks

When does True Suckling begin? What is it characterized by?

Around the 18th to 24th week Distinct backwards/forwards movements of the tongue

What can alter the Frequency of suckling motions?

Taste

What is the only movement pattern that can be utilized by neonates? Why?

Suckling The tongue completely fills the oral cavity and does not extend beyond the labial border

When are some HEALTHY preterm infants able to suckle and swallow well enough to sustain full oral feedings?

BY 34 weeks gestation

What are decreased rates of fetal sucking often associated with? (2)

Digestive tract obstruction Neurologic damage

Why are In-Utero Swallowing Milestones important?

The foundation for feeding can be impacted if there is any disruption in utero or if the infant is born preterm

What is the normal pattern of sucking for infants? What is this also referred to as?

Suck-swallow-Breath 1:1 Ratio

What is a 2:1 swallowing ratio in infants?

Suck-Suck-Swallow-Breath

Oral feeding (suckling, swallowing, and breathing) coordination is the most complex __________ the newborn infant undertakes.

Sensorimotor process

What does Oral Feeding require?

Sequential timing of the tongue, larynx, and laryngeal muscles

How many muscles are used in coordinating a safe and efficient pharyngeal swallow? How many nerves?

26 6

When does the development of independent, social feeding experiences begin? How long does it extend?

At birth Progresses throughout the first few years of childhood

What do successful feeding experiences in infancy foster? | 4

Efficient nipple control Reaching Smiling Social play

Feeding gradually becomes a ___________.

Social event

What depends on successful feeding and swallowing?

Successful emergence of communication

Normal feeding patterns reflect early _________ that are the basis for later communication skills.

Developmental pathways

What are the five steps in the Synactive Model of Behavioral Organization?

Physiological Stability (maintaining breathing, etc.) Motor Organization (symmetrical mouth movement, etc.) Behavioral State Organization (calm, can handle being moved etc.) Attention/Interaction (alert, etc.) Self-Regulation (can self-calm, etc.)

Who treat infants in the Neonatal Intensive Care Unit (NICU)? (4)

Special Care Nursery Labor and Delivery Pediatric Floor Pediatric Intensive Care Unit

What is Infant Driven Feeding driven by? (7)

Feeding quality vs quantity Behaviors and infant stability Neurodevelopment Clarification of feeding abilities and progress Giving more autonomy to caregiver Optimizing critical decision-making Objective + detailed documentation

What is performed in an Infant Feeding Evaluation (for infants birth to 1 yo)? Who does it involve?

Clinical evaluation of the infant swallowing (bottle or breastfeeding) Involves SLP and OT

What does an Infant Feeding Evaluation (for infants birth to 1 yo) typically include? (2)

Non-nutritive and nutritive assessment Sometimes only non-nutritive in medically complex premies or infants

What three things are required for an infant to be ready for feeding? (3)

Alert or fussy prior to care or once handled Rooting and/or hands to mouth behavior (some to lots) Good to adequate tone

When do we begin infant feeding if infant is going to be breastfed? (3)

Delay first feeding to mother Defer bottle treatment for a predetermined amount of time May supplement by bottle

When do we begin infant feeding if infant is going to be bottle-fed? What is the protocol? (5)

Schedule a time when parents can participate // Swaddle infant (hands close to face, knees and hips tucked) Place head in neutral Offer tastes (drops on lips/tongue) Look for engagement from infant Don't feed for more than 20 minutes (so infant can rest)

What is performed in an Infant Feeding Evaluation? | 3

Oral mechanism examination Clinical signs and symptoms of oral difficulty Clinical signs and symptoms of pharyngeal difficulty

What are clinical signs and symptoms of Oral Difficulty in infants? (5)

Inefficient extraction Disorganized suck swallow breathe pattern Anterior spillage Decreased ability to latch on to the nipple Disorganized tongue/jaw function

What are clinical signs and symptoms of Pharyngeal Difficulty in infants? (5)

Coughing/throat clearing Spitting, gagging, emesis (vomiting) Physiological changes such as drop in O2 saturations, increase in heart or respiratory rate Changes in upper airway sounds via cervical auscultation Weak, hoarse or wet sounding cry

What are we looking for when we gauge the quality of infant feeding? (3)

Use of nipple Strong, coordinating suck-swallow-breath throughout feed No fatigue

What interventions can we use for infants who are struggling with feeding? (6)

Modified side-lying External Pacing Specialty Nipple Cheek Support Frequent Burping Chin Support

What is Modified Side-Lying? What does it do?

Infant is positioned in inclined side-lying position with head in midline Assists with bolus management.

What is External Pacing? What does it do?

Tip bottle downward/break seal at breast to remove or decrease the flow of liquid Facilitates SSB pattern.

What is a Specialty Nipple? | 2

Any nipple other than standard Designed for specific purpose (nipple shield, slow-flow, Special Needs Feeder, etc.)

What is Cheek Support? What does it do?

Providing gentle unilateral support Improves intra oral pressure.

What is Frequent Burping?

Burp infant based on behavioral cues not on time

What is Chin Support? What does it do?

Providing gentle forward pressure on mandible Helps to ensure effective latch/tongue stripping if small chin or wide jaw excursion.

What is Vital Stim? | 2

Neuromuscular Electrical Stimulation (NMES) Used to stimulate muscles to gain strength (Best to do with nutritional swallow if possible)

What do we continue to monitor for infants with feeding/swallowing difficulties? (2)

Weight gain Feeding quality

What are the three main goals of infant feeding treatment?

Reduce infant’s and caregiver's stress in order to promote feeding quality Help families to take an active role in helping their infant be successful Teach parents to read and respond to their infant’s cues