6.1 Infant Dysphagia Flashcards
What is a Feeding Disorder?
2
Persistent failure to eat adequately for a period of at least one month
Results in significant loss of weight or failure to gain weight
When do Feeding Disorders tend to manifest?
Prior to six years
Onset is usually in first year of life
What are symptoms of a Feeding Disorder?
5
Unsafe or inefficient swallowing
Growth delay
Lack of tolerance to different textures and tastes
Poor appetite regulation
Rigid eating patterns
What is a Swallowing Disorder?
Specific type of feeding disorder in which child exhibits unsafe or inefficient swallowing pattern that undermines feeding process
What is Swallowing?
The act of moving a substance (bolus) from the oral cavity to the esophagus
What are those with Swallowing Disorders at risk for?
2
Penetration
Aspiration
What may put a child at risk for a Swallowing Disorder?
5
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
What do children with Cerebral Palsy exhibit problems with during their first year of life?
(4)
Sucking
Swallowing
Malnutrition
Failure to Thrive (FTT)
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
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
What do INFANTS need for a positive feeding time?
5
Positive
Alert
Calm
Show readable cues for hunger + fullness
Willingness to try to tastes and textures
What do TODDLERS need for a positive feeding time?
4
Interest in eating
Ability to indicate hunger and fullness
Predictable meal schedule
Positive behaviors
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)
What can happen if a child eats too slow?
Nutritional deficiencies
What can happen if a child eats too fast?
2
Choking
Aspiration
What are the 4 types of Feeding and Swallowing Disorders?
Inefficiency
Over selectivity
Refusal
Feeding Delay
What is Inefficiency?
2
Inability to meet caloric and nutritional needs
Due to unproductive feeding and swallowing
What is Overselectivity?
1+4
Restrictions in food…
- Taste
- Type
- Texture
- Volume
What is Refusal?
2+3
Complete refusal to feed
Due to ongoing…
- Medical issues
- Gastro-intestinal distress
- Traumatic experiences
What is Feeding Delay?
Delayed development of feeding skill milestones
What is Enteral or Tube Feeding?
Liquid nutrition is delivered through a tube
can be sole avenue for nutrition or supplemental to oral intake
What type of Tube Feeding is used for short-term treatment?
Nasogastric tube
What type of Tube Feeding is used for longer-term treatment?
2 names
Gastronomy tube
Jejunostomy tube
Special support also is given to caregiver-child feeding ______ and to promoting _______ even when not used for feeding
Relationship
Oral abilities
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
