Assessment

Question 1

assessments

Answer 1

• General observation (4 week old)
• OME
• Oral trial
• Solids/textures offered (8 Months+)

Question 2

General observation

Answer 2

alertness, colour, tone,

Question 3

OME

Answer 3

o Reflexes (rooting)
o Appearance, range of motion, sensation
o Nutritive vs non-nutritive sucking
o mouth feel

Question 4

Appearance OME

Answer 4

Lips jaw, oral cavity, tongue, palate, soft palate

Question 5

how do you assess Nutritive vs non-nutritive sucking

Answer 5

place the pad of your gloved finger facing downonto the baby’s tongue
- Best assessed before a feed
- see if they have a rooting reflex and will latch on to your finger themselves (If appropriate)
Feel/observe the type of sucking motion
• A ‘munching’ motion indicates a non-nutritive suck
• A ‘stripping’ or wave-like motion indicates an attempt to nutritive suck

Question 6

what do you feel for in an OME?

Answer 6

• Strength of suck
• Resistance to your finger being moved
• Jaw strength
• Tongue movements

Question 7

what is an oral trial?

Answer 7

o Observation of breast and bottle feed

o Observation of Oral movements; lips, tongue, jaw

Question 8

what do you take note of in an oral trial?

Answer 8

 Positioning, equipment used (teat/bottle), fluid consistency (formula/EBM), rate of feeding, amount taken
 Swallow skills, pre, during, post, including signs of aspiration
 State, calm, alert, drowsy, over aroused, distressed, asleep
 Behaviour (of child & carer)
 Reason for feed finishing

Question 9

what do you assess in Solids/textures offered

Answer 9

o	Anticipation/mouth opening
o	Lip movement
o	Biting
o	Chewing pattern
o	Swallowing: timing, multiple swallows, nasal regurgitation, gagging, coughing, residue
o	amount eaten
o	Reason for finishing

Question 10

what are the signs of aspiration

Answer 10

• Recurrent ‘bacterial’ chest infection, particularly upper right lung lobe
• Choking and coughing before, during and/or after swallowing
• Wet or gurgly sounding voice quality during and after oral intake
• Breath changes; increased WOB, effortful or ‘wet’ sounding breathing
• Facial colour changes (blue, purple or red)
• Signs of distress (particularly if weak or absent cough reflex); nasal flaring, eyes widening, watery eyes, arching back

Question 11

what does a munching sucking motion indicate

Answer 11

a non-nutritive suck

Question 12

what does a stripping sucking motion indicate

Answer 12

an attempt to nutritive suck

Question 13

What instrumental assessment can you use with infants

Answer 13

Cervical Auscultation
• CA is to be used as part of a full clinical assessment, it is not standard alone
• Need to know the big picture
• Particularly useful for infants who are breast or bottle feeding
• Not typically used when assessing solids

Question 14

What instrumental assessment can you use with toddlers

Answer 14

Videofluroscopic Swallow Study 
Considerations: 
•	Volume accepted 
•	Positioning 
•	Usual cutlery, bowls, cup, bottle