Ch. 5 Flashcards
Purposes of infant feeding:
- Satisfies _________
- Provides ________ for growth and development
- Provides ______-_______ and _____-____ stimulation
- Facilitates state ______ and maintain homeostasis
- Provides ______ and sense of well-being
- Enhances _______ and interactions with ______
- Serves as _______ for other functions, including speech
- Satisfies hunger
- Provides nourishment for growth and development
- Provides oral-sensory and oral-motor stimulation
- Facilitates state regulation and maintain homeostasis
- Provides calming and sense of well-being
- Enhances bonding and interactions with caregiver
- Serves as foundation for other functions, including speech
Oral anatomy of an infant is smaller and different than an adult:
- Oral cavity is _______ relative to _____ size.
- ______ pads (fat inside cheeks) are ______.
- There are no _______.
- Tongue rests _______ to alveolar ridge and contacts lower_______.
- Temporomandibular joint does not allow much ________ of jaw
- Oral anatomy is well suited for _______ (extension-retraction movements of the tongue).
Oral cavity is small relative to tongue size.
Buccal pads (fat inside cheeks) are large.
There are no teeth.
Tongue rests anterior to alveolar ridge and contacts lower lip.
Temporomandibular joint does not allow much movement of jaw
Oral anatomy is well suited for suckling (extension-retraction movements of the tongue).
Pharyngeal anatomy of an infant is smaller and different than that of an adult:
- Pharynx is ________.
- Tongue ______, soft palate, and ______ walls are in ______ approximation.
- Larynx is _________ the size of an adult’s and is ______ in the hypopharynx.
- High position of the infant larynx causes the _______ to pass superiorly to the free margin of the soft palate and project into the _______.
Pharynx is short.
Tongue base, soft palate, and pharyngeal walls are in close approximation.
Larynx is one-third the size of an adult’s and is high in the hypopharynx.
High position of the infant larynx causes the epiglottis to pass superiorly to the free margin of the soft palate and project into the nasopharynx.
Anatomy relevant to infant feeding:
Pharyngeal anatomy is well suited for the _____-_____-_____ synchrony.
______, ______, _____relationship are ideal for the suck-swallow-breathe synchrony.
Pharyngeal anatomy is well suited for the suck-swallow-breathe synchrony.
Head, chin, neck relationship are ideal for the suck-swallow-breathe synchrony.
Oral Phase:
________ ______ and generation of negative ______ occur for sucking
nipple compression and generation of negative pressure occur for sucking
Pharyngeal Phase:
_______, velum, and posterior pharyngeal provide driving force for _____ _______ to esophagus
tongue base, velum, and posterior pharyngeal provide driving force for bolus transfer to esophagus
Esophageal Phase:
_____ _______ ______ opens for bolus transfer to _______; ______ ______ _____ opens to allow bolus entrance into ______
upper esophageal sphincter opens for bolus transfer to esophagus; lower esophageal sphincter opens to allow bolus entrance into stomach
Coordination of _____, ______, ______ is crucial to prevent _______.
Suck-swallow-breathe ratio during is generally ______ or _______.
Decreased _______ during feeding may be a problem for some medically compromised infants.
Coordination of sucking, swallowing, and breathing is crucial to prevent aspiration (entry of material into the airway).
Suck-swallow-breathe ratio during is generally 1:1:1 or 2:1:1.
Decreased ventilation during feeding may be a problem for some medically compromised infants.
Significant _____, _____, _____ growth takes place in the first 2 to 3 years of life.
Oral cavity becomes ________ with mandibular growth.
Tongue tip moves _____ _______ alveolar ridge.
Teeth _______.
Pharynx ________.
Neuromuscular, particularly ________ function matures.
Growth and maturation lead to changes in ________ ___________pattern.
Significant oral, pharyngeal, and laryngeal growth takes place in the first 2 to 3 years of life.
Oral cavity becomes larger with mandibular growth.
Tongue tip moves back to under alveolar ridge.
Teeth erupt.
Pharynx elongates.
Neuromuscular, particularly oral-motor function matures.
Growth and maturation lead to changes in feeding and swallowing pattern.
Cleft Lip and Alveolus only:
- Infant may have initial problems achieving an adequate _____ ______ on the nipple.
- Inadequate lip seal may cause difficulty generating ______ _______ for sucking.
Infant may have initial problems achieving an adequate lip seal on the nipple.
Inadequate lip seal may cause difficulty generating negative pressure for sucking.
Cleft Palate Only:
- Depends on the extent of the cleft
- Infant may be unable to generate ______ _______ for suction.
- Infant may be unable to find a hard palatal surface for ______ of the nipple.
- Infant may experience ______ _________.
Depends on the extent of the cleft
Infant may be unable to generate negative pressure for suction.
Infant may be unable to find a hard palatal surface for compression of the nipple.
Infant may experience nasal regurgitation.
Cleft lip and palate:
-Infant may have all the difficulties noted above (lip and alveolus only, palate only), including these:
Difficulty achieving an adequate _____ ______ on the nipple
Inability to generate _____ _______ for suction
Inability to find _____ ______ for compression of the nipple
Nasal _______
Infant may have all the difficulties noted above, including these:
Difficulty achieving an adequate lip seal on the nipple
Inability to generate negative pressure for suction
Inability to find palatal surface for compression of the nipple
Nasal regurgitation
Postoperative recommendations vary among centers:
- Some _______ sucking following surgery and may may recommend the use of ______ or _______ instead.
- Some recommend supplemental _____ _______ for a short time.
- Some allow ______ feeding after surgery.
Postoperative recommendations vary among centers:
- Some discourage sucking following surgery and may may recommend the use of cup or spoon instead.
- Some recommend supplemental tube feeding for a short time.
- Some allow unrestricted feeding after surgery.
Anomalies that can contribute to a feeding or swallowing problem: \_\_\_\_\_\_\_\_\_ (small mandible) \_\_\_\_\_\_\_\_\_ (large tongue) \_\_\_\_\_\_\_\_\_ stenosis (narrowing) \_\_\_\_\_\_\_\_\_ anomalies \_\_\_\_\_\_\_\_\_ cleft \_\_\_\_\_\_\_\_\_\_\_\_\_ fistula \_\_\_\_\_\_\_\_ or cranial nerve involvement \_\_\_\_\_\_\_ (posterior displacement of the tongue in the pharynx) Midface \_\_\_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_\_\_\_ or lung disease \_\_\_\_\_\_\_ atresia
Anomalies that can contribute to a feeding or swallowing problem: Micrognathia (small mandible) Macroglossia (large tongue) Pharyngeal stenosis (narrowing) Vascular anomalies Laryngeal cleft Tracheoesophageal fistula Cortical or cranial nerve involvement Glossoptosis (posterior displacement of the tongue in the pharynx) Midface retrusion Congenital heart or lung disease Choanal atresia
Conditions that often affect feeding and swallowing include the following:
________ __________ sequence
____________ syndrome
____________ microsomia
Conditions that often affect feeding and swallowing include the following:
Pierre Robin sequence
Moebius syndrome
Hemifacial microsomia
Most infants with a cleft are able to feed with __________ ________________
Infant’s performance during the ______ feedings determines which _______ _______and technique will be best.
Most infants with a cleft are able to feed with simple modifications.
Infant’s performance during the initial feedings determines which feeding method and technique will be best.
Breastfeeding trials should be __________.
With cleft lip, breastfeeding is usually not a ___________.
With cleft palate, it is very challenging due to difficulties with __________ and _______
Options with cleft palate include:
__________ nursing
Modified ________/_________
______________ breast milk should always be recommended if breastfeeding is not possible.
Breastfeeding trials should be supported.
With cleft lip, breastfeeding is usually not a problem.
With cleft palate, it is very challenging due to difficulties with compression and suction.
Options with cleft palate include:
Supplemental nursing
Modified nipples/bottles
Pumping breast milk should always be recommended if breastfeeding is not possible.
Characteristics to consider when choosing a modified nipple
Pliability Shape Length Hole type Hole size
Nipples: \_\_\_\_\_\_\_\_\_\_\_ nipple \_\_\_\_\_\_\_\_\_\_ nipple (as illustrated here) \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ Nipple \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ nipple
Orthodontic nipple
Pigeon nipple (as illustrated here)
Ross® Premature Nipple
Standard traditional nipple
Specialized dipole and bottle systems:
_________ __________ Cleft Lip/Palate Nurser
____________ Cleft Palate Nurser
______________Feeder® (formerly the Haberman® Feeder)
__________ ___________ Feeder and Bottle
Mead JohnsonTM Cleft Lip/Palate Nurser
Ross® Cleft Palate Nurser
SpecialNeeds Feeder® (formerly the Haberman® Feeder)
Medela® SoftCup Feeder and Bottle
Table 5.1
Mead Johnson:
Bottle and nipple _______, but can use any nipple with ____________
__________, long, & ________ nipple
_____________ nipple
__________ of bottle allows assistive squeeze to increase flow
Ability to monitor size of ______ being delivered by squeeze is _________
Bottle and nipple unit, but can use any nipple with bottle
Straight, long, & firm nipple
Crosscut nipple
Pliability of bottle allows assistive squeeze to increase flow
Ability to monitor size of bolus being delivered by squeeze is poor
SpecialNeeds Feeder:
This bottle/nipple unit is relatively ________
It has a ________, moderate length, ____ nipple
It delivers fluid by _________ of nipple alone.
_______ ______ opening allows for adjustment of flow to _______ rates.
___________ valve decreases air intake.
Consider parent’s _______.
This bottle/nipple unit is relatively expensive.
It has a straight, moderate length, soft nipple
It delivers fluid by compression of nipple alone.
Nipple slit opening allows for adjustment of flow to three rates.
One-way valve decreases air intake.
Consider parent’s skills.
Medela SoftCup System:
_______/_______ unit
Used for infants that cannot tolerate________ placement of nipple
Allows _______ of liquid in _______ amounts
Bottle/soft cup unit
Used for infants that cannot tolerate intraoral placement of nipple
Allows presentation of liquid in measured amounts
Angled Neck Bottle:
Helpful when positioning has to be very __________
Allows for _______ flow of milk without forcing baby to adapt extended _______ position
Helpful when positioning has to be very upright
Allows for downward flow of milk without forcing baby to adapt extended head-neck position
Pigeon Nipple and Bottle:
- Nipple is ______________, with one thin side and one thicker side.
- _________ side is for positioning against infant tongue to extract liquid flow with compression.
- The Pigeon nipple is ________ (wider).
- ________________ allows for flow into nipple with no back flow.
- Bottle is ________ to allow for assistive squeezing.
- Flow rate can be adjusted with _________ of collar on bottle.
Nipple is “Y” crosscut, with one thin side and one thicker side.
Thinner side is for positioning against infant tongue to extract liquid flow with compression.
The Pigeon nipple is larger (wider).
One-way valve allows for flow into nipple with no back flow.
Bottle is pliable to allow for assistive squeezing.
Flow rate can be adjusted with tightness of collar on bottle.
Positioning the Infant: \_\_\_\_\_\_\_\_\_\_\_\_ (at least 60º) is best. Facilitates control of \_\_\_\_\_, \_\_\_\_\_\_, \_\_\_\_\_\_, \_\_\_\_\_\_ movements Allows \_\_\_\_\_\_ to assist with swallowing Helps prevent \_\_\_\_\_ \_\_\_\_\_\_\_\_\_
Semi-upright (at least 60º) is best.
Facilitates control of jaw, cheek, lip, and tongue movements
Allows gravity to assist with swallowing
Helps prevent nasal regurgitation
Positioning the Nipple:
Place nipple ______ _______ bone to aid nipple compression
Place nipple under palatal bone to aid nipple compression
Pacing Intake:
Fluid must be provided in ______ with the infant’s sucking compressions.
Fluid must be provided in rhythm with the infant’s sucking compressions.
Feeder should _____ pace when there are signs of stress:
Eye ______ or changes in facial expression
Decreased ________
________ of feeding
_______ or ________
Signs of _______ air intake
Signs of ______
Feeder should modify pace when there are signs of stress:
Eye widening or changes in facial expression
Decreased alertness
Avoidance of feeding
Coughing or choking
Signs of excessive air intake
Signs of fatigue
Flow can be regulated by:
_______ nipple slightly _________
Partially ________ the nipple from the oral cavity
Flow can be regulated by:
Tilting nipple slightly upwards
Partially removing the nipple from the oral cavity
Oral Facilitation Strategies: Includes _____ and _____ support
Includes jaw and cheek support
Preventing Excessive Air Intake:
Increase the ______ of burping.
Burp infant at least _____ every ______.
Increase the frequency of burping.
Burp infant at least once every ounce.
Managing Nasal Regurgitation:
Feeder should:
Allow infant time to ______ or ______ to clear the nasal passage.
Ensure that the infant is in an ______ position.
Use a ______ flow nipple or ____ the pace.
Feeder should:
Allow infant time to cough or sneeze to clear the nasal passage.
Ensure that the infant is in an upright position.
Use a slower flow nipple or slow the pace.
Consitency of Feeding Methods:
Infant should be fed in the ______ _____, with the same _____ and ______, and same ______ during each feeding.
Infant should be fed in the same position, with the same nipple and bottle, and same technique during each feeding.
Feeding obturator—a ______ _______ which can be used in first few _____ to assist infant with _____ _____ in feeding
Feeding obturator—a prosthetic appliance which can be used in first few months to assist infant with cleft palate in feeding
Use of Feeding Obturators: Advantages:
Keeps the _____ from resting ______ the cleft
Provides a _____ _____ so tongue can achieve _____ of the nipple against it
Advantages:
Keeps the tongue from resting inside the cleft
Provides a solid surface so tongue can achieve compression of the nipple against it
Use of Feeding Obturators:
Most _______ centers no longer use feeding obturators, as they feel they are _________.
Most infants with cleft feed well with _________.
Most craniofacial centers no longer use feeding obturators, as they feel they are unnecessary.
Most infants with cleft feed well with modifications.
Oral Hygiene
- Mouths of infants are essentially _____ _____.
- Infants with clefts have _____ in cleft area and nose, which can cause ______.
- Caregiver should ______ the cleft and surrounding areas after______ with a washcloth, gauze, or Toothette®.
Mouths of infants are essentially self-cleaning.
Infants with clefts have fluids in cleft area and nose, which can cause infection.
Caregiver should cleanse the cleft and surrounding areas after feedings with a washcloth, gauze, or Toothette®.
Transitioning to a cup:
Consider when transitioning to a cup is __________ appropriate (usually between 6 and 9 months).
The ___________ feeder can help with transition.
Most surgeons recommend ______ from bottle prior to palate surgery because nipple in the mouth and ______ could cause ______ of repair
Consider when transitioning to a cup is developmentally appropriate (usually between 6 and 9 months).
The Medela SoftCup™ feeder can help with transition.
Most surgeons recommend weaning from bottle prior to palate surgery because nipple in the mouth and sucking could cause breakdown of repair
Introduction of solid foods:
Usually begun around _______ months, with rice cereals and ______ foods
Assist in transition by using appropriate _______, small ______, slow _____, alternating with liquid to assist with ______.
Rapid spoon-feeding or large spoonfuls can cause more frequent ____________ and disorganized swallowing.
Usually begun around 4 to 6 months, with rice cereals and strained foods
Assist in transition by using appropriate positioning, small boluses, slow pace, alternating with liquid to assist with clearance.
Rapid spoon-feeding or large spoonfuls can cause more frequent nasal regulation and disorganized swallowing.
Assessment and Management of complex feeding problems:
_____ __________
________________ Swallowing Studies (VFSS)
____________ ___________Evaluation of Swallowing (FEES)
Clinical assessment
Videofluoroscopic Swallowing Studies (VFSS)
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Clinical Assessment:
Should be performed by a ______ ________ (qualified SLP or OT)
Assesses infant’s ability to _______ feed
Determines effect of ___________ strategies on feeding performance
Should be performed by a feeding specialist (qualified SLP or OT)
Assesses infant’s ability to safely feed
Determines effect of compensatory strategies on feeding performance
VFSS:
Also called _______ __________ _______
Performed by a ______ and a speech-language pathologist
Allows visualization of _______, ________, _________ phases of swallowing
Can observe ________, response to aspiration, nasopharyngeal reflux, and effect of _______ strategies
Also called modified barium swallow
Performed by a radiologist and a speech-language pathologist
Allows visualization of oral, pharyngeal, and esophageal phases of swallowing
Can observe aspiration, response to aspiration, nasopharyngeal reflux, and effect of compensatory strategies
FEES
Involves the _______ passage of an endoscope for viewing of the pharyngeal and laryngeal structures
Allows assessment of _____ _______ during swallowing
Provides information regarding sensory threshold in the ______ and ______
Can clearly view structures and management of _______
Disadvantage is temporary _____ of ______ when ______ ______ closes during the swallow
Involves the transnasal passage of an endoscope for viewing of the pharyngeal and laryngeal structures
Allows assessment of airway protection during swallowing
Provides information regarding sensory threshold in the pharynx and larynx
Can clearly view structures and management of secretions
Disadvantage is temporary loss of view when VP valve closes during the swallow
Feeding team may include the following members:
Feeding team may include the following members: Gastroenterologist Nutritionist Nurse Speech-language pathologist Occupational therapist Behavioral psychologist Otolaryngologist Pulmonologist Consulting radiologist
Alternative Feeding Methods for severe cases:
Orogastric or __________ (NG) tube—for _______ feeding
________ (G) tube—for infants with _______ oral reflexes or poor ________ ________ while swallowing
Orogastric or nasogastric (NG) tube—for supplemental feeding
Gastrostomy (G) tube—for infants with abnormal oral reflexes or poor airway protection while swallowing
Ultimate goals of the feeding method are to provide:
Adequate _______ and weight ______
_______ _______ for infant and caregiver
Enhancement of __________ process
Sensorimotor ________ for normal development
Ultimate goals of the feeding method are to provide:
Adequate nutrition and weight gain
Pleasurable experiences for infant and caregiver
Enhancement of bonding process
Sensorimotor stimulation for normal development
