Ch 7- Feeding & Cleft

Question 1

What are the encapsulated fat masses in the cheeks of infant’s called? What is their function?

Answer 1

Buccal pads are the encapsulated fat masses inside the cheek. Function: stabilize the lateral walls of the oral cavity

Question 2

How does tongue anatomy (size, placement) differ in infants vs. adults?

Answer 2

(1) Infant tongues are about 1/2 the size of an adult tongue, but still relatively large; fills oral cavity. (2) Tongue tip position is more anterior (front) due to lack of teeth.

Question 3

What oral characteristics in infants facilitate early suckling?

Answer 3

(1) buccal pads (fat in cheeks) stabilize the oral, (2) tongue fills the oral cavity (3) tongue protrudes past alveolar ridge, contacts lower lip, (4) TMJ does not allow movement of jaw, causing mouth opening to be smaller in infants.

Question 4

_____ is characterized by extension-retraction movements of tongue as well as development of more mature up-down tongue movements

Answer 4

Suckling

Question 5

What is suckling?

Answer 5

Suckling is characterized by extension-retraction movements of tongue as well as development of more mature up-down tongue movements (true sucking)

Question 6

What is the pharynx of a newborn like?

Answer 6

Pharynx of the newborn is short, so the tongue base, velum, & Pharyngeal Walls are close together. The inferior border of the velum rests in front of the epiglottis & velum has a large area of contact with the tongue.

Question 7

An infant’s larynx is ____ the size of an adult’s larynx

Answer 7

1/3rd

Question 8

An infant’s larynx is positioned high in the ______, adjacent to cervical vertebrae ___ through ___

Answer 8

An infant’s larynx is positioned high in the *hypopharynx, adjacent to cervical vertebrae *C-I through *C-3

Question 9

The larynx of an adult is located at the cervical vertebrae __ to __ levels

Answer 9

*C-6 to *C7

Question 10

The high position of the infant larynx causes the epiglottis to pass ____ to the free margin of the soft palate & project into the nasopharynx

Answer 10

The high position of the infant larynx causes the epiglottis to pass superior to the free margin of the soft palate & project into the nasopharynx

Question 11

Epiglottis is ______-shaped, proportionally ____ (wide/ narrow), & more ___ (horizontal/ vertical) in the infant than the adult

Answer 11

Epiglottis is TUBULAR shaped, proportionally NARROW (wide/ narrow), & more VERTICAL (horizontal/ vertical) in the infant than the adult

Question 12

Infant’s feeding process is dependent on smooth synchronization of _________, _________, & _________

Answer 12

Infant’s feeding process is dependent on smooth synchronization of sucking, swallowing, & breathing

Question 13

Rhythmic sucking is part of the ____ phase

Answer 13

Oral phase of swallowing in infants

Question 14

_____Reflux: aids in search for the nipple & subsequent lip seal around the nipple

Answer 14

*Rooting Reflux: aids in search for the nipple & subsequent lip seal around the nipple

Question 15

_____ Reflex- initiated as the tongue elevates to squeeze nipple against the bony surface of the alveolar ridge & hard palate

Answer 15

Sucking Reflex- initiated as the tongue elevates to squeeze nipple against the bony surface of the alveolar ridge & hard palate

Question 16

As the tongue moves back during sucking, the infant’s jaw drops, enlarging space in the ______ _______

Answer 16

oral cavity

Question 17

Space in the oral cavity generates _____ pressure, resulting in suction & expression of fluid into the oral cavity

Answer 17

Space in the oral cavity generates *negative pressure, resulting in suction & expression of fluid into the oral cavity

Question 18

The ____ Phase is Initiated once fluid bolus is channeled by the tongue into the pharynx

Answer 18

The pharyngeal phase is initiated once fluid bolus is channeled by the tongue into the pharynx

Question 19

When liquid reaches the posterior oral cavity, the _____, _____, & _____ ____ ____ all work together to provide the pressure, (driving force) for bolus transfer through the pharynx

Answer 19

When liquid reaches the posterior oral cavity, the tongue base (BOT), velum, & posterior pharyngeal wall (PPW) all work together to provide the pressure, (driving force) for bolus transfer through the pharynx

Question 20

During the pharyngeal phase of swallowing the velum elevates partially because of . . . . [hint: movement]

Answer 20

During the pharyngeal phase of swallowing the velum elevates partially because of ….the backward movement of the tongue

Question 21

______ pressure and ____ are created when the back of the tongue (posterior aspect) moves downward & the oral cavity is enlarged. (p. 197)

Answer 21

*Negative pressure and *suction are created when the back of the tongue (posterior aspect) moves downward & the oral cavity is enlarged.

Question 22

Respiration ceases . . .

Answer 22

Respiration ceases ….at the time of swallow initiation, when vocal fold adduction occurs

Question 23

The esophageal phase is Initiated when the . . . (p. 197-198)

Answer 23

…bolus moves through the pharynx & into the esophagus

Question 24

The ______ ______ _____ is normally closed but stretches open as the bolus travels through the hyopopharnx into the esophagus

Answer 24

Upper Esophageal Sphincter (UES)

Question 25

The _____ ______ _____ relaxes to allow the bolus to enter the stomach

Answer 25

LES (lower esophageal sphincter)

Question 26

After each swallow, the velum moves ____ to the BOT and in front of the _____ . The tongue returns to a(n) ____ position, sucking & breathing resume, and both of the ____ and ___ esophageal sphincters maintain a closed position.

Answer 26

After each swallow, the velum moves down to the BOT and in front of the epiglottis . The tongue returns to a(n) _anterior___ position, sucking & breathing resume, and both of the __upper and _*lower__ esophageal sphincters maintain a closed position.

Question 27

How is the airway protected as we grow and structures grow apart?

Answer 27

Neuromuscular maturation results in increased mobility of hyoid & larynx to elevate & provide sphincteric closure during swallowing.

Question 28

Why do infants with primary palate (lip & alveolus) clefts NOT have significant problems with feeding usually?

Answer 28

With breastfeeding, the breast tissue conforms to fill in the cleft area. With bottle feeding, use of soft widebased nipple will close the area

Question 29

What problem might infants with primary palate have initially?

Answer 29

Achieving an adequate lip seal on the nipple to generate effective negative pressure for sucking.

Question 30

How can parents assist with lip closure for feeding?

Answer 30

By gently holding the upper lip together while baby sucks (p. 199)

Question 31

Do infants with a small cleft of the velum only need special modifications?

Answer 31

Not typically. Infant may be able to occlude the cleft with the back of the tongue to obtain negative pressure (p. 199)

Question 32

Infants with a cleft that extends through the velum & hard palate are more likely to experience feeding difficulties such as…

Answer 32

Unable to generate negative pressure for suction

Question 33

Infants with a complete cleft of the soft & hard palate usually not able to breastfeed because…

Answer 33

Unable to create negative pressure for suction. Use of Medela may benefit, but hydration status should be monitor. Supplemental or exclusive transition to bottle feeding is highly likely (p. 199)

Question 34

Infant may be unable to find a hard palatal surface for compression of the nipple for infants with…

Answer 34

more extensive clefts of hard palate

Question 35

The reflux of fluid into the nasopharyngeal & nasal cavities is called ______ ___________

Answer 35

Nasal Regurgitation

Question 36

Open cleft can result in. . .

Answer 36

… excessive intake of air to cause bloating & frequent spitting up. (p. 199)

Question 37

Why is weight gain & adequate nutrition of primary concern for infants with cleft?

Answer 37

Nasal regurgitation needs to be subtracted from total intake, difficulty feeding can cause excessive expenditure of energy (calories) during feeding.

Question 38

How much does a full-term newborn usually consume & how long to feed them?

Answer 38

Newborn needs 2-3 oz per lb of body weight and takes 20-30 minutes to complete a feeding

Question 39

Why does infant with cleft lip & palate have difficulty feeding?

Answer 39

Not typically able to breastfeed, need assistive feeding due to Inability to achieve anterior seal with lips, inability to compress nipple because of open palate, and failure to generate negative pressure suction (p. 199). Nasopharyngeal reflux 2nd to open nasopharynx

Question 40

Postoperative Feeding–After Cleft Lip & Palate Repair recommendations vary from _____ feeding to a _____ feeding approach

Answer 40

Unrestricted to Restricted– e.g. discourage sucking, recommend use of a cup/ spoon. Some recommend supplemental feeding tube for 7-10 days

Question 41

Micrognathia

Answer 41

Small Manible

Question 42

Macroglossia

Answer 42

Large tongue

Question 43

Pharyngeal Stenosis

Answer 43

Narrowing

Question 44

Laryngeal Cleft or Tracheoesophageal fistula can result in …

Answer 44

aspiration during feeding secondary to miscommunication btwn esophagus & trachea

Question 45

Cortical or cranial nerve involvement can result in _______, ________, or _________ ____-____ _____

Answer 45

hypotonia, hypertonia, or generalized oral-motor dysfunction. Can affect neuromuscular coordination required for sucking & swallowing.

Question 46

Conditions that can cause airway compromise include ______, _____ ____, ____ ____ or _____ ___, or _____ _____

Answer 46

glossoptosis (posterior displacement of tongue in pharynx), midface retrusion, congenital heart or lung disease, or choanal atresia (congenital closure of the opening to the pharynx from the back of the nose) can interfere with suck-swallow-breathe sequence