Ch 7- Feeding & Cleft Flashcards
What are the encapsulated fat masses in the cheeks of infant’s called? What is their function?
Buccal pads are the encapsulated fat masses inside the cheek. Function: stabilize the lateral walls of the oral cavity
How does tongue anatomy (size, placement) differ in infants vs. adults?
(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.
What oral characteristics in infants facilitate early suckling?
(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.
_____ is characterized by extension-retraction movements of tongue as well as development of more mature up-down tongue movements
Suckling
What is suckling?
Suckling is characterized by extension-retraction movements of tongue as well as development of more mature up-down tongue movements (true sucking)
What is the pharynx of a newborn like?
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.
An infant’s larynx is ____ the size of an adult’s larynx
1/3rd
An infant’s larynx is positioned high in the ______, adjacent to cervical vertebrae ___ through ___
An infant’s larynx is positioned high in the *hypopharynx, adjacent to cervical vertebrae *C-I through *C-3
The larynx of an adult is located at the cervical vertebrae __ to __ levels
*C-6 to *C7
The high position of the infant larynx causes the epiglottis to pass ____ to the free margin of the soft palate & project into the nasopharynx
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
Epiglottis is ______-shaped, proportionally ____ (wide/ narrow), & more ___ (horizontal/ vertical) in the infant than the adult
Epiglottis is TUBULAR shaped, proportionally NARROW (wide/ narrow), & more VERTICAL (horizontal/ vertical) in the infant than the adult
Infant’s feeding process is dependent on smooth synchronization of _________, _________, & _________
Infant’s feeding process is dependent on smooth synchronization of sucking, swallowing, & breathing
Rhythmic sucking is part of the ____ phase
Oral phase of swallowing in infants
_____Reflux: aids in search for the nipple & subsequent lip seal around the nipple
*Rooting Reflux: aids in search for the nipple & subsequent lip seal around the nipple
_____ Reflex- initiated as the tongue elevates to squeeze nipple against the bony surface of the alveolar ridge & hard palate
Sucking Reflex- initiated as the tongue elevates to squeeze nipple against the bony surface of the alveolar ridge & hard palate
As the tongue moves back during sucking, the infant’s jaw drops, enlarging space in the ______ _______
oral cavity
Space in the oral cavity generates _____ pressure, resulting in suction & expression of fluid into the oral cavity
Space in the oral cavity generates *negative pressure, resulting in suction & expression of fluid into the oral cavity
The ____ Phase is Initiated once fluid bolus is channeled by the tongue into the pharynx
The pharyngeal phase is initiated once fluid bolus is channeled by the tongue into the pharynx
When liquid reaches the posterior oral cavity, the _____, _____, & _____ ____ ____ all work together to provide the pressure, (driving force) for bolus transfer through the pharynx
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
During the pharyngeal phase of swallowing the velum elevates partially because of . . . . [hint: movement]
During the pharyngeal phase of swallowing the velum elevates partially because of ….the backward movement of the tongue
______ pressure and ____ are created when the back of the tongue (posterior aspect) moves downward & the oral cavity is enlarged. (p. 197)
*Negative pressure and *suction are created when the back of the tongue (posterior aspect) moves downward & the oral cavity is enlarged.
Respiration ceases . . .
Respiration ceases ….at the time of swallow initiation, when vocal fold adduction occurs
The esophageal phase is Initiated when the . . . (p. 197-198)
…bolus moves through the pharynx & into the esophagus
The ______ ______ _____ is normally closed but stretches open as the bolus travels through the hyopopharnx into the esophagus
Upper Esophageal Sphincter (UES)
The _____ ______ _____ relaxes to allow the bolus to enter the stomach
LES (lower esophageal sphincter)
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.
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.
How is the airway protected as we grow and structures grow apart?
Neuromuscular maturation results in increased mobility of hyoid & larynx to elevate & provide sphincteric closure during swallowing.
Why do infants with primary palate (lip & alveolus) clefts NOT have significant problems with feeding usually?
With breastfeeding, the breast tissue conforms to fill in the cleft area. With bottle feeding, use of soft widebased nipple will close the area
What problem might infants with primary palate have initially?
Achieving an adequate lip seal on the nipple to generate effective negative pressure for sucking.
How can parents assist with lip closure for feeding?
By gently holding the upper lip together while baby sucks (p. 199)
Do infants with a small cleft of the velum only need special modifications?
Not typically. Infant may be able to occlude the cleft with the back of the tongue to obtain negative pressure (p. 199)
Infants with a cleft that extends through the velum & hard palate are more likely to experience feeding difficulties such as…
Unable to generate negative pressure for suction
Infants with a complete cleft of the soft & hard palate usually not able to breastfeed because…
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)
Infant may be unable to find a hard palatal surface for compression of the nipple for infants with…
more extensive clefts of hard palate
The reflux of fluid into the nasopharyngeal & nasal cavities is called ______ ___________
Nasal Regurgitation
Open cleft can result in. . .
… excessive intake of air to cause bloating & frequent spitting up. (p. 199)
Why is weight gain & adequate nutrition of primary concern for infants with cleft?
Nasal regurgitation needs to be subtracted from total intake, difficulty feeding can cause excessive expenditure of energy (calories) during feeding.
How much does a full-term newborn usually consume & how long to feed them?
Newborn needs 2-3 oz per lb of body weight and takes 20-30 minutes to complete a feeding
Why does infant with cleft lip & palate have difficulty feeding?
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
Postoperative Feeding–After Cleft Lip & Palate Repair recommendations vary from _____ feeding to a _____ feeding approach
Unrestricted to Restricted– e.g. discourage sucking, recommend use of a cup/ spoon. Some recommend supplemental feeding tube for 7-10 days
Micrognathia
Small Manible
Macroglossia
Large tongue
Pharyngeal Stenosis
Narrowing
Laryngeal Cleft or Tracheoesophageal fistula can result in …
aspiration during feeding secondary to miscommunication btwn esophagus & trachea
Cortical or cranial nerve involvement can result in _______, ________, or _________ ____-____ _____
hypotonia, hypertonia, or generalized oral-motor dysfunction. Can affect neuromuscular coordination required for sucking & swallowing.
Conditions that can cause airway compromise include ______, _____ ____, ____ ____ or _____ ___, or _____ _____
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
