Ch10:

Question 1

Aspiration

Answer 1

-There is an increased risk of aspiration during feeding in a reclined position, as the pull of gravity accelerates the flow of liquid into the entrance of the esophagus without the benefit of the “gate” previously provided by the opposed epiglottis and soft palate
Assessed using: Video fluoroscopic swallow study (VFSS) (aka upright modified barium swallow study (UMBSS))

Question 2

Cleft lip and palate

Answer 2

A separation or hole in the oral structures typically joined together at midline during the early weeks of fetal development.

Question 3

Cleft Lip

Answer 3

Separation of the upper lip, which may be seen as a small indentation, or a larger opening that extends up to the nostril

Question 4

Cleft Palate

Answer 4

Separation of the anterior hard or posterior soft palate and may occur with or without a cleft lip

Question 5

Differential attention for behavioral intervention

Answer 5

Positive reinforcement is combined with ignoring or redirection of inappropriate behaviors to improve oral intake

Question 6

Dysphagia

Answer 6

• Difficulty swallowing

- Interventions include food or liquid consistency adaptations

Question 7

Enteral or nonoral feeding

Answer 7

Required use of tube feeding, gastronomy

Delays self-feeding, oral motor and oral sensory impairments

Question 8

Environmental adaptations

Answer 8

• Changes to the mealtime structure or environment to promote success with oral feeding.
• May be recommended to modify the child’s daily mealtime routines. (scheduling and location of meals, length of meal periods, sensory stimulation within the environment, and/or changes to the order of mealtime activities (ex. order of food presentation).

Question 9

Food or liquid bolus

Answer 9

A ball-like mixture of food and saliva that forms in the mouth during the process of chewing

Question 10

Indications: Fiberoptic endoscopic evaluation of swallowing (FEES)

Answer 10

• Analyze the swallow mechanism
• Rule out aspiration
• Identify safe food and liquid consistencies
• Visualize anatomic structures during swallowing

Question 11

Advantages: Fiberoptic endoscopic evaluation of swallowing (FEES)

Answer 11

• Allows variability in positioning the child during eating or drinking
• No x-ray radiation exposure
• Can be combined with traditional laryngoscopy

Question 12

Limitations: Fiberoptic endoscopic evaluation of swallowing (FEES)

Answer 12

• Requires child to be awake and cooperative while having small tube inserted in the nose and pharynx while swallowing
• Often requires coordination between swallowing therapist and otorhinolaryngologist or ear, nose, and throat physician
• Visualization while swallowing is occurring can be difficult because structures close and contract

Question 13

Gagging

Answer 13

May be caused by difficulty with oral management of foods and may be protective, sensory-based, triggered with touch or specific food textures, emotional or used as a means of communicating.

Question 14

Gastroesophageal Reflux Disease (GERD)

Answer 14

When a child exhibits frequent or chronic vomiting after feeding

Question 15

Gastroesophageal Reflux (GER)

Answer 15

A normal physiologic process that is not unusual for babies, and many infants spit up occasionally as their gastrointestinal system matures.

Question 16

Indications: Gastrointestinal endoscopy

Answer 16

Provides a direct view of GI tract to diagnose inflammation or structural abnormalities

Question 17

Advantages: Gastrointestinal endoscopy

Answer 17

• Direct observation of esophageal and stomach tissues for changes that may have occurred with chronic GER
• Tissue biopsies are often studied for the presence of eosinophils, which may indicate food allergies

Question 18

Limitations: Gastrointestinal endoscopy

Answer 18

-Invasive procedure, requiring anesthesia
-The presence of inflammation or abnormalities may not correlate with clinical symptoms (e.g., vomiting, other feeding problems)
Cannot determine the frequency of GER

Question 19

Gastrostomy tube

Answer 19

Used for children needing sustained enteral nutrition support (longer than a few weeks)

Question 20

Modified food and liquid consistencies

Answer 20

• Different textures and sensory properties of foods may be considered in an intervention plan.
• Foods with a smooth, cohesive consistency (yogurt and pureed fruits or vegetables) are easier to manage when a child has oral sensory and oral motor impairments.
• Thick, lumpy, or pasty foods (oatmeal) require more oral motor strength and sensory tolerance when compared with smoother and thinner puréed foods.
• Foods that are dense, crunchy, sticky, or uneven in consistency are more difficult to manage and require more advanced chewing skills.

Question 21

Nasogastric Tube

Answer 21

• Delivers nonoral/enteral feeding support
• May also create sensory distress for the child during placement of the tube. When these tubes are needed over a long period, they are typically reinserted or replaced at least once per month, causing further sensory distress to the child

Question 22

Phases of swallowing

Answer 22

• Oral Preparatory Phase
• Oral Phase
• Pharyngeal Phase

Question 23

Oral Preparatory Phase

Answer 23

• Oral manipulation of food using the jaw, lips, tongue, teeth, cheeks, and palate.
• This activity results in the formation of a food bolus.
• Amount of time spent in this phase varies, depending on the texture of the food or liquid.
• This phase is often reflexive in young infants and under voluntary control in older children.

Question 24

Oral Phase

Answer 24

• Begins when the tongue elevates against the alveolar ridge of the hard palate, moving the bolus posteriorly, and ends with the onset of the pharyngeal swallow.
• Generally reflexive in young infants and under voluntary control in older children.

Question 25

Pharyngeal Phase

Answer 25

• The swallow is triggered when the bolus reaches the anterior faucial arches.
• The hyoid and larynx move upward and anteriorly, the epiglottis retroflexes to cover the opening of the airway, and the vocal cords come together to protect the airway.
• The pharyngeal phase ends with the opening of the upper esophageal sphincter as the bolus passes the airway and moves toward the esophagus.
• This phase is primarily reflexive.

Question 26

Positioning adaptations

Answer 26

• Oral motor and feeding activities require skilled movement and coordination of many small muscle groups, which are supported by overall gross motor control and stability
• Postural instability and neuromuscular impairments cause difficulty with oral motor control if they do not have adequate positioning support.
• Positioning changes may immediately impact difficult oral motor problems, such as tonic bite and tongue thrust movement patterns.
• Positioning adaptations provide proximal support (support at the trunk and neck) which influences distal movement and control.

Question 27

Selective eating or food refusal

Answer 27

• Many typical children refuse new foods when they are first introduced as toddlers. Evidence suggests that it takes multiple presentations of a food before a child feels comfortable with it and before a true food preference can be determined
• May develop power struggles during mealtime
• May relate to underlying medical causes, such as GERD, food allergies, and eosinophilic esophagitis (EoE)
• May be seen in children with ASD, given their propensity for rigid and repetitive behaviors and olfactory, gustatory, or tactile sensitivities

Question 28

Video fluoroscopic swallow study

Answer 28

• Also commonly called an upright modified barium swallow study (UMBSS), is the radiographic procedure of choice for assessing the oral, pharyngeal, and upper esophageal anatomy and function during feeding and swallowing
• It is most useful in identifying aspiration or the risk of aspiration and in tailoring treatment for infants and children with dysphagia.