Ch10: Flashcards
Aspiration
-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))
Cleft lip and palate
A separation or hole in the oral structures typically joined together at midline during the early weeks of fetal development.
Cleft Lip
Separation of the upper lip, which may be seen as a small indentation, or a larger opening that extends up to the nostril
Cleft Palate
Separation of the anterior hard or posterior soft palate and may occur with or without a cleft lip
Differential attention for behavioral intervention
Positive reinforcement is combined with ignoring or redirection of inappropriate behaviors to improve oral intake
Dysphagia
- Difficulty swallowing
- Interventions include food or liquid consistency adaptations
Enteral or nonoral feeding
Required use of tube feeding, gastronomy
Delays self-feeding, oral motor and oral sensory impairments
Environmental adaptations
- 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).
Food or liquid bolus
A ball-like mixture of food and saliva that forms in the mouth during the process of chewing
Indications: Fiberoptic endoscopic evaluation of swallowing (FEES)
- Analyze the swallow mechanism
- Rule out aspiration
- Identify safe food and liquid consistencies
- Visualize anatomic structures during swallowing
Advantages: Fiberoptic endoscopic evaluation of swallowing (FEES)
- Allows variability in positioning the child during eating or drinking
- No x-ray radiation exposure
- Can be combined with traditional laryngoscopy
Limitations: Fiberoptic endoscopic evaluation of swallowing (FEES)
- 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
Gagging
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.
Gastroesophageal Reflux Disease (GERD)
When a child exhibits frequent or chronic vomiting after feeding
Gastroesophageal Reflux (GER)
A normal physiologic process that is not unusual for babies, and many infants spit up occasionally as their gastrointestinal system matures.
Indications: Gastrointestinal endoscopy
Provides a direct view of GI tract to diagnose inflammation or structural abnormalities
Advantages: Gastrointestinal endoscopy
- 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
Limitations: Gastrointestinal endoscopy
-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
Gastrostomy tube
Used for children needing sustained enteral nutrition support (longer than a few weeks)
Modified food and liquid consistencies
- 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.
Nasogastric Tube
- 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
Phases of swallowing
- Oral Preparatory Phase
- Oral Phase
- Pharyngeal Phase
Oral Preparatory Phase
- 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.
Oral Phase
- 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.
Pharyngeal Phase
- 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.
Positioning adaptations
- 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.
Selective eating or food refusal
- 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
Video fluoroscopic swallow study
- 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.
