Chapter 15 Flashcards
what does the SLP who specializes in feeding and swallowing disorders in children serve as?
the feeding specialist and carries the responsibility of strengthening the child’s oral-motor system and building the capacity for safe feeding and swallowing
what does the oral motor system refer to?
the physical structures and neuromuscular functions involved with both eating and speaking
what three things does the feeding specialist focus on?
improving oral motor functions
oral-motor muscular tone
oral-motor sensation
Definition of feeding disorder
a child’s persistent failure to eat adequately for a period of at least 1 month, which results in a significant loss of weight or a failure to gain weight
when do feeding disorders manifest?
prior to 6 years of age, and in most cases the onset is in the first year of life
true or false: feeding disorders can occur as a secondary disorder to broader medical or developing condition
true
four symptoms associated with feeding disorders
unsafe or inefficient swallowing patterns
growth delay affecting height and/or weight lack of
tolerance of food textures and tastes
poor appetite regulation
rigid eating patterns
Definition of swallowing disorder
a specific type of feeding disorder in which the child exhibits an unsafe or inefficient swallowing pattern that undermines the feeding process
Definition of deglutition
the complex neuromuscular act of moving substances from the oral cavity to the esophagus
Definition of bolus
substance being moved from the oral cavity to the esophagus
Definition of penetration
food or liquid enters the larynx, which can cause choking or respiratory distress
Definition of aspiration
food or liquid passes through the larynx and into the lungs
true or false: not all children with feeding disorders have problems swallowing, but all children with swallowing problems exhibit a feeding disorder
true
treatment for swallowing disorder
managing the failure to eat adequately
training the child to safely and effectively swallow
providing alternative feeding for the period in which swallowing is unsafe
true or false: mild and transient feeding problems are not common in young children
false - they are common
true or false: conditions that cause frailty in infants are increasing in their prevalence
true
Definition of nutrition
an individual’s intake of calories and nutrients to meet requirements for energy, growth, development, and learning
Definition of undernutrition and malnutrition
conditions in which children’s basic nutritional requirements are not being met, most often because of environmental circumstances or developmental disabilities
Definition of growth
children’s height/length and weight achievements, as well as the weight to-length relationship
what is the greatest detriment to growth?
poor nutrition
three categories of growth deficiency
the child who is underweight weighs less than expected, based on age
the child who is wasting weighs less than expected, based. on height
the child who is stunting is shorter than expected, based on age
which category of growth deficiency is typically signified long-standing malnutrition or undernutrition?
the child who is stunting is shorter than expected, based on age
Definition of catch-up growth
an increase in growth velocity as children recover from a period of growth deficiency
feeding and Swallowing Development: birth to 6 months
At birth, babies possess an estimated 27 primitive reflexes, of which four greatly facilitate their ability to feed outside the womb
Definition of suckling reflex
emerges prenatally and is elicited by stimulating an infant’s lips
Definition of rooting reflex
elicited by stimulating the area around the infant’s mouth, causing the infant’s head to turn in the direction of the stimulus
Definition of grasping reflex
enabled the infant’s fingers to close around a stimulus to the palm
what happens if the infant-parent attachment is underdeveloped?
the infant may act out during feeding, fail to signal hunger, or resist feeding altogether
Definition of gagging reflex
a protective reflex present at birth which persist throughout the lifespan
Definition of homeostasis
a quiet, alert, and wakeful state
what protects the larynx from foreign entry?
gagging reflex
feeding and Swallowing Development: six months to 12 months
parents often begin offering solid foods
oral motor patterns begin to transition from mainly anterior-to-posterior movement to a more up-and-down munching pattern
babies are very curious and oral and this stage and increasingly prefer self-feeding
feeding and Swallowing Development: twelve months and beyond
babies are continually delighted by new tastes and textures
by 18 months most toddlers are effective, efficient eaters, although total mastery of all foods is not expected until closer to 24 months
Definition of Oral Preparatory Phase
this step to prepare the substance to be swallowed for swallowing
Definition mastication
grind the food into a manageable texture to swallow
true or false: only without liquids does a bolus is formed
false - even WITH fluids, a bolus forms to assists in controlling the flow of the liquid
true or false: throughout the oral preparatory phase, respiration continues with inhalation and exhalation through the nose
true
Definition of oral phase
this step moves the bolus to the rear of the oral cavity and prepares it for propulsion down the throat
true or false: the individual still maintains a normal respiratory pattern during the oral phase
true
Definition of pharyngeal phase
this step propels the bolus downward through the throat to the entrance of the esophagus
when does the pharyngeal phase begin?
when the bolus reaches the posterior portion of the oral cavity
why is the pharyngeal phase so important?
because the bolus can potentially enter the laryngeal pathway to the lungs or the nasal cavity, prohibiting breathing
what happens if material does go down the wrong way?,
a reflexive cough occurs to propel the material back out
Definition of reflexive cough
a protective reflex in which exhaled air is forced upward through the vocal folds to expel any foreign matter
Definition of apneic moment
when respiration experiences a brief halt that further minimizes the risk of material entering the airway
Definition of esophageal phase
this step moves the bolus through the esophagus into the stomach by an involuntary wave, or contraction
Definition of Dysphagia
a condition in which an individual exhibits difficulty in at least one of the phases of the swallow, causing swallowing to be inefficient or unsafe
what happens when swallowing is inefficient?
it does not provide adequate nutrition
what happens when swallowing is unsafe?
individuals are at risk of penetration or aspiration because of poor coordination or management of the bolus as it moves through the swallowing phases
why is silent aspiration occurs a particular concern?
because there is no sign - such as choking, coughing, or speaking with a wet or gurgly voice -to suggest that aspiration is occurring
what can penetration result in?
choking, causing a loss of oxygen to the brain and leading to brain damage or death
what can aspiration result in?
pneumonia and pulmonary damage
true or false: dysphagia is a disease
false: it is a symptom that results from an underlying etiology, or cause
three ways pediatric feeding and swallowing disorders are classified
descriptive features
casual classifications
Biopsychosocial Perspective
Definition of descriptive features
Classification of disorders based on descriptive features focuses on the clinical presentation, or observable symptoms, of the disorder
Definition of transient feeding and swallowing problem
a short-lived or readily correctable disorder
e.g., baby with an unoperated cleft lip
Definition of episodic feeding or swallowing disorder
a disorder that occurs periodically. (e.g., during cancer treatment)
Definition of chronic feeding or swallowing problem
a disorder that is ongoing over months or years and cannot be resolved easily
Definition of hyperphagia
excessive overconsumption of food
Definition of pica
consuming inappropriate nonnutritive substances like pebbles, glass, etc.)
Definition of causal Classifications
Classification of disorders based on etiology focuses on known or suspected causes of the disorder.
Definition of organic disorders
result from known organic causes
Definition of neuromuscular dysfunction
disorders that result from an impairment of the neurological or motoric systems required for safe and efficient feeding and swallowing (e.g., cerebral palsy)
Definition of mechanical obstruction
disorders resulting from an obstruction in the feeding and swallowing apparatuses (e.g., esophageal atresia)
Definition of medical/genetic abnormality
disorders resulting from illness, trauma, or disability (e.g., reflux)
Definition of nonorganic disorders
the cause is not clearly evident or does not stem from a physical impairment
physical/emotional causes of a disorder
disorders stem from a physical or emotional reaction to the environment (e.g., abuse, or maternal depression)
educational causes of a disorder
disorders include inadequate caregiver knowledge of feeding, eating, and nutrition
environmental causes of a disorder
disorders are primarily financial constraints which make food under-available
behavioral causes of a disorder
disorders result from learned behaviors (e.g., tantrums during eating to control the environment)
Definition of Failure to Thrive (ITT)
a widely used term to describe children whose weight or height deviates significantly from the norm for their age and gender because of nutritional inadequacy
three major reasons ITT occurs?
Inadequate access to food
Inadequate intake of food
Inadequate retention or absorption of food
true or false: even though the terms feeding disorder and failure to thrive are often used interchangeably, not all children with feeding disorders have ITT and not all children with ITT have feeding disorders
true
what terms do experts prefer when referring to pediatric feeding disorder and why?
pediatric undernutrition and growth deficiency
because emphasizing that few cases of pediatric undernutrition result from a single cause
what three things are normal feeding and swallowing?
safe, efficient, and organized
what three things are feeding and swallowing disorders?
unsafe, inadequate, or-inappropriate
Definition of dysphagia
the dysfunction of or damage to a child’s oral-motor system or an inappropriate eating rate, either too fast or too slow
when is feeding and swallowing unsafe ?
when they pose a risk of penetration or aspiration of the bolus into the airway
Definition of hypotonia
low muscle tone
what syndromes does dysphagia accompany?
those that feature low muscle tone, delayed motor development, and physical deformities affecting the oral-motor area
four primary reasons inadequate feeding and swallowing occur
inefficiency
overselectivity
refusal
feeding delay due to illness or trauma
Definition of inadequate feeding and swallowing: inefficiency
hildren are unable to meet their own caloric and nutritional needs because the process of feeding and swallowing is not productive
Definition of inadequate feeding and swallowing: overselectivity
children with overselective eating patterns are restrictive in the taste, type, texture, and/or volume of food they will eat
Definition of inadequate feeding and swallowing: refusal
a complete refusal to feed
causes of refusal
a physical or medical issue that has not been resolved (e.g., constipation)
gastrointestinal distress (e.g., reflux)
conditioned dysphagia
Definition of conditioned dysphagi
a traumatic experience results in resistance to eating after choking, ingestion of poison, severe allergic reactions, etc
five causes and risk factors for inadequate feeding and swallowing
Low birth weight
Developmental disabilities (mental retardation, autism, cerebral palsy, etc.)
Prematurity
Prenatal drug exposure
Diet restrictions (e.g.: modified diet for diabetes)
two defining Characteristics of inappropriate feeding and swallowing
Children demonstrate undesirable and disruptive behaviors during mealtimes
Growth and development may be compromised as successful feeding is disrupted
causes and risk factors for inappropriate feeding and swallowing
behaviors and attributes of the caregiver and/or the child that become complexly intertwined in the feeding process
about ____ of feeding disorders in young children result from nonorganic causes
one-third
how are pediatric feeding and swallowing disorders identified?
early Identification and Referral
comprehensive Assessment
true or false: many children do not demonstrate overt feeding disorders immediately
true
who would a child with an inappropriate feeding or swallowing disorder be referred to?
ENT, gastroenterologist or feeding specialist
what does a comprehensive assessment for a feeding and swallowing problem entail?
case history, a physical feeding/swallowing evaluation, and observation of mealtime interactions
Definition of case history
gathers information on the child’s and family’s eating and feeding experiences to explore possible problems, study changes in behaviors over time, and document specific manifestations of the disorder
Definition of physical feeding and swallowing evaluation
a careful evaluation of the structures and functions of the child’s oral-motor mechanism at rest and during feeding as the child eats and drinks
structural examination looks for asymmetry, drooling, and abnormal patterns or reflexes and signs of aspiration
Definition of modified barium swallow study
uses radiography to follow a substance from the child’s lips through the pharyngeal and esophageal aspects of the swallow top see whether aspiration or penetration is occurring
what does a modified barium swallow study determine?
pictures of the child are taken during the oral, pharyngeal, and esophageal stages of the swallow to determine whether swallowing and feeding are safe and efficient
Definition of observation of mealtime interactions
live observation of the child during mealtime interactions with caregiver
Definition of multidisciplinary collaboration
the current standard of care for treatment of pediatric feeding and swallowing disorders involving the pediatrician, nutritionist, feeding specialist, etc.
what do Ineffective treatments for feeding and swallowing disorders result in?
severe undernutrition and growth deficiency
three roles of the NICU feeding specialist
conducts evaluations of feeding and swallowing
provides interventions top enhance their developmental achievements
encouraging communication
stimulating the oral-motor mechanism
designing and monitoring feeding interventions
Definition of special clinics
inpatient treatment in an intensive, hospital-based program
Definition of home visits
visits to observe food preparation, discipline feeding relationships, etc.
two main treatment goals of feeding and swallowing disorders
to ensure that nutritional needs are met
feeding and swallowing do not endanger the child’s life
two physiology targets of feeding and swallowing treatment
emphasize the organic and neurodevelopmental aspects of eating and drinking
improving the coordination of the swallow to achieve efficiency and safety
three psychology targets of feeding and swallowing treatment
emphasize the behavioral aspects of eating and drinking
decreasing resistance and fussiness when eating
following a consistent meal schedule
what qualifies a child for alternative and Supplemental Feeding?
those who cannot meet 80% of their caloric needs orally
who have not gained weight or who have continuously lost weight for 3 months
whose weight and height ratio is below the 5th percentile
whose feeding time is greater than 5 to 6 hours daily
Nasogastric tubes are used for ____-term feeding.
short
Gastrostomy (G) tubes are used for ____-term feeding
long
how is adult dysphagia identified?
bedside swallow examination and, if needed, a modified barium swallow (MBS) study
Definition of modified barium swallow (MBS) study
uses radiography and should be used only when it is necessary for further diagnosis
true or false: most instrumental procedures require a physician’s prescription if they are to be paid for by the insurance company
true
true or false: SLPs are typically responsible for actually conducting the instrumental dysphagia examination and interpreting the assessment
false - yes SLPs conduct the exam, but radiologist interpret the assessment
two types of treatment for Dysphagia
compensatory and restorative
Definition of compensatory treatment techniques
strategies that compensate for a specific problem in order to make swallowing safe and efficient
Definition of restorative treatment techniques
improve or restore swallow function
true or false: despite dietary modifications and compensatory strategies, some individuals are unable to meet their nutritional requirements orally
true
true or false: it is unusual for dysphagia patients to receive both oral intake and tube feedings
false - it is not unusual
