Chapter 4, Class 6

Question 1

Which of the following cases below illustrate maternal conditions could impact the health of an infant or lead to premature delivery? (Choose all that apply.)

Answer 1

1) This mother is a smoker, drinks alcohol daily and has a history of cocaine abuse. (YES)

XNO2) This mother has waited until she was 33 years old to start a family. She is concerned because she is a bit overweight (about 175 lbs.) already.

3) This mother has had Diabetes (Type I) since her teens but watches her diet closely. She has been diagnosed as having low iron content during a recent blood tests. (YES)

XNO4) This mother had rubella (measles) as a child as well as several bouts with strep throat when she was in grade school.

Question 2

What does the acronym GERD stand for?

Answer 2

Gastro-esophogeal reflux disease

Question 3

Unresolved GERD can lead to recurrent aspiration and pneumonia in an infant and impair ability to thrive.

Answer 3

True

Question 4

What is meant by the term “hematemesis” ?

Answer 4

Blood that is noted in the material that is spit up by an infant who has chronic reflux with complications.

Question 5

According to your textbook, cleft palate is a rare disorder occurring in only 1 out of 100,000 live births.

Answer 5

False

Question 6

Which of the following syndromes can be associated with cleft palate? (Choose all that apply.)

Answer 6

Pierre Robin syndrome
Down syndrome
Mobius sequence (syndrome)
Fetal alcohol syndrome
XXHirschsprung's Disease

Question 7

You are working with an 8 year old child who has a diagnosis of mild Autism Spectrum Disorder. His mother is very concerned because he will not eat raw vegetables or fruits and refuses to drink milk. His favorite foods are mashed potatoes and gravy, vanilla pudding and oatmeal. How would you describe his problems?

Answer 7

Oral hypersensitivity with problems concerning textures of foods and strong flavors.

Question 8

Although adults with TBI exhibit a high incidence of swallowing and feeding problems, infants and children with TBI do not usually have feeding problems.

Answer 8

False

Question 9

In their article regarding the impact of NG tubes on dysphagia, Leder & Suiter (2008) found that ________.

Answer 9

the presence of an NG tube did not effect swallowing success of lead to increase aspiration events.

Question 10

According to Langmore, et al. (1998), the top three predictors of aspiration pneumonia are_____.
(select three)

Answer 10

number of decayed teeth the patient exhibits

whether or not they can perform oral care procedures independently.

whether or not they are dependent on someone to help feed them or can the person feed himself/herself.

Question 11

According to Ault (1998), which of the following symptoms are commonly seen in older children with unresolved GER? (Choose all that apply.)

Answer 11

Heartburn

Recurrent respiratory infections (like pneumonia)

Regurgitation of stomach contents

Question 12

Ault calls the ______test the ‘gold standard’ for diagnosis of GER in infants.

Answer 12

pH monitoring probe

Question 13

Maternal Conditions

Answer 13

–	Poor diet
–	Multi-parity (+3 living children)
–	Abnormal weight (200 lbs.)
–	Smoking
–	Alcohol or drug abuse
–	Medical disorders:  
•	Diabetes 
•	Cardiac disease  
•	Preeclampsia
–	Corticosteroids 
–	Anemia

Question 14

• Maternal effects, cont.

– Infections:

Answer 14

• Toxoplasmosis
• Rubella
• Cytomegalovirus
• Herpes
• Sexually transmitted diseases
• Streptococcus

Question 15

• Intrapartum:

Answer 15

–	Preterm labor
–	Medications
–	Abruptio placentae,
–	Placenta previa,
–	Umbilical cord prolapse
–	Breech delivery
–	Shoulder dystocia
–	Ceasarian delivery
–	Obstetric analgesia
–	Obstetric anesthesia

Question 16

• Prematurity

Answer 16

• Before 37 weeks- preterm
• 12% of all US births are premature
• 2% less than 32 weeks
• Often multiple births are premature
• 57% twins; 93% triplets
• Viable at 23 weeks
• Low weight (normal weight 2500-3999 grams)

Question 17

• Potential Problems in Newborns

Answer 17

–	Respiratory
–	Cardiovascular
–	Neurologic
–	Hematologic
–	Nutritional 
–	Gastrointestinal
–	Metabolic
–	Renal
–	Temperature regulatory
–	Immunologic
–	Opthalmalologic

Question 18

• Special Problems

– Necrotizing Enterocolitis (NEC)

Answer 18

• Infection or decreased blood supply to the intestine
• Variable severity
• Causes not well known
• Restricted from oral feedings
• Signs and symptoms
• Long-term effects

Question 19

• Special Problems

– Gastroesophogeal Reflux/ Disease (GER/GERD)

Answer 19

• Flow of stomach contents back into esophagus
• GER Common in premature infants and others
• GERD = pathological or complicated
• Respiratory compromise
• Treatments
• Positioning
• Medications

Question 20

• Fistulas

Answer 20

–	Tracheoesophageal Fistula and Atresia (TEF)
–	Esophageal Fistula
•	Occur early in first trimester
•	Five variants
•	Clinical signs
•	Requires surgical intervention
•	Post operative concerns

Question 21

• Respiratory Disorders

Answer 21

Respiratory Distress Syndrome- RDS (Hyaline Membrane Disease)
• Usually seen with prematurity
• Treatment:
• Continuous positive airway pressure (CPAP)-can’t feed
• Positive end-expiratory pressure (PEEP)
• Surficant replacement tx, oxygen, ventilation
• Complications long-term: bronchopulmonary dysphasia
• Oral and pharyngeal abnormalities
• Long-term tube feeding

Question 22

– More Respiratory problems

Answer 22

Transient Tachypnia (TTN)
•	Cause unknown
•	Usually temporary with good prognosis
•	Probably poor clearance of lung fluid during birth
•	Signs:  Breathe rapidly, respiratory distress, cyanosis,
•	Subcostal retractions, nasal flaring, 
•	Treatment:  oxygen
•	Can’t feed on CPAP

Question 23

– Apnea

Answer 23

• Cessation of breathing
• More than 20 seconds
• Also shows bradycardia
• Premature infants: apneic periods of 5-10 seconds then 5-10 seconds of rapid breathing
• At least 25% of premies (below 1800 grams/34 weeks) have at least one apneic episode; all infants less than 28 weeks)
• Usually gone by 34-35 weeks or more
• Causes: CNS versus obstructive
• Immature chemocontrol
• Also: infections, metabolic disorder, impaired oxygenation system, maternal drugs, intracranial lesions, poor temperature regulations and GERD
• Treatment: Monitoring + stimulation
• Medications

Question 24

– Broncho-pulmonary Dysplasia (BPD)

Answer 24

• Inflammation and Scarring of
• Seen in premies
• Abnormal development of the lung tissue
• Causes:
• Neurological Disorders

Question 25

• Microencephaly

Answer 25

``` – Hydrocephalus – Intracranial Hemorrhage – Seizures – Periventricular Leukomalacia – Birth injuries ```

Question 26

• Cardiovascular Disorders

Answer 26

– Cardiac septation – Patent ductus arteriosus – Tetralogy of Fallot – Truncus arteriosus

Question 27

• Congenital Anomalies | – Cleft lip and palate

Answer 27

* Cause: Failure of mesenchymal masses in medial nasal and maxillary prominences to join * Incidence= 1 in 700 live births * More boys than girls * Many associated difficulties: * Many different syndromes Post-surgical complications

Question 28

• Pediatric Feeding disorders

Answer 28

• Inability to consume sufficient calories for optimal grown and development

Question 29

• Signs of problematic Eating

Answer 29

– Poor weight gain – Coughing, choking, or gagging during meals – Problems with vomiting – History of a traumatic choking incident – History of eating and breathing coordination problems with ongoing respiratory issues – Inability to make the transition to baby food purees by 10 months – Inability to accept table food solids by 12 months – Inability to make the transition from breast to bottle to cup by 16 months – Has not bee weaned from baby foods by 16 months – Aversion or avoidance of all foods of specific texture or food groups – Food range of fewer than 20 foods – Crying or arching by the infant at most meals – Family fighting about food and feeding – Repeated parental reports that the child is difficult for everyone to feed – Parental history of an eating disorder with a child not meeting weight goals (Groher & Crary , 2008, pg. 57)

Question 30

• Typical Feeding Development/ Disorders

Answer 30

– Review from last session – Hand-outs from The Source for Pediatrics – Textbook; Table 4-2, Pages 58-64

Question 31

• Medical Impact on Feeding

Answer 31

``` – Prematurity – Gastrointestinal Disorders – Esophogitis – Eosinophilic Esophagitis (EE) – Celiac Disease – Others: • Hirschsprung’s Disease, cyclic vomiting syndrome, gastroparesis, intestinal pseudo-obstruction, irritable bowel syndrome, dyspepsia ```

Question 32

• Cardiac and Respiratory Conditions

Answer 32

– Disorders of the head and neck – Allergies • 2-2.5% of population has food allergies • 8 foods make up 90%: • Peanuts, tree nuts, mild, eggs, wheat, soy, fish, shellfish

Question 33

• Sensory Impact on Feeding

Answer 33

– Sensory modulation problems – Sensory registration problems – Sensory defensiveness/hypersensitivity – Hyposensitivity

Question 34

– Autism Spectrum Disorders

Answer 34

* 62% have food selectivity problems | * GERD/ Constipation

Question 35

– Cerebral Palsy

Answer 35

* Tonic Bite Reflex | * Undernourishment

Question 36

– Brain Injury

Answer 36

* 30-60% children with TBI have feeding problems | * Oral motor dysfunction, self-feeding problems, frontal lobe involvement

Question 37

– Down Syndrome

Answer 37

* 80% have feeding difficulties | * Low muscle tone

Question 38

• Myofacial Anomalies

Answer 38

– Tongue Thrust | – Video Presentation

Question 39

Cleft Palate Syndromes

Answer 39

``` Kabucki Syndrome Mobius Syndrome Pierre Robin Syndrome CHARGE Beckwith-Wiedemann syndrome Goldenhar’s syndrome Apert’s syndrome Treacher-Collins Syndrome Freeman-Sheldon syndrome Down Syndrome ```

Question 40

– Eosinophilic Esophagitis (EE)

Answer 40

• Eosinophilic esophagitis is an inflammatory condition of the esophagus that affects both children and adults, and men more than women. • Eosinophilic gastroenteritis may be due allergy to an as yet unknown food allergen. • The major symptom in adults with eosinophilic esophagitis is dysphagia (problems swallowing) for solid food. • Eosinophilic esophagitis stiffens the esophagus so that solid foods have difficulty passing through the esophagus and into the stomach. • Other common causes of dysphagia for solid food are esophageal strictures and Schatzki rings. • The diagnosis of eosinophilic esophagitis usually is made during an endoscopy (EGD), performed for the evaluation of dysphagia. The diagnosis is confirmed by biopsy of the esophagus. • The treatment of eosinophilic esophagitis is with proton pump inhibitors and swallowed fluticasone propionate. --Gentle esophageal dilatation is used when meditations fail to relieve dysphagia.

Question 41

• Hirschsprung's disease

Answer 41

is a blockage of the large intestine due to improper muscle movement in the bowel. It is a congenital condition, which means it is present from birth