Chapter 9 Flashcards
- Are children with low birth weight likely to swallow normally if they have no other neurological or muscular problems?
Yes, they are
- Are children with low birth weight NOT at risk for penetration or aspiration at birth if they do not have neurological or neuromuscular disorders?
No, it is not always obvious if the child has a neurological problem, in addition, a child born with low birth weight may be unable to effect a normal cough or throat clear following penetration
- What percentage of children born w/ cerebral palsy may have a swallowing problem?
Up to 89%
- Does the pediatric feeding and swallowing team include the parent?
Yes, it does
- Is it true that gastroesophageal reflux is primarily an adult disorder and rarely found in children?
It is false, it can happen to anyone and many of the gastrointestinal problems seen in infants are related to other conditions and diseases
- In the newborn, are the tongue and epiglottis approximate to each other?
Yes, they are
- Is the small oral cavity in the infant part of the reason that children have so much difficulty swallowing at or shortly after birth?
No, the small mouth brings structures together to make sucking easier
- At what age do the respiratory and digestive pathways of humans separate?
2-3 years
- T/F: The FEES exam should be avoided in children as it is an invasive procedure and likely to cause injury to the child due to movement.
False, infant FEES exams are completed about 97% of the time
- Does data suggest that GERD is rare in infants?
No, it doesn’t. Data suggests that GERD may be a strong contributor to swallowing problems in infants w/ Down Syndrome and other syndromes
- Is the larynx the major organ that responds reflexively to acts of swallowing?
It is
- Why is the esophagoglottal closure reflex essential in the newborn?
The esophagoglottal closure reflex protects against regurgitation or retrograde bolus transit
- Should radiological exams of young children be avoided because of the risk of radiation exposure?
No, radiation has some risk but a modified barium study may be the best way to determine if the child can swallow safely
- Will a newborn with an abnormal sucking pattern usually have a swallowing problem?
Yes, they will
- Is a small amount of liquid in the lungs of a healthy infant generally not a concern for the swallowing specialist?
No, it IS a concern. An infant’s lungs are small and fragile and cannot handle even a small amount of liquid without serious effects
- Has the true incidence of swallowing problems been defined? How about the true incidence of feeding problems?
Neither of these incidences has been well-defined in infants
- Is premature birth a risk factor for a swallowing problem?
- Yes, prevalence of pediatric dysphagia is increased due to premature birth
- Also it is a risk factor for swallowing problems in as many as 37% of children
- What are the three mechanisms accounting for glottal closure?
- the laryngeal adductor reflex
- the esophagoglottal reflex
- the pharyngoglottal reflex
- Compared to an adult, the infant’s tongue is _____ relative to the size of the oral cavity
-large
- T/F: Regurgitation and vomiting in the infant are clear signs of an existing swallowing disorder requiring either a FEES or a videofluroscopic exam.
-false, regurgitation/vomiting is common in infants due to a rapid rise in esophageal pressure and the relatively small stomach
- Overly large tongue is an indicator of which disorder?
Down Syndrome
- Episodes of respiratory insufficiency are an indicator of which disorder?
Pierre Robin Syndrome
- Oral motor dysfunction is an indicator of which disorder?
Cerebral palsy
- Multiple physical and mental disorders are indicators of which disorder?
Fetal Alcohol Syndrome
- Behavioral feeding problems are indicators of which disorder?
Autism
- The suck reflex is assessed by…
-feel elevation of cricoid during swallow
- The rooting reflex is assessed by…
-Stroking the infant’s cheek
- The gag reflex is assessed by…
-Touching back of tongue with tongue blade
- The swallow reflex is assessed by…
-Feel pull toward the palate with finger
- Epidemiological data on the incidence of feeding and swallowing problems…
Lacks precision due to confusion of diseases with symptoms and terminology
- The newborn anatomy is different from an adult because…
The tongue and epiglottis are approximate to each other
32-Sucking motion develops in the child because…
C-The oral cavity increases in size
- The reflex responsible for protecting the airway during swallowing is the…
Laryngeal adductor reflex
- The early infant reflex that is assessed by placing the finger on the area of the cricoid cartilage and feeling upward movement when the child is stimulated to swallow is the…
-Swallow reflex
- The sequence for a normal swallowing event for an infant would be:
Suck, swallow, breathe
- The incidence of swallowing disorders in the newborn and infant are confounded by numerous issues relating to the birth, the mother, and the family history. Review those issues that relate to risk factors to both short-term and long-term swallowing disorders.
- if something goes wrong during the pregnancy/birth or there is a genetic component, sometimes newborns can develop a swallowing disorder
- it is a temporary complication if the disorder can go away in time with proper treatment
- if this issue is something such as a syndrome or a long term disease then, it can affect the newborn long term
37A-What is the laryngeal adductor reflex and what is its role in swallowing?
- a vago-cagal reflex necessary for airway protection
- organized by the brainstem
- consists of early R1 and late R2 responses that prevent aspiration by causing thyroarytenoid and lateral cricoaryntenoid muscle contraction and thus vocal fold closure
- one of the 3 glottal reflexes
37B- What is the esophageal closure reflex and what is its role in swallowing?
- the role of the hyoid bone and quantitate its movement during belching.
- esophageal distention by either air or balloon evokes a glottal closure
- one of the 3 glottal reflexes
37C- What is the pharyngeal closure reflex and what is its role in swallowing?
- injection of small amounts of water into the pharynx causes brief vocal fold closure
- slow introduction of graded amounts of fluid into the pharynx causes partial adduction of the vocal folds, but rapid injection results in complete closure of cords
- one of the 3 glottal reflexes
- For a child with cerebral palsy, one year of age, the MBS would be preferred to the FEES under what conditions? For the same child, would a FEES exam be the better exam and why?
- FEES is preferred when cerebral palsy is more severe due to the fact that it requires minimal patient cooperation
- MBS is preferred when a more accurate reading is required. This test involves more patient cooperation and exposes the child to radiation so it should only be used when absolutely necessary
- What are three criteria for pursuing an instrumental swallow exam in an infant or young child?
- exam will give additional info needed for diagnosis and formation of a treatment plan
- the infant or child will behave appropriately during the exam
- the exam team is fully competent to provide a safe testing environment for the child, including children with special needs. If all requirements are met then the instrumental exam may be arranged. Above all else, priority is placed on maintaining a safe swallow throughout the testing procedure
- What are 6 advantages of doing a FEES exam over a videofluoroscopic exam? (be able to name 4 ideally)
- it can test effects of therapeutic maneuvers
- it can detect aspiration from oral secretion
- no radiation
- can be performed on children at 1month
- requires only limited patient cooperation
- uses familiar foods makes the testing smoother
