Chapter Five Flashcards
Infant Feeding and Early Development
Purpose of infant feeding:
Satisfies hunger
Provides nourishment for growth and development
Provides oral-sensory and oral-motor stimulation
Facilitates state regulation and maintain homeostasis
Provides calming and sense of well-being
Enhances bonding and interactions with caregiver
Serves as foundation for other functions, including speech
Anatomy Relevant to Infant Feeding
Oral anatomy of an infant is \_\_\_\_\_\_and different from that of an adult. 1. 2. 3. 4. 5.
Oral anatomy is well suited for _____ (extension-retraction movements of the tongue).
smaller
Oral cavity is small relative to tongue size.
Buccal pads (fat inside cheeks) are large.
There are no teeth.
Tongue rests anterior to alveolar ridge and contacts lower lip.
Temporomandibular joint does not allow much movement of jaw
suckling
_________of an infant is also smaller and different from that of an adult.
Pharynx is ____
____________are in close approximation.
Larynx is______the size of an adult’s and is _____in the hypopharynx.
High position of the infant larynx causes the ______to pass superiorly to the free margin of the soft palate and project into the nasopharynx.
Pharyngeal anatomy
short.
Tongue base, soft palate, and pharyngeal walls
one-third ;high
epiglottis
Pharyngeal anatomy is well suited for _________
_______are ideal for the suck-swallow-breathe synchrony.
the suck-swallow-breathe synchrony.
Head, chin, neck relationship
Oral phase—
nipple compression and generation of negative pressure occur for sucking
Pharyngeal phase—
Esophageal phase—
Pharyngeal phase—tongue base, velum, and posterior pharyngeal provide driving force for bolus transfer to esophagus
Esophageal phase—upper esophageal sphincter opens for bolus transfer to esophagus; lower esophageal sphincter opens to allow bolus entrance into stomach
Synchrony of Sucking, Swallowing, and Respiration
Coordination of sucking, swallowing, and breathing is crucial to…
Suck-swallow-breathe ratio during is generally _____
Decreased _____during feeding may be a problem for some medically compromised infants.
prevent aspiration (entry of material into the airway).
1:1:1 or 2:1:1.
ventilation
Changes with Growth and Maturation
Significant oral, pharyngeal, and laryngeal growth takes place in the first \_\_\_\_\_of life: 1. 2. 3. 4. 5.
Growth and maturation lead to changes in _______
2 to 3 years
- Oral cavity becomes larger with mandibular growth.
- Tongue tip moves back to under alveolar ridge.
- Teeth erupt.
- Pharynx elongates.
- Neuromuscular, particularly oral-motor function matures.
feeding and swallowing pattern.
Cleft Lip and Alveolus Only
Infant may have initial problems …
Inadequate _____may cause difficulty generating ______ for sucking.
achieving an adequate lip seal on the nipple.
lip seal
negative pressure
Cleft Palate Only
Depends on the ____of the cleft
Infant may be unable to generate …
Infant may be unable to find a ______for ______of the nipple.
Infant may experience ______
extent
negative pressure for suction.
hard palatal surface ; compression
nasal regurgitation.
After the Cleft Lip andPalate Repair
Postoperative recommendations ____among centers.
Some discourage ____following surgery and may recommend the use of ______
Some recommend __________
Some allow ______
vary
sucking; cup or spoon instead.
supplemental tube feeding for a short time.
unrestricted feeding after surgery.
Other Craniofacial Anomalies
Anomalies that can contribute to a feeding or swallowing problem:
Micrognathia (small mandible) (Pierre Robins Sequence)
Macroglossia (large tongue)
Pharyngeal stenosis (narrowing)
Vascular anomalies
Laryngeal cleft
Tracheoesophageal fistula
Cortical or cranial nerve involvement
Glossoptosis (posterior displacement of the tongue in the pharynx)
Midface retrusion: concave shaped face
Congenital heart or lung disease
Choanal atresia
Craniofacial Conditions
Conditions that often affect feeding and swallowing include the following:
Pierre Robin sequence
Moebius syndrome
Hemifacial microsomia
Feeding Methods, Modifications, and Facilitation Techniques
Most infants with a cleft are able to feed with ______
__________determines which feeding method and technique will be best.
simple modifications.
Infant’s performance during the initial feedings
Cleft Lip and Palate
Infant may have all the difficulties noted above, including these:
Difficulty achieving an adequate lip seal on the nipple
Inability to generate negative pressure for suction
Inability to find palatal surface for compression of the nipple
Nasal regurgitation
Breastfeeding
_______should be supported.
With cleft lip, breastfeeding is _______.
With cleft palate, _________.
Options with cleft palate include:
1.
2.
_______ should always be recommended if breastfeeding is not possible.
Breastfeeding trials
usually not a problem (press finger on lip to close cleft and help create negative pressure)
it is very challenging due to difficulties with compression and suction
- Supplemental nursing
- Modified nipples/bottles
Pumping breast milk
Modified Nipples
Characteristics to consider when choosing a modified nipple:
Pliability: how compliant is the nipple; inversely proportional to the infants oral motor skills
Shape: traditional, orthodontic (elongated),
Length
Hole type
Hole size
Nipples
Orthodontic nipple
Pigeon nipple (as illustrated here)
Ross® Premature Nipple
Standard traditional nipple
Specialized Nipple and Bottle Systems
Mead JohnsonTM Cleft
Lip/Palate Nurser
Ross® Cleft Palate Nurser
SpecialNeeds Feeder® (formerly the Haberman® Feeder)
Medela® SoftCup Feeder and Bottle
Mead JohnsonTM Cleft Lip/Palate Nursing System
Bottle and nipple unit, but can use any nipple with bottle
Straight, long, & firm nipple
Crosscut nipple
Pliability of bottle allows assistive squeeze to increase flow
Ability to monitor size of bolus being delivered by squeeze is poor
SpecialNeeds Feeder®
This bottle/nipple unit is relatively expensive.
It has a straight, moderate length, soft nipple
It delivers fluid by compression of nipple alone.
Nipple slit opening allows for adjustment of flow to three rates.
One-way valve decreases air intake.
Consider parent’s skills.
Medela® SoftCup System
Bottle/soft cup unit
Used for infants that cannot tolerate intraoral placement of nipple
Allows presentation of liquid in measured amounts
Angled Neck Bottle
Helpful…
Allows for…
Helpful when positioning has to be very upright
Allows for downward flow of milk without forcing baby to adapt extended head-neck position
Pigeon Nipple and Bottle
Nipple is “__” crosscut, with ….
Thinner side is for ___________ to extract liquid flow with compression.
The Pigeon nipple is _____
One-way valve allows for ________
Bottle is _____to allow for ________.
Flow rate can be adjusted with _______on bottle.
Y; one thin side and one thicker side.
positioning against infant tongue
larger (wider).
flow into nipple with no back flow.
pliable ;assistive squeezing
tightness of collar
Positioning the Infant
Semi-upright (______) is best.
1.
2.
3.
at least 60º
Facilitates control of jaw, cheek, lip, and tongue movements
Allows gravity to assist with swallowing
Helps prevent nasal regurgitation
Positioning the Nipple
Place nipple…
under palatal bone to aid nipple compression.
Pacing Intake
Fluid must be provided …
Feeder should modify pace when there are signs of stress: 1. 2. 3. 4. 5. 6.
in rhythm with the infant’s sucking compressions.
- Eye widening or changes in facial expression
- Decreased alertness
- Avoidance of feeding
- Coughing or choking
- Signs of excessive air intake
- Signs of fatigue
Pacing Intake
Flow can be regulated by:
Tilting nipple slightly upwards
Partially removing the nipple from the oral cavity
Oral Facilitation Strategies
Includes:
jaw and cheek support
Preventing Excessive Air Intake:
Increase the frequency of burping.
Burp infant at least once every ounce.
Managing Nasal Regurgitation
Feeder should:
Allow infant time to cough or sneeze to clear the nasal passage.
Ensure that the infant is in an upright position.
Use a slower flow nipple or slow the pace.
Consistency of Feeding Method
Infant should be fed in
the same position, with the same nipple and bottle, and same technique during each feeding.
Feeding obturator—
obturator—a prosthetic appliance which can be used in first few months to assist infant with cleft palate in feeding
IMAGE
Use of Feeding Obturators
Advantages:
1.
2.
Disadvantages: 1. 2. 3. 4.
- Keeps the tongue from resting inside the cleft
- Provides a solid surface so tongue can achieve compression of the nipple against it
- Expense
2Need for frequent replacement due to growth
- Retention issues
- Irritation of mucosa
Use of Feeding Obturators
Most craniofacial centers…
Most infants with cleft….
no longer use feeding obturators, as they feel they are unnecessary.
feed well with modifications.
Mouths of infants are essentially ______.
Infants with clefts have ….
Caregiver should …..
self-cleaning
fluids in cleft area and nose, which can cause infection.
cleanse the cleft and surrounding areas after feedings with a washcloth, gauze, or Toothette®.
Transitioning to a Cup
Consider when transitioning to a cup is developmentally appropriate (________).
_________can help with transition.
Most surgeons recommend …..
usually between 6 and 9 months
The Medela SoftCup™ feeder
weaning from bottle prior to palate surgery because nipple in the mouth and sucking could cause breakdown of repair.
Introduction of Solid Foods
Usually begun around ____, with _____and ____foods
Assist in transition by using appropriate _____________ to assist with clearance.
Rapid spoon-feeding or large spoonfuls can cause __________.
4 to 6 months; rice cereals and strained
positioning, small boluses, slow pace, alternating with liquid
more frequent nasal regulation and disorganized swallowing
Assessment and Management of Complex Feeding Problems:
1.
2.
3.
- Clinical assessment
- Videofluoroscopic Swallowing Studies (VFSS)
- Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Clinical Assessment
Should be performed by…
Assesses…
Determines…
a feeding specialist
infant’s ability to safely feed
effect of compensatory strategies on feeding performance
Videofluoroscopic SwallowingStudy (VFSS)
Also called _______
Performed by …
Allows visualization of ….
Can observe …
modified barium swallow
a radiologist and a speech-language pathologist
oral, pharyngeal, and esophageal phases of swallowing
aspiration, response to aspiration, nasopharyngeal reflux, and effect of compensatory strategies
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Involves…
Allows assessment of…
Provides info regarding…
Can clearly view…
Disadvantage is…
Involves the transnasal passage of an endoscope for viewing of the pharyngeal and laryngeal structures
Allows assessment of airway protection during swallowing
Provides information regarding sensory threshold in the pharynx and larynx
Can clearly view structures and management of secretions
Disadvantage is temporary loss of view when VP valve closes during the swallow
Interdisciplinary Feeding Team Evaluation
Severe cases should be evaluated by…
Feeding team may include the following members:
a team of feeding specialists.
Gastroenterologist
Nutritionist
Nurse
Speech-language pathologist
Occupational therapist
Behavioral psychologist
Otolaryngologist
Pulmonologist
Consulting radiologist
Alternative Feeding Methods for Severe Cases
Orogastric or nasogastric (NG) tube—for supplemental feeding
Gastrostomy (G) tube—for infants with abnormal oral reflexes or poor airway protection while swallowing
Summary
Ultimate goals of the feeding method are to provide:
Adequate nutrition and weight gain
Pleasurable experiences for infant and caregiver
Enhancement of bonding process
Sensorimotor stimulation for normal development
