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Dysphagia Exam 2 > Class #10 Evaluation of Infants and Children > Flashcards

Class #10 Evaluation of Infants and Children Flashcards

1
Q

Arvedson’s Criteria for Referral

________ in-coordination

Weak ____

__________ during feeding

Excessive ____ or recurrent ______during feeds,

New onset of feeding difficulty

Diagnosis of disorders associate with ______or ______

Severe ______or _______problems during feeds,

History of recurrent ____and feeding difficulty

Concern for possible ______during feeds

______ or decreased _____during feeds,

Feeding periods longer than ____ minutes and

Unexplained food _____and _____

A

Sucking and swallowing in-coordination

Weak suck

Breathing disruptions or apnea during feeding

Excessive gagging or recurrent coughing during feeds,

New onset of feeding difficulty

Diagnosis of disorders associate with dysphagia or failure to thrive

Severe irritability or behavior problems during feeds,

History of recurrent pneumonia and feeding difficulty

Concern for possible aspiration during feeds

Lethargy or decreased arousal during feeds,

Feeding periods longer than 30-140 minutes and

Unexplained food refusal and failure to thrive

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2
Q

Physiological
Respiration

Respiratory rate:

Newborns = Between ___breaths per minute

Highest when ____, lowest when ____

During feeding?

Oxygen _____: (SaO2)

Expressed as a _____

Normal infants >____

Pre-term babies ____ or above

A

30-60

awake; asleep

?

Saturation

percentage

95%

90%

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3
Q

Review: Infant States of Alertness

State 1:
State 2: 
State 3:  
State 4:  
State 5:  
State 6:
A 
State 1:  Deep Sleep
State 2:  Light Sleep
State 3:  Drowsy or semi-dozing
State 4:  Quiet Alert
State 5:  Active Alert
State 6:  Crying
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4
Q

Developmental Stages of Premature Babies

  1. ________: ( )
  2. ________: ( )
  3. _________: ( )
A
  1. “In-turning”: Younger than 32 weeks
  2. “Coming Out”: 32-35 weeks
  3. “Active Reciprocity”: 36 weeks to 40 weeks
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5
Q

“In-turning” Younger than 32 weeks:

A

Respond to environment in physiologic manner

Mainly in sleep state

Involuntarily jerk

Easily stressed

May need ventilator

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6
Q

“Coming Out”: 32-35 weeks

A

More frequently alert

Maintain color

Oxygen saturation

Begin feeding process

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7
Q

“Active Reciprocity”: 36 weeks to 40 weeks:

A

Capacity for self-arousal

Seek stimuli

Tolerate some stressful interactions

Maturation and tolerance of caregivers

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8
Q

State-related Stress Cues

Diffuse sleep or awake states with _____sounds, facial twitches, and _____smiling

Eye ____; roving eye movements

Strained _____or ____; silent crying

Staring

Frequent active _____

Panicked or worried _____: hyper-alertness

_____-eyed, strained alertness; lidded, _____alertness

Rapid state _____; frequent buildup to arousal\irritability and prolonged diffuse arousal

Crying

_____and inconsolability

______and _____

A

whimpering; discharge

floating

fussing or crying

averting

alertness

Glassy; drowsy

oscillations

Frenzy

Sleeplessness and restlessness

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9
Q

Clinical Evaluation

Published clinical assessments:

A

Arvedson, J., (1993)

Wolf & Glass

Palmer, Crawley & Blunco (1993)

Shaker, C. & Woida, A (2007)
Ross & Brown, 2003

Sheppard, J.

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10
Q

Infant Subsystems

A

Physiological

Motor System

State System

Attention System

Self-Regulatory System of states

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11
Q

Pre-Assessment History

Interpreting Feeding History:

A

Hand-Out: Clusters

APGAR Scales

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12
Q

Oral Reflexes

  1. In utero-life:
  2. Birth-life:
  3. 28 weeks- life:
  4. In utero-life:
  5. 32 weeks- 6 months:
  6. 17 weeks- 4 months:
  7. birth to 3-4 months:
  8. 3 weeks to 1-2 years:
  9. 28 weeks to 9-12 months:
A
  1. Gag
  2. Cough
  3. Transverse tongue
  4. Swallow
  5. Rooting
  6. Suckling
  7. Palmomental
  8. Santmyer
  9. Phasic bite
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13
Q

Review of large-motor reflexes

A

Plantar Grasp

Flexor withdrawal

Extensor thrust

Motor reflexes

Galant reflex

Asymmetric tonic reflex

Neonatal neck righting

Proprioceptive placing of legs

Neonatal positive support

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14
Q

Positive support reflex:

A

As the baby is bounced the legs straighten to support the weight

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15
Q

Asymmetrical Tonic Neck Reflex (ATNR)

A

As the head is turned, the arm and leg on the same side as the chin extend, and the other arm and leg flex.

Image

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16
Q

Oral-Motor Assessment

Neonatal Oral-Motor Assessment Scale (NOMAS Scale) Marjorie Palmer

Rates ____and ____skill

Sorts behaviors into:

A

jaw and tongue

Normal
Disorganized
Dysfunctional

17
Q

Instrumental EvaluationsAppropriate for Infants

A

Cardio-Respiratory Monitoring

Pulse Oximetry

Multi-channel pneumogram

Polysonogram/Ultrasound

Technitium Scan

Ph Probe

Videofluoroscopic Swallowing
Study

Pediatric Fiberoptic

Endoscopic Evaluation

Extracorporeal Membrane

Oxygenation (ECMO)

18
Q

Cardio-respiratory Monitoring

Gives numeric value and wave form tracing for ____ and _____

Strengths:

Limitations:

A

heart rate; respiratory rate

a) Quick status
b) Alarms if distressed
c) HR wave useful for brief changes

a) May not reflect brief changes
b) Movement artifacts

19
Q

Pulse Oximetry

External sensor monitors
_________

Strengths:

Limitations:

A

oxygen saturation

Strengths:

a) Non-invasive
b) Helps with suck-swallow –breath coordination
c) More reliable than color change

Limitations:

a) Affected by movement
b) Brief period of time
c) Can’t see brief changes

20
Q

pH Probe

Sensor inserted…

A

through the nose to an area above the LES to continuously measure acidity

21
Q

pH Probe

Strengths:
a)
b)

Limitations:
a)
b)
c)

A

a) Measures continuously over 24-hour period
b) Measures length and frequency of acid reflux

a)Does not measure 
alkaline reflux (Formula)

b) May not record how high reflux travels up esophagus
c) Must last 10 seconds to be counted

22
Q

Nuclear Scintigraphy

______Scan

________ given with feeding and imaged each _____for _____after _____

A

Technetium

Radionuclide isotope

30 seconds

1 hour

feeding

23
Q

Nuclear Scintigraphy

Strengths:

Limitations:

A

Measures both acid and
alkaline reflux

Evaluates gastric emptying

Evaluate height of reflux

Relatively low radiation
exposure

Limitations:
May be oversensitive

GER measured for only 1 hour

Not continuous- don’t know how long episodes last.

24
Q

Extracorporeal Membrane Oxygenation (ECMO)

A

Images

25
Q

Pediatric VFSS

Reasons to do a VFSS/MBS?

______safety issues

________ the child

_______

Consistencies/Order:

A

Radiation

Preparing

Positioning

Liquid
Thickened Liquid
Pureed
Pudding Thick
Chewable Foods
26
Q

Issues Unique to Assessing Older Children

1.
a)
b)
c)
d)
e)

2.
a)
b)

A
  1. Postural Issues/ Seating
    a) Reclining high chair
    b) Upright high chair
    c) Reclining car seat
    d) Booster seat
    e) Tumble form seats

Food presentation

a) Adaptive equipment
b) Self-feeding goals

27
Q

Clinical Evaluation - Older Children

1.
2.
3.

A
  1. Case History
  2. Pre-feeding activities/materials (pg. 224)
  3. Oral-mechanical Examination
28
Q

Pre-feeding activities/materials:

A

Chewy tubes

Mini-massagers

Toothettes

Warm washcloths

Food-shaped toys

Whistles, kazoos, etc.

Bubbles, cotton balls to blow, etc.

29
Q

Oral-mechanical Examination

A

Groher & Crary, (Box II-6 pg. 225)

The Source for Pediatrics

MOST Exam (Marsalla)

30
Q

Observation of the feeding process

Special considerations:
Infant:
Toddler:
Older Child:

Symptoms (red flags):

Family Goals:

A

xx

31
Q

Article Review

Suiter and Leder (2010)

A

56 children from 2-12 years to determine effectiveness of 3 ounce water test in determining dysphagia

Children were examined with FEES and then immediately given the 3 ounce water test

All who passed the water test did not aspirate on FEES

32
Q

Other articles

A

DeMatteo (2005)

Newman (2001)

Arvedson (1996)

Dysphagia Exam 2 (5 decks)

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