Class #4 Normal Swallowing in Infants Flashcards
Definitions unique to pediatrics
Ankyloglossia:
Apnea:
Atelectasis:
short frenum
stopping of breath
alveoli in lungs don’t expand or collapse
Atresia:
Atresia choanae:
absence of normal opening
posterior nasal cavity not open
Bradycardia:
Bronchopulmonary dysplasia:
drop in heart rate below 90 bpm
chronic lung disorder seen in neonates- requires ventilator
Choelstatic jaundice:
Cyanotic:
caused by bile in liver
bluish color due to lack of oxygen
Embryogensis:
Gavage feedings:
development of embryo
feeding through tube
Hypoplasia:
Mandibular hypoplasia:
incomplete development of tissue or organ
incomplete development of mandible
Microcephaly:
Micrognathia:
small head
small mandible
Moebius sequence:
Neonate:
sequence of events in utero, damage to CN and face
newborn
Phenyldetonuria (PKU):
Pierre Robin Syndrome:
metabolic disorder at birth
symptom cluster: small mandible, tongue, clefts of hard palate
Spina bifida:
Subglottic stenosis:
defect in spinal column
narrowing or trachea
Tachycardia:
Tachynpea:
elevated heart rate
elevated level of breathing
Toxemia:
Tracheomalacia:
toxic products in blood
softening of tracheal cartilages
Transitional feeding:
stage of eating from liquid to solid
Embryonic Development
____ stages of development
Embryonic Period: _______
Fetal period-_________
Fetus viable after ___ weeks
After _________can survive with medical support
______week crucial to _____ and ______ development
(cranial nerves formed _________)
23
end of 8th week
9 weeks to birth
23
25-29th week
4th-8th
neural and organ development
5th-6th week
Swallowing Development
Early in 4th Week: _________ develops
Non-nutrative sucking- __________, seen in “premies” at ____weeks
12th-13th week- ________
Pharyngeal apparatus
11th-12th weeks; 27-28
swallows amniotic fluid
Rooting reflex by ______
Trigeminal nerve, taste buds- ________
Smell by _____
32 weeks
12-13 weeks
28-29 weeks
Birth- learns ___________
Stable pattern by _______ weeks (necessary for breast or bottle feeding)
suck-swallow/breathe patterns
34-36
Premature Infants
2 major prerequisites:
1.
2.
Arvedson says….
- Strong, rhythmic non-nutrative suck (2 per second) [Sucking air, thumb, pacifier, etc)
- Stable airway
most achieve oral feeding at 34-37 weeks, some strong babies at 32 weeks.
Normal Anatomy
1. 2. 3. 4. 5. 6. 7.
- Hyoid is high in the neck
- Gentle curve in pharynx
- Larynx more superior and anterior
- Tongue relatively larger-fills oral cavity
- Sucking pads stabilize cheeks
- Small mandible makes tongue seem large
- Nasal breathers
In first years
Breathe through ________
_________ disappear
_____ elongates
_______ increases
Angle changes between ________
mouth and nose
Sucking pads “fat pads/cheeks”- help stabilize the nipple
Neck
Laryngeal vestibule
naso- and oro-pharynx
Developmental Milestones
Sucking vs. suckling:
a)
b)
c)
a) Initially suckle-, 2nd-3rd trimester
b) Backward/forward motion
c) Lips are loose
Develop sucking pattern -____________
a)
b)
6-9 months old
a) Tongue moves up and down
b) More organized expression of milk
Development of functional oral motor, swallowing, & respiration
Milestones:
Textbook Table 3-1;
The Source (pg. 19-24) and
Arvedson, (pg. 378)
Nutrative vs. non-nutrative suckling -
a)
b)
c)
sucking air or fist
a) More repetitive
b) 6 per second
c) 6-8 per swallow
Nutrative-
a)
b)
c)
bottle or nipple
a) Initially a long burst of sucks changing to more intermittent
b) One per second
c) Young infants: 1:1 suck to swallow; older 2-3 sucks per swallow
Infant Swallowing Reflexes
1. 2. 3. 4. 5. 6.
- Gag
- Phasic bite:
- Tongue protrusion
- Rooting: searching for food
- Suckling
- swallowing
Apgar Scores
__ skills
Score ____
Interpreted as:
Poor=
Fair=
Good=
4
0,1,2
Poor= 0-3 Fair= 4-7 Good= 7-10
Early FeedingTransitional Feeding
See hand-outs from The Source
Infant Oral reflexes present at term
Gag
Stimulus:
CNs involved:
Age of disappearance:
touch posterior tongue or pharynx
IX, X
persists
Phasic bite
Stimulus:
CNs involved:
Age of disappearance:
pressure on gums
V
9-12 months
Tongue protrusion
Transverse
Stimulus:
CNs involved:
Age of disappearance:
touch tongue or lips
XII
4-6 months
6-9 months
Rooting
Stimulus:
CNs involved:
Age of disappearance:
touch corner of mouth
V, VII, XI, XII
3-6 months
Suckling
Stimulus:
CNs involved:
Age of disappearance:
nipple in mouth or stroking top of tongue
V, VII, IX, XII
6-12 months
Swallowing
Stimulus:
CNs involved:
Age of disappearance:
Bolus of food in pharynx
V, VII, IX, X, XII
Perisists
Apgar score at ___ and ___ minutes following birth
Attributes: 1. 2. 3. 4. 5.
1 and 5
- Heart rate
- Respiratory effort
- Muscle tone
- Irritability
- Color
States of alertness 1. 2. 3. 4. 5. 6.
- Deep sleep: the baby is asleep and has a regular respiratory pattern. Eyes are closed with no eye movements. Responses to external stimuli are delayed.
- Light sleep: Eyes are closed, though rapid eye movements may be noted beneath closed eye lids, eyes may open occasionally. Low level motor activity present. Irregular respiration.
- Drowsy or semi-dozing: Infant may look dazed and unavailable. Activity level is variable.
- Quiet alert: Infant is strongly focused on a stimulus. There is a bright almost gazed look. Motor activity is minimal.
- Active alert: Considerable motor activity, including thrusting of extremities. Often responds to a stimuli with more movement. Brief fussy periods.
- Crying: Crying intensely. Difficult to break through the crying with any stimulus.
