Cleft 5 Flashcards
Purpose of infant feeding:
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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
How is the oral anatomy of an infant different from that of an adult?
- Oral anatomy of an infant is smaller and different from that of an adult.
1. Oral cavity is small relative to tongue size.
2. Buccal pads (fat inside cheeks) are large.
3. There are no teeth.
4. Tongue rests anterior to alveolar ridge and contacts lower lip.
5. Temporomandibular joint does not allow much movement of jaw
-Oral anatomy is well suited for suckling (extension-retraction movements of the tongue).
Anatomy Relevant to Infant Feeding
How is the pharyngeal anatomy of an infant different from that of an adult?
- Pharyngeal anatomy of an infant is also smaller and different from that of an adult.
1. Pharynx is short.
2. Tongue base, soft palate, and pharyngeal walls are in close approximation.
3. Larynx is one-third the size of an adult’s and is high in the hypopharynx.
4. High position of the infant larynx causes the epiglottis to pass superiorly to the free margin of the soft palate and project into the nasopharynx.
Anatomy relevant to infant feeding
- Pharyngeal anatomy is well suited for the suck-swallow-breathe synchrony.
- Head, chin, neck relationship are ideal for the suck-swallow-breathe synchrony.
Physiology Relevant toInfant Feeding
**oral phase-
pharyngeal phase
esophageal phase
- Oral phase—nipple compression and generation of negative pressure occur for sucking
- 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..
- _____ ratio is…
- decreased…
- Coordination of sucking, swallowing, and breathing is crucial to prevent aspiration (entry of material into the airway).
- Suck-swallow-breathe ratio during is generally 1:1:1 or 2:1:1.
- Decreased ventilation during feeding may be a problem for some medically compromised infants.
Changes with Growth and Maturation
-Significant oral, pharyngeal, and laryngeal growth takes place in the first... 1. 2. 3. 4. 5.
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- Significant oral, pharyngeal, and laryngeal growth takes place in the first 2 to 3 years of life.
1. Oral cavity becomes larger with mandibular growth.
2. Tongue tip moves back to under alveolar ridge.
3. Teeth erupt.
4. Pharynx elongates.
5. Neuromuscular, particularly oral-motor function matures.
-Growth and maturation lead to changes in feeding and swallowing pattern.
Cleft Lip and Alveolus Only
- Infant may have initial problems achieving
- inadequate…
- Infant may have initial problems achieving an adequate lip seal on the nipple.
- Inadequate lip seal may cause difficulty generating negative pressure for sucking.
Cleft Palate only
- Depends on the …
- Infant may be unable to …
- Infant may be unable to …
- Infant may experience…
- Depends on the extent of the cleft
- Infant may be unable to generate negative pressure for suction.
- Infant may be unable to find a hard palatal surface for compression of the nipple.
- Infant may experience nasal regurgitation.
Cleft Lip and Palate
- Infant may have all the difficulties noted above, including these:
1. Difficulty achieving…
2. Inability to generate …
3. Inability to find …
4. ___ ___
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
After the Cleft Lip andPalate Repair
- __ ___vary among centers.
- Some discourage …
- Some recommend …
- Some allow ….
- Postoperative recommendations vary among centers.
- Some discourage sucking following surgery and may may recommend the use of cup or spoon instead.
- Some recommend supplemental tube feeding for a short time.
- Some allow unrestricted feeding after surgery.
Other craniofacial anomalies
Anomalies that can contribute to a feeding or swallowing problem:
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Anomalies that can contribute to a feeding or swallowing problem: Micrognathia (small mandible) 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 Congenital heart or lung disease Choanal atresia
Craniofacial conditions
-Conditions that often affect feeding and swallowing include the following:
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…
- Infant’s performance during the …
- Most infants with a cleft are able to feed with simple modifications.
- Infant’s performance during the initial feedings determines which feeding method and technique will be best.
SLPs make recommendations, alter feeding
Breastfeeding
- Breastfeeding trials should be supported.
- With cleft lip, breastfeeding is usually not a problem.
- With cleft palate, it is very challenging due to difficulties with compression and suction.
- Options with cleft palate include:
1. Supplemental nursing (insert tube, pace tube so milk flows)
2. Modified nipples/bottles - Pumping breast milk should always be recommended if breastfeeding is not possible.
Modified Nipples
Characteristics to consider when choosing a modified nipple:
Characteristics to consider when choosing a modified nipple:
Pliability - (compliancy - correlated to motor system - boiling water to make it softer)
Shape - (traditional, orthodontic)
Length - (reach to soft palate, if only hard palate cleft)
Hole type - (cross cut [doesn’t drip], traditional round)
Hole size - ()
Nipples
types
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- Orthodontic nipple
- Pigeon nipple (as illustrated here)
- Ross® Premature Nipple
- Standard traditional nipple
