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NICU Kelly Escamila > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What infant oral/pharyngeal anatomy is present (<6 mths)?

A

Sucking pads present in cheeks.
Tongue is larger in relation to oral cavity.
Jaw is smaller in relation to oral cavity.

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2
Q

What is the functional difference in infant anatomy (<6 mths)?

A

Sucking pads decrease size of oral cavity.
Provide structure and stability to cheeks.
Tongue decreases the size of the oral cavity.
Oral cavity is filled by the oral tongue.

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3
Q

When do sucking pads disappear by?

A

4-6 months

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4
Q

Infant oral/pharyngeal anatomy ~6 months.

A

Velum and epiglottis in contact with each other at rest and during oral phase (secondary to epiglottis’ elevated position)
Epiglottis is shorter narrower, softer, and projects posteriorly at an ~45’ angle (close to horizontal position).

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5
Q

What is the functional difference in ~6 mths oral/pharyngeal anatomy.

A

Provides an additional “valve” for airway protection by closing off oral cavity.
Provides an additional “valve” for airway protection.

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6
Q

What is hyolaryngeal excursion?

A

Elevation and protrustion of the hyoid to close airway during the swallow.

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7
Q

Where is the hyoid located in an infant?

A

C2-C3

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8
Q

Where is the hyoid located in a 5 year old child.

A

C4-5.

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9
Q

What is the infant oral/pharyngeal anatomy?

A
  • Proportionally larger head relative to body size.
  • Weak head and neck muscles.
  • Larynx located more anterior and higher in the neck close to base of epiglottis.
  • Hyoid bone sits more anterior and higher.
  • Swallow reflex triggered near level of the valleculae.
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10
Q

What is the functional difference for infant oral/pharyngeal anatomy?

A
  • Infants unable to hold heads up independently.
  • Additional airway protection secondary to position.
  • Anterior laryngeal excursion.
  • Pharynx shorter and swallow is triggered in a lower position.
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11
Q

Who do all nutrition changes need to be administered or approved by?

A

A registered dietician or physician.

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12
Q

Who is the only one who can change a child’s tube-feeding diet and feeding schedule?

A

A registered dietician or doctor.

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13
Q

How are SLP’s involved in the team for feedings?

A

We guide the child through the transition from enteral feedings to a PO diet.

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14
Q

What are alternatives for oral nutrition?

A

High Calorie Diet

Non-Oral Nutrition

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15
Q

What is a high calorie diet for an infant?

A
  • Increase calories per ounce
  • breast milk and standard formulas (typically 20 cal/oz)
  • Increase to 22-26 cal/oz.
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16
Q

Types of enteral feeding methods

A 
Orogastic Tube (OG)
Nasogastric Tube (NG)
Gastrostomy Tube (G)
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17
Q

Describe an OG tube.

A

Tube down mouth to stomach.

  • temporary
  • noxious to baby/trigger gag response
  • Used if nasal blockage/can’t do NG tube
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18
Q

Describe an NG tube

A

Tube down nose to stomach

  • temporary
  • most common short-term feeding method
  • max use is usually 3-4 weeks except with micro premies
  • Can be problem if nasal blockage or narrowing exists
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19
Q

Describe a G-tube

A

Inserted through abdominal wall directly to stomach

  • port/button from belly area held in place by balloon in the inner wall of stomach
  • Semi-permanent
  • Replaced every 6-12 mths
  • placed if can’t get oral feedings by 40 weeks and keep in NICU
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20
Q

What types of enteral feeding options are there?

A

Bolus Feedings via gravity
Bolus Feedings via Pump
Continuous Drip Feedings

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21
Q

Describe a gravity bolus feeding.

A

Formula poured into large syringe and drains via gravity. Typically within 10-15 minutes every 3-4 hours in order to feel full/satiated quickly and hungry over time.

Can feed off of biological cues

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22
Q

What is a negative to gravity bolus feeding?

A

Some children with GI problems are unable to tolerate being fed so quickly.

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23
Q

Describe bolus feeding via pump.

A

Electric pump calibrated for amount over time. Usually 30-90 minutes.

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24
Q

What are the pros of pump feedings?

A
  • Good for children with GI problems who can’t tolerate regular gravity bolus feedings.
  • Allows them to have a “close to” normal feeding pattern vs continuous pump.
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25
Q

What are the cons of pump feedings?

A
  • Doesn’t allow for normal satiation feeling (can last longer than 30 minutes.
  • Cumbersome to carry pump
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26
Q

Describe continuous drip feeding.

A

Attached to g-tube and electronic pump at a set rate per hour. Regulates slow drip rate. Usually 1-1.5 oz over an hour with range of 8-12 hours. Typically throughout night.

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27
Q

What are the pros to continuous drip feedings?

A

Beneficial for children who can’t tolerate normal-size boluses or have GI difficulties.

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28
Q

What are the cons to continuous drip feedings?

A

Hinders progression towards full PO feedings as it disrupts the child’s normal hunger/satiation cycle. (Child always feels partially full). Goal to transition to bolus feedings ASAP.

29
Q

What is the correct way to breastfeed a newborn?

A

Sidelying, head and neck in alignment with body, slight chin tuck as jaw is opened wide to accept nipple, infant’s body is fully supported by and pressed into mother’s body (BORDERS)

30
Q

What is the max amount of time feedings should take?/

A

30 minutes (even if has bigger quantities)

31
Q

At what age range does the suck drive the swallow?

A

<6 months

32
Q

What is the normal feeding position for 0-4/6 months?

A

-Overall flexion
-Head and neck in alignment through midline* MOST IMP
-Hips flexed at 45-90 degree angle
-Body bordered on sides and back BORDERS
(PHYSIOLOGICAL FLEXION or “FETAL POSITION”)

33
Q

What in addition is important for 0-3 months in feeding positions/stability?

A

Therapist uses Positional Stability due to lack of core strength

34
Q

What is different in positions/stability during feedings after 3 months?

A

Infant uses Postural Stability (stability is provided intrinsically through muscular, tonal, and postural strength)
-Premies may stay longer in this stage

35
Q

What are common feeding positions?

A

Sidelying
Cradle
En Face
Propped

36
Q

What is sidelying feeding position?

A

Pressed up against mother’s body, *most natural and safest position for newborn
Most common in breastfeeding

37
Q

What is cradle position?

A

Still able to provide full borders and support for infant (breastfeeding)

38
Q

What is en face feeding position?

A

Baby facing adult with adult fully supporting head and neck, difficult to support trunk
(More upright/with bias to upright)

39
Q

What is propped feeding position?

A

Baby is propped on lap or pillow and bottle is held for baby, adult has no control of head or support of trunk.

40
Q

What is beneficial in sidelying?

A

It is natural & normal.

If too much liquid, it will fall out of the cheek rather than down the pharynx.

41
Q

What is the rooting reflex? (Elicited by, Purpose, Integrated by)

A

Elicited=When oral area is touched, he turns his head int he direction of the touch and vigorously opens mouth
Purpose=Allows infant to locate source of food
Integrated=by 3-4 months

42
Q

What is the sucking reflex? (Elicited by, Purpose, Integrated by)

A

Elicited=Light touch to the lips or tongue from nipple or finger initiates sucking response (jaw opens naturally)
Purpose=Insures infant will obtain nourishment
Integrated=by 3-6 months

43
Q

What is the gag reflex? (Elicited by, Purpose, Integrated by)

A

Elicited=in infants at mid-tongue area; older baby and adult at the posterior tongue or pharyngeal wall area
Purpose=to protect the person from ingesting items that are too large for the digestive tract or protect the airway from blockage. Will allow extra time for “tongue thrust” until adjusted age
Integrated=Present through adulthood

44
Q

What is the tongue thrust reflex? (Elicited by, Purpose, Integrated by)

A

Elicited=When contact is made to the infant’s tongue or intraoral cavity
Purpose=protective response that prevents anything other than a nipple in the infant’s mouth as he cannot handle anything else?
Integrated=by 4-6 months

45
Q

What is the transverse tongue reflex? (Elicited by, Purpose, Integrated by)

A

Elicited=by touching or stroking the lateral borders of the tongue, causes tongue to lateralize to direction of touch, should be equal bilaterally
Purpose=aides in development of lateral tongue movement during eating of solids
Integrated=Under volitional control by 6-8 months

46
Q

What is the phasic bite reflex? (Elicited by, Purpose, Integrated by)

A

Elicited=rapid, rhythmical up and down movement of the jaw for a bite-and-release pattern (no lateral movement)
Purpose=aides in development of chewing
Integrated=by 7-8 months (to a more mature biting pattern)

47
Q

When can we introduce rice/pureed food?

A

4-6 months

48
Q

When can we work on the transverse tongue reflex WITHOUT food?

A

6-8 months

49
Q

When can we introduce chewable foods?

A

8-9 months

50
Q

What is the 1st thing we look at during an evaluation?

A

State of alertness

51
Q

What are the different states of alertness?

A 
Sleeping
Drowsy
Quiet Alert
Active Alert
Crying
52
Q

What is a drowsy state of alertness?

A

eyes open but dull and heavy-lidded, may look dazed and “unavailable,” movements are smooth with mild startles. May not see accurate typical reflexes

53
Q

What is a quiet alert state of alertness?

A

Strongly focused on a stimulus, focus of attention is steady but can change easily after a brief delay, motor activity is minimal. Good time to fee infant

54
Q

What is an active alert state of alertness?

A

Considerable motor activity, thrusting of extremities, brief “fussy” periods (good time to feed infant)

55
Q

What is a crying state of alertness?

A

Crying intensely, it is difficult to break through the crying with any stimulus.

56
Q

What state of alertness is a good time to feed infant?

A

Quiet Alert and Active Alert

57
Q

What is the normal gestational period?

A

38-40 weeks

58
Q

At what age do you see sucking in utero?

A

15-18 weeks gestation

59
Q

When do you see sucking in an exrauterine environment

A

28 weeks gestation

60
Q

When can very basic suck training occur?

A

30 weeks gestation

61
Q

When do you begin to see Suck, Swallow, Breath coordination (though consistant and random)

A

32 weeks gestation

62
Q

When is a coordinated sucking and breathing pattern established?

A

34-35 weeks gestation

63
Q

What is the #1 reason premies aspirate?

A

Respiratory in coordination with feeding not developed

64
Q

What is the earliest to introduce feedings?

A

32 weeks but prefer 34 weeks

65
Q

At what age do medical professionals adjust age for prematurity?

A

38 weeks (considered premie)

66
Q

When is a premie considered “developmentally appropriate?

A

When they have skills appropriate for their adjusted age.

67
Q

How long/at what age does a premie have to “catch up developmentally?

A

2 yrs

68
Q

When is the simple, rhythmical motor reflex integrated by?

A

3-6 months

NICU Kelly Escamila (1 decks)

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