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Feeding Flashcards

1
Q

Fiber endoscopic evaluation

A

An evaluation used to assess swallowing in which a flexible instrument is placed through the nostrils to view the pharynx, larynx, and trachea

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2
Q

Modified barium swallow

A

An evaluation using digital imaging to assess oral, pharyngeal, and upper esophageal function while ingesting various textures of food and liquids

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3
Q

Mendelsohn maneuver

A

Technique used to prolong the opening of the upper esophageal sphincter during a swallow, involves pushing the tongue into the upper palate while manually maintaining the Adam’s apple in an elevated position

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4
Q

Supraglottic swallow

A

Compensatory swallowing technique used to close the vocal cords before and during swallow
Steps:
- Take deep breath
- Hold breath while swallowing
- Cough to lear saliva or food

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5
Q

Pre-oral phase

A

Smell and visual appreciation of food
Stimulation of saliva
Mouth and UE motor movements to initiate the process of eating

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6
Q

Oral preparatory phase

A

Voluntary intake of food into mouth
Bolus formation with saliva
Chewing with molars and activation of buccal muscles to prevent pocketing
Bolus movement to the center of the tongue

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7
Q

Oral phase

A

Use of cheek and tongue muscles to retain bolus centrally
Posterior migration of bolus

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8
Q

Chin tuck

A

Compensatory swallowing maneuver that involves moving the chin towards the chest while swallowing, protects the airway and reduces the risk of aspiration

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9
Q

Advanced dysphagia diet

A

Dietary food texture modification described as soft consistency for safer swallowing that requires more advanced chewing ability
Examples:
- baked potato with skin
- moist pancackes
- thin sliced meat

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10
Q

Mechanically altered dysphagia diet

A

Dietary food texture modification described as moist, semi-solid consistency for safer swallowing that requires some chewing ability
Examples:
- cottage cheese
- ripe banana
- moist meat loaf
- scrambled eggs

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11
Q

Puree dysphagia diet

A

Dietary food texture modification described as smooth, uniform consistency for safer swallowing that requires very little chewing ability
Examples:
- pudding and plain yogurt
- smooth apple sauce
- whipped potatoes

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12
Q

Moderately thick dysphagia diet

A

Thickened liquid consistency so that it drips from a spoon for safer swallowing, progression from mildly thick that may be prepared with thickening gel or powder

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13
Q

Mildly thick dysphagia diet

A

Thickened liquid consistency for safer swallowing that is a progression from thin liquid
Examples:
- tomato juice
- fruit nectars
- egg nog

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14
Q

Thin dysphagia diet

A

Liquid consistency that requires an intact swallow
Examples:
- water
- ice chips
- broth
- coffee
- gelatin

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15
Q

Dysphagia diet levels

A
  1. Pureed foods
  2. Mechanical altered
  3. Dysphagia-advanced
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16
Q

Esophageal phase

A

Return of upper esophageal sphincter to tonic state
Passage of food through the esophagus to the stomach

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17
Q

Pharyngeal phase

A

Soft palate elevation
Larynx and hyoid elevation and protraction
Cessation of airflow to prevent aspiration
Vocal cord closure when whole bolus is moved through the pharynx

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18
Q

Dysphagia

A

Difficulty at any stage of the swallow- oral to esophageal

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19
Q

Hypotonic feeding issues

A

Poor head, neck and trunk stability
- Fall over
- Elevation of shoulders
- Hyperext of neck
Open mouth-drooling
Wide excursion
Difficulty grading
- Open or closed
Difficulty in mid ranges
- Not hard enough or wears self out
Loss of food
Tongue may be inactive
- Or extreme in range
Lips may not seal or be active
- Spoon drag
Cheeks
- Packing`

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20
Q

Paralytic dysphagia

A

Lower motor neuron
Weakness or paralysis of oral structures
Swallowing reflex may be absent
Common in:
- CVA, TBI and Developmental disorders (MR)

21
Q

Pseudobulbar dysphagia

A

Upper motor neuron
Hyper or hypotonic oral structures
More common in pediatric population
Common in:
- CVA, CP, TBI

22
Q

Mechanical dysphagia

A

Loss of structure or weakness due to trauma or surgery
Common in:
- Cancer, MVA

23
Q

Put these in the order of which you would introduce them to a patient:
protein shake
water
diet coke
coffee with cream
black coffee

A

Protein shake
Coffee with cream
Diet coke
Black coffee
Water

24
Q

Texture progression for typical kids

A

Pureed - baby food
Mashed - potatoes, peas
Chopped
Full

25
Dysphagia diet for adults or kids
1. thick puree - pudding or apple sauce 2. soft chewables - soft fruit (banana), cooked veggie 3. drier chewable - bread, cookie 4. foods that require biting - meat 5. mixed textures - oatmeal with raisins
26
Fluid progression
1. None 2. Spoon thick (commercial thicken) 3. Texture of honey 4. Nectar (pulp orange juice) 5. Thin flavored fluids (coffee with cream, coke) 6. Water
27
Dysphagia level I diet
Pureed Difficulty protecting airway - Crush injury, trachs Little or no jaw or tongue control Delayed swallow Homogenous food, no bumps or lumps, same consistency Moves slower to allow the swallow reflex to kick in Goal is for oral feeding, stepping stone, may not be enough for caloric intake alone
28
Dysphagia level II diet
Soft food Beginning rotary chew Some tongue control Minimally delayed swallow Mild to moderate problems Stick together Good bolus, not fall apart Provide good proprioceptive feedback
29
Dysphagia level III diet
Advanced diet Able to chew Able to form a bolus from different textures Minimal jaw or tongue issues Swallow can be mildly delayed but intact bilaterally Think things a kid can eat without supervision - rice, cooked veggies - no skins, tough or dry course food
30
Dysphagia level IV diet
Regular diet
31
How to initiate a swallow in pt with slow or delayed swallow
Frozen pacifier Popsicle Formula
32
How to improve transit with feeding
Handling of head and jaw Outside support Thickened liquids - Proprioception - Easier control Positioning
33
How to increase strength or tone with feeding
Tongue exercises, jaw exercises-increase ROM and strength Peanut butter, gum, tapping, vibration Chin tuck and turning toward affected side
34
How to effect poor tongue control with feeding
Exercises Quick stretch
35
Compensatory strategies for weakness with feeding
Manipulate food Inspect after meals Place food on strong side Break meals up
36
Compensatory strategies for abnormal reflexes with feeding
Avoid provoking them Positioning Exaggerate opening and closing of mouth
37
Compensatory strategies for hyposensitivity with feeding
Temperature Flavors
38
Compensatory strategy for delayed swallow
Chin tuck
39
Dysphagia
Difficulty at any stage of the swallow- oral to esophageal
40
Suckling
The back-and-forth motion of the tongue At 32-34 weeks gestation, a normal child can usually sustain life Present at birth - Primary method of feeding until 8-10 months - Nonnutritive (soothing)- rhythmic; not indicative of the ability to feed - Nutritive- rhythmic with bursts and pauses * Time to swallow
41
Sucking
Negative pressure, jaw movement, tongue can move up and down True suck 4-6 months (negative pressure) Tongue now moves up and down-can easily suck baby food Cup may be introduced Jaw stability is fair 6 months-as they move to a cup may have episodes of choking 9 months-strong suck from cup or bottle, minimal jaw excursion, stability is fair (physically able to move to chew soft foods, mashed foods) 12 months- jaw stability con’t to increase Suck stops May stabilize by biting cup 24 months-jaw stable, can drink from a cup
42
Munching
Jaw just going up and down, no rotary
43
Chewing
Rotary and tongue lateralization
44
Coordination of suck-swallow-breathe
Happens from birth to 4-12 months because they haven’t gained that sitting posture yet 1 month - 1 suck, 1 swallow then - 2-3 sucks to swallow and breathe the whole time - Cough-lost this coordination - Breathing slows, within or between sucks 3-4 months - 20 sucks then swallow 9 months - Stop to swallow or breath 12months-should not be coughing - Suck followed by swallow and breathing
45
Signs of silent aspiration
- No swallow response - Pooling or wet sounds on auscultation - Change in voice - Change in patient color, vitals, or decreased O2 level
46
Development of feeding
Birth-1year: suckling 3 months: suck develops 5-6 months: suck is stronger, primitive bite reflex to “munch”, lip and tongue control improving 9 months: munching is voluntary, starting to move food around, lips are active 12 months: move to a cup, may lose liquids - rotary chew starts 18 months: jaw is stable, can drink from a cup - chews with lips closed 24 months: adult like patterns for suck and chew, swallows with lips closed, good tongue control - all table food
47
Biting and chewing development
3-5 months - Reflexive munching - Can handle purred foods (suck it off spoon) 6 months - Some tongue lateralization - Control of the tongue 7-8 months - Diagonal patterns begin - Bite to hold only 9 months - Munching continues - Adds diagonal patterns - Voluntarily bites on objects - Lips are active rakers 12 months - Rotary chewing begins - Jaw stability - Controlled mobility - Coordination of tongue- moves food easily in mouth - Easily chews food, including meat 18 months - Meat and raw veggies - Bite to cut - Tongue can move food - Packing - No food loss 24 months - All food - Graded bite - Mature, circular bite - Good tongue movement - Good lip closure
48
Development of self-feeding
6-8 months try to hold bottle - Radial digital (thumb and pointer) grasp on cookie 9-13 months - Develop posture that allows for self feeding - Good finger feeders - Older children may refuse to be fed (like doing it themselves) 15-18 months - Good with a spoon - pronated grasp, good with sticky food - May poke at spoon feeding at 12 months 24 months - Spoon with out spillage - Spoon feeding requires: - Posture - Midline head support - Hand to mouth skills - Disassociation of lip and tongue 30-36 months - Uses a fork Straws - 2 years - Sippy cups - spillage initially - Straws - require lip closure and strong suck - Also, cognitive skills - No spillage - By 2 there should be no backwash
49
Types of dysphagia
1. Paralytic - Lower motor neuron - Weakness or paralysis of oral structures - Swallowing reflex may be absent - Common in: CVA, TBI and Developmental disorders (MR) 2. Pseudobulbar - Upper motor neuron - Hyper or hypotonic oral structures - Common in: CVA, CP, TBI 3. Mechanical - Loss of structure or weakness due to trauma or surgery Common in: cancer, car accident

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