Feeding and Oral Motor

Question 1

1. Eating is the body’s number ONE priority TRUE FALSE

Answer 1

False

Question 2

1. Eating is instinctive TRUE FALSE

Answer 2

True - for the first month of life

Question 3

1. Eating is the MOST complex physical task that humans engage in TRUE FALSE

Answer 3

True
ONLY task requiring EVERY organ system
26 muscles and 6 cranial nerves to coordinate one swallow!
ONLY task children do that requires simultaneous coordination of all 8 sensory systems!

Question 4

1. Eating is a two step process TRUE FALSE

Answer 4

FALSE!
About 32 steps in process of learning to eat!

Question 5

What month do we start learning more motor control of eating?

Answer 5

6

Question 6

Children should not touch or play with their food

Answer 6

FALSE!
Wearing food is normal part of development!
You learn about food BEFORE it gets to mouth
“Play with a purpose!”

Question 7

If a child is hungry enough, he/she will eat. They will not starve themselves. T or F

Answer 7

FALSE!
- TRUE- for 94-96% of pediatric population
-For children with feeding difficulties, they can “starve” themselves (usually inadvertently)…
- Failure to Thrive dx
- Feeding “doesn’t work” or hurts & no amount of hunger will overcome that fact
- Medical issues can lead to suppressed appetite over time, decreased response to hunger to cue eating

Question 8

Children should eat 5-6 meals a day. T or F

Answer 8

TRUE!
Small stomachs and attention spans
Takes 5-6 meals to get enough calories for proper growth/development
Unless eating adult sized meals 3x/day

Question 9

If a child won’t eat, there is EITHER a behavioral or an organic problem. T or F

Answer 9

FALSE!
- Studies indicate that 65-95% of children with feeding problems have COMBINATION of behavioral AND organic problems
- Start with a physical issue with eating quickly learn behavior to avoid
- As nutritional status declines from behavioral/environmental reason for not eating, organic problems will arise

Question 10

Children should never eat junk/ “bad” food

Answer 10

FALSE!
- Careful about labeling food “good/bad” when teaching children to eat & establishing healthy relationships with food
- “Junk foods” can provide stepping stones in teaching children with feeding difficulties to learn to eat a variety of other foods
- “Bad” foods are sometimes easier to handle oral-motor wise & more sensory appeal

Question 11

Feeding is supposed to be fun!

Answer 11

TRUE!
- Children eat better when food is engaging, interesting & attractive
- Better eating occurs when conversations during mealtime are focused on food & educational/fun (examples…)

Question 12

What is Eating:

Answer 12

“Ability to keep and manipulate food or liquid in the mouth and swallow it”

Question 13

What is Feeding:

Answer 13

“The Process of setting up, arranging, and bringing food [or liquid]..to the mouth”

Question 14

Anatomy of Oral and Pharyngeal Structure: first months

Answer 14

First Months:
Mandible- small in relation to skull

Tongue- fills oral cavity

Fat pads- narrow oral cavity, help stabilize cheeks

Epiglottis- higher in neck & makes contact with soft palate

Hyoid, Larynx -higher in neck, positioned under tongue & epiglottis

Positioning allows airway protection of liquids (Prevents Aspiration)

Question 15

Anatomy of Oral and Pharyngeal Structure: 6 months

Answer 15

By 6 months:
Fat pads- disappear
Tongue- posterior 1/3 positioned in pharynx
Pharynx elongates
Hyoid, Larynx descend
Epiglottis- no longer touches soft palate
More active lip closure to create suction

Question 16

Stages of Normal Swallow: oral

Answer 16

Preparing & Transporting of food from front of mouth to pharynx

Oral preparatory phase- processing food to allow to pass through P & E
Extracting liquid from nipple (reflex driven first), chewing food to create bolus…
Soft palate lowered to prevent bolus from entering pharynx
Airway open- nasal breathing
Bolus transported from front of mouth back towards pharynx
Phase ends with initiation of swallow
Voluntary neural control (minus newborn reflex driven sucking)

Question 17

Stages of Normal Swallow: Pharyngeal

Answer 17

Movement of bolus through pharynx to esophagus
Start: initiation of swallow
End: Opening of upper esophageal sphincter

Swallow reflex initiated (involuntary)
Tongue blocks oral cavity
Soft palate block nasopharynx
Epiglottis covers larynx(prevent aspiration)
Cessation of breathing occurs
Length: 0.46sec - 0.89 sec in infants age 3-170 days

Question 18

Stages of Normal Swallow: Esophageal

Answer 18

Movement of bolus through esophagus to stomach
Starts: Bolus moves through upper esophageal sphincter
Ends: Bolus moves through lower esophageal sphincter

Involuntary neural control
Peristalsis moves bolus down esophagus
Breathing can occur during this phase

Question 19

which swallow function does OT intervene with?

Answer 19

Oral

Question 20

Development of Oral Motor Control

Answer 20

• Development variable on when different foods and feeding experiences are introduced
• As case with any motor task: oral-motor skills become more precise through practice (trial and error)
• Reflex driven first (which ones?!)
  Sequence more important to look at than age

Question 21

Development of Oral Motor Control

Answer 21

Can be looked at through activities that help to develop these oral-motor skills:
Bottle & Breast Feeding
Spoon feeding
Cup Drinking
Biting
Chewing

Question 22

Bottle & Breast Feeding
Nonnutritive Sucking:

Answer 22

enhance alertness/soothe/regulate; 2x rate of Nutritive suckling, in bursts
Nutritive Sucking: essential for growth; slower rate (1 suck per sec), wider jaw excursions
0-6mo: back/forward mvts, rhythmical action, pronounced opening/closing jaw, lips loose but not active
6-9 mo: tongue raised and lowers, jaw smaller mvts, stronger lip closure allows increased vertical tongue mvt

Question 23

Suck-swallow-breathe coordination

Answer 23

*Swallowing coincides with cessation of breathing
Suck-Swallow ratio dependent on flow rate (Faster flow=more frequent swallows=less time for breathing)

Question 24

Spoon feeding

Answer 24

Parents start spoon-feeding pureed foods ages 4-6 months
*2012 American Academy of Pediatrics recommends infants receive ONLY breast milk/formula for first 6 months…why??

Initial spoon feeding: infant can not use upper lip to remove food from spoon
Infant uses suckle pattern (in-out tongue & up-down jaw, lack of lip activity)
Most food pushed out

6 months: infant holds mouth open for spoon, tongue in mouth
Suckle and suck combo to transport bolus back

6-9 months: more active lip involvement to start to clear spoon

12 months: upper lip active & moves inward to clear spoon

24 months: mature spoon feeding: upper & lowerlips moving in, suck predominates, tounge and jaw movements independent of one another, min food lost

Question 25

Why do kids get more food on their face

Answer 25

tongue is moving in and out because they lack muscle control of tongue.

Question 26

What can OTs do to help with my Feeding Problem?!

Answer 26

Adaptations (equipment, consistency)
Positioning
Help family establish routines
Sensory play
Oral Motor Play Activities
Other Ideas??