Feeding and Oral Motor Flashcards
- Eating is the body’s number ONE priority TRUE FALSE
False
- Eating is instinctive TRUE FALSE
True - for the first month of life
- Eating is the MOST complex physical task that humans engage in TRUE FALSE
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!
- Eating is a two step process TRUE FALSE
FALSE!
About 32 steps in process of learning to eat!
What month do we start learning more motor control of eating?
6
Children should not touch or play with their food
FALSE!
Wearing food is normal part of development!
You learn about food BEFORE it gets to mouth
“Play with a purpose!”
If a child is hungry enough, he/she will eat. They will not starve themselves. T or F
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
Children should eat 5-6 meals a day. T or F
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
If a child won’t eat, there is EITHER a behavioral or an organic problem. T or F
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
Children should never eat junk/ “bad” food
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
Feeding is supposed to be fun!
TRUE!
- Children eat better when food is engaging, interesting & attractive
- Better eating occurs when conversations during mealtime are focused on food & educational/fun (examples…)
What is Eating:
“Ability to keep and manipulate food or liquid in the mouth and swallow it”
What is Feeding:
“The Process of setting up, arranging, and bringing food [or liquid]..to the mouth”
Anatomy of Oral and Pharyngeal Structure: first months
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)
Anatomy of Oral and Pharyngeal Structure: 6 months
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
Stages of Normal Swallow: oral
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)
Stages of Normal Swallow: Pharyngeal
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
Stages of Normal Swallow: Esophageal
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
which swallow function does OT intervene with?
Oral
Development of Oral Motor Control
- 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
Development of Oral Motor Control
Can be looked at through activities that help to develop these oral-motor skills:
Bottle & Breast Feeding
Spoon feeding
Cup Drinking
Biting
Chewing
Bottle & Breast Feeding
Nonnutritive Sucking:
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
Suck-swallow-breathe coordination
*Swallowing coincides with cessation of breathing
Suck-Swallow ratio dependent on flow rate (Faster flow=more frequent swallows=less time for breathing)
Spoon feeding
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
Why do kids get more food on their face
tongue is moving in and out because they lack muscle control of tongue.
What can OTs do to help with my Feeding Problem?!
Adaptations (equipment, consistency)
Positioning
Help family establish routines
Sensory play
Oral Motor Play Activities
Other Ideas??
