Feeding Disorders Flashcards
Some of the most common medical diagnoses associated with feeding dysfunction:
prematurity
neuromuscular abnormalities
structural malformations (such as cleft lip &/or palate)
gastrointestinal conditions
visual impairments
tracheostomies
Children develop difficulties with feeding, eating, &/or swallowing as a result of
medical, oral sensorimotor, & behavioral factors, either alone or in combination.
high prevalence of feeding difficulties w/ Sensory, motor, or behavioral challenges influence the child’s food preferences and willingness to eat.
ASD dx
Children with developmental disabilities may fail to meet basic nutritional needs because of ….
delayed or deficient oral motor and self-feeding skills.
Oral motor dysfunction causing poor nutrition is strongly associated with…
poor growth and adverse health outcomes.
Food refusal &/or food selectivity can relate to….
anxiety
hypersensitivities
behavioral rigidity or need for routine
behavioral dysregulation
A child who has frequent or chronic vomiting after feeding may be diagnosed with
GERD
not uncommon, and most babies spit up on an occasional basis as their gastrointestinal system matures
Not harmful to the baby
No adverse effects on feeding or growth should be identified
Infant will outgrow these symptoms w/ gaining postural control and stability and maturation of the gastrointestinal system.
Reflux
becomes problematic when chronic spitting up and vomiting leads to problems with the infant’s or child’s health, ability to eat successfully, and poor growth or inadequate weight gain.
GERD
common medical condition that can influence a child’s success with feeding
may create significant discomfort, resulting in a negative experience associated with eating
may cause esophagitis, vomiting, skin rash, itchiness, pain, breathing difficulties, &/or discomfort during eating, contributing to the child’s unwillingness to eat and subsequent negative behavior
Food allergies
Some of the most common food allergies:
milk, eggs, soy, wheat, peanuts
Enteral feeding support can be delivered via
nasogastric
gastrostomy
orogastric tubes
Prerequisites for eating and drinking
Intact oral structures and cranial nerves
Anatomic structures of the mouth and throat change significantly during
the first 12 months of life
Children with that commonly exhibit oral hypersensitivity:
Developmental and neurological conditions
Autism
Pervasive developmental disorders
Cerebral palsy
TBI
Genetic conditions
Sensory processing disorders
Children with oral hypersensitivity
often react negatively to touch near or within the mouth.
may turn away from feeding or tooth brushing activities, restrict food variety, gag frequently, or have difficulty transitioning to age-appropriate food textures
also common in children who have received extensive medical interventions
Children diagnosed with generalized tactile defensiveness
Medical interventions:
Endotracheal intubation
Orogastric or nasogastric tube feeding
Tracheostomy
Frequent oral suctioning may have caused ongoing distress, gagging, or pain, affecting the development of the sensory system
Children may tolerate greater sensory input if the activity is
under the child’s control and provided in the context of a motivating, developmentally appropriate play activity
Children with GERD, constipation, or food allergies may feel uncomfortable when eating and develop what as result?
food refusal behaviors as a result
Children who gag with textured foods or refuse cup drinking:
Inadequate sensory or motor skills
Behavioral issues that Children with ASD may exhibit:
selective eating or refuse to try new foods
given their propensity for rigid and repetitive behaviors and olfactory , gustatory, &/or tactile sensitivities.
Behavioral inconsistencies may be seen
in which the child accepts cup drinking in the preschool setting, but refuses to drink from a cup at home.
Efficient cup drinking requires more mature…
oral motor skills than bottle feeding
Difficulty transitioning from the bottle to the cup can be caused by
poor jaw stability or delayed lip and tongue control, affecting the child’s ability to manage a liquid bolus.
Hypersensitive children may also seek
the calming, organizing sensory input that comes from sucking during bottle or breastfeeding.
To help children prepare for cup drinking activities, therapists may initially work on
jaw stability, lip closure, tongue movements, and oral sensitivity through positioning, handling, and oral motor activities.
External jaw support can be provided by
the therapist whose index finger is placed underneath the lower mandibular bone and the thumb is placed on the anterior chin.
Oral motor problems are seen frequently in children with global neuromuscular impairments caused by
Cerebral palsy
TBI
Prematurity
Genetic conditions —> Down Syndrome.
may cause a child to retract the tongue into the mouth to avoid stimulation, contributing to maladaptive oral movement patterns.
Oral hypersensitivity
Intervention plan for oral hypersensitivity
promote strength and coordination for the development of more advanced oral feeding skills
Oral Motor Impairments
Oral hypersensitivity
Jaw weakness
neuromuscular impairments
Tonic bite
Tongue thrust
Li/cheek weakness and retraction
separation or hole in the oral structures usually joined together at midline during the early weeks of fetal development.
Cleft lip or palate
separation of the upper lip, which may be seen as a small indentation, or a larger opening that extends up to the nostril.
Cleft lip
separation of the anterior hard or posterior soft palate and may occur with or without a cleft lip.
Cleft palate
rare congenital birth defect characterized by an underdeveloped jaw, backward displacement of the tongue and upper airway obstruction
Pierre-Robin sequence
weak muscle tone (hypotonia), experience feeding difficulties, and tend to grow more slowly than other infants
Smith-Lemli-Opitz syndrome
group of conditions that affect the development of their oral cavity (mouth, tongue, teeth, and jaw), face (head, eyes and nose) and finger and toes (digits)
Orofaciodigital syndrome
Young infants with cleft lip or palate have difficulty creating suction to express liquid during breastfeeding or bottle feeding DUE TO
LACK OF CLOSURE BETWEEN ORAL AND NASAL CAVITIES
small recessed jaw
Micrognathia
when the tongue is disproportionately large in comparison with the size of the mouth or jaw
Macroglossia
Swallowing: 4 Phases
Oral Preparatory Phase
Oral Phase
Pharyngeal Phase
Esophageal Phase
Poor lip closure, weakness of muscles (Orbicularis Oris, weakness of facial nerve)
DROOLING
Food remains between cheeks & gums. (Weakness of Buccinator)
POCKETING
Weakness of extrinsic and intrinsic tongue muscles
DIFFICULTY POSITIONING BOLUS
Common Problems in the Oral Preparatory Phase
DROOLING
POCKETING
DIFFICULTY CHEWING
DIFFICULTY POSITIONING BOLUS
due to the anterior 2/3 of the tongue having increased sensitivity to any object or food, eliciting a gag
hyperactive gag
due to lack of gag when the posterior 1/3 of tongue is impaired
hypoactive gag
food into airway, weakness of Longus Colli, Longus Capitus, Rectus Capitus anterior, and Scalenus Anterior is associated with this
ASPIRATION
associated with aspiration
CHOKING
Weakness of palatine muscles that elevate larynx and weakness of this muscle allow food into vocal cords causing the gurgling voice
GURGLING VOICE
Weakness of Palatine muscles that assist soft palate and uvula in rising and moving backward
NASAL REGURGITATION
Common Problems in the Pharyngeal Phase
ASPIRATION
CHOKING
GURGLING VOICE
DELAYED SWALLOW
NASAL REGURGITATION
Common Problems in the Esophageal Phase
Difficulty with solid foods
Regurgitation in supine: return of solids or fluids to the mouth from the stomach.
