Feeding, eating, swallowing - exam 3

Question 1

Discuss the important parts of an occupational therapy feeding evaluation

Answer 1

• Have parent bring in foods child typically eats and foods child typically will NOT eat
• Have parent bring in typical utensils the child uses
• Best scenario is feeding evaluation in the home – see a typical environment if possible!

naturalistic: parent/caregiver feed the infant/child FIRST. Observe the parent child interaction.
elicited: Therapist feeds the infant/child. The feeding session is modified to elicit behaviors or to observe feeding skills that have not occurred spontaneously.

Question 2

Identify common structural and physiological factors affecting the pharyngeal phase of eating:
laryngomalacia, laryngeal cleft, vocal cord paralysis, tracheostomy

Answer 2

laryngomalacia: collapse of the supraglottic laryngeal structures
- symptoms on inspiration since these floppy structures may be pulled into the airway during inspiration.

laryngeal cleft: - rare congenital anomaly characterized by a midline defect of variable length between the posterior larynx and trachea and the anterior wall of the esophagus

vocal cord paralysis: - may be caused by head trauma, a neurologic insult such as a stroke, a neck injury, lung or thyroid cancer, a tumor pressing on a nerve, or a viral infection.

tracheotomy: incision into the trachea (windpipe) that tracheostomy: hole that is formed (stoma)

Question 3

Define/identify important anatomical structures in the head and neck in regard to eating and swallowing.

Answer 3

Epiglottis: Leaf shaped mucosal covered cartilage; projects over larynx during swallow
• Faucial arches: Formed by muscles at posterior border of oral cavity; assists in movement of soft palate
• Vallecula: Anterior extension of hyopharynx
• Pyriform sinuses: Lateral to larynx; 2 mucosal pouches on either side of laryngeal orifice; common place for food to get trapped
• Larynx: Valve to trachea that closes during swallow; consists of epiglottis, false and true vocal folds
• Hyoid bone: Attachment to epiglottis and strap muscles; elevates when swallowing
• Cricopharyngeal muscle: Upper esophageal sphincter; relaxes to allow passage for food from pharynx into esophagus
• Lower esophageal sphincter: Junction of esophagus and stomach; valve closes passage; relaxes to allow food to pass

Question 4

Understand the difference between penetration and aspiration during the swallow phase of eating

Answer 4

penetration: when food or liquid hits the vocal folds during the swallow phase of eating. food or liquid is cleared from the larynx (typically by a cough) and DOES NOT move pass the vocal folds into the lungs
aspiration: when food or liquid passes through the vocal folds, enters the trachea and the lungs

Question 5

Describe tests that are recommended to identify eating or GI disorders (i.e. modified barium swallow study, upper GI, PhProbe…)

Answer 5

MBS: - radiology study

• A record of the how food travels from the oral cavity to the esophagus is taken
• gives detailed information about the oral and pharyngeal phases of the swallow.
• document if aspiration is occurring
• simulates real feeding experience

upper GI: - radiographic study typically completed in supine

1. Identifies structural abnormalities of the esophagus, stomach, and intestines
2. Evaluates height of reflux in the esophagus

impedence/Ph probe: - A thin light wire with an acid sensor is inserted through the nose into the lower part of the esophagus

• detect and record the amount of stomach contents coming back up into the esophagus when a child cries, arches, coughs, gags, vomits, has chest pain, etc.
• determines if the contents are acidic or not (alkaline), how long they stay in the esophagus as well as how often this occurs.

Question 6

Describe hypoxic-ischemic encephalopathy (HIE).

Answer 6

HIE is a lesion in the brain that may cause problems later in life, depending on the severity of the HIE. HIE is the leading cause of severe, non-prgressive neurological deficits resulting from pre-natal event.

from asphyxia (an interruption in the exchange of oxygen and carbon dioxide that may occur at birth due to trauma, prolonged labor or compression of the umbilical cord)

tx: hypothermia ASAP

Question 7

Describe the significance of intraventricular hemorrhage (IVH).

Answer 7

• bleeding in/around ventricles in the brain
• causes: unstable respiratory status, hypoxemia, difficult deliveries, or any stresses that increase blood pressure
• especially the germinal matrix

prognosis grades I and II: good
grades III and IV: higher risk for neurological deficits

Question 8

Describe brochopulmonary dysplasia (BPD)

Answer 8

A chronic lung disease (CLD) in infants. Infants who have an abnormal chest x-ray and continue to require oxygen supplementation after 28 days of life (DOL) are considered to have BPD.

• commonly seen in ELBW infants.
• can be caused by trauma, intubation, or prolonged mechanical venitilation.
• Potential long-term developmental problems may be seen such as mild intellectual deficits, motor coordination deficits, visual perceptual functioning
• Most likely will affect early feeding experiences and typically infants with BPD take longer to achieve full oral feeding (by breast or bottle)

Question 9

Discuss how to interact with a premature infant during therapeutic treatment sessions (i.e. approach vs. distress cues)

Answer 9

• work with the other professoionals at the same time to limit interactions
• stop immediately if any distress cues

DO NOT interact when: deep sleep

best state for feeding: drowsy

best state for infant handling/interacting: awake/quiet (not active)

Question 10

Understand the relationship between infants/children with cardiac defects and feeding.

Answer 10

1. Expect the infant or child’s appetite, sleeping patterns, and behavior to be altered, especially acutely following surgery.
2. Infants and children may initially regress in some skills acutely after cardiac surgery (ie. revert to taking the bottle after being weaned away)
3. Recurrent laryngeal nerve – may be avulsed/stretched, or damaged during heart surgeries. This nerve innervates the vocal cords, can affect infant or child’s ability to protect the airway, especially if the cords are paralyzed in an abducted position. at greater risk for aspiration
4. The infant child may have long-term cognitive effects from prolonged hypoxia from uncorrected cardiac defects
5. The infant may have reduced endurance for feeding and may tire before finishing full bottle.

Question 11

Define a “high risk” infant

Answer 11

Any newborn who has a high probability of manifesting in childhood a sensory, motor, cognitive/language, or social delay later in life. Any infant at high risk should be followed for up to 1 year in a high-risk clinic. The following could place an infant in a high-risk category:

• Prematurity
• Birth weight
• Pathophysiology