Feeding Swallowing

Question 1

What are the main causes of feeding and swallowing disorders?

Answer 1

Causes include:
* Structural anomalies in the aerodigestive tract
* Neurologic conditions
* Cardiopulmonary conditions
* Multifactorial factors.

Question 2

What percentage of typically developing children experience feeding difficulties?

Answer 2

At least 25%.

Question 3

What percentage of developmentally delayed or medically fragile children has feeding and swallowing dysfunction?

Answer 3

40% to 70%.

Question 4

What is the prevalence of feeding and swallowing dysfunction in patients with cerebral palsy?

Answer 4

75% to 80%.

Question 5

What functions does the larynx serve?

Answer 5

Functions include:
* Connection of the upper and lower respiratory airway
* Closure for protection of the lower airway during swallowing
* Generation of sound for voice.

Question 6

At birth, where is the larynx positioned?

Answer 6

Adjacent to cervical vertebrae C1 to C3.

Question 7

What is the approximate size of the infant larynx relative to an adult’s?

Answer 7

Approximately 1/3 the size of the adult larynx.

Question 8

What is the typical measurement of the membranous portion of the true vocal folds in infants?

Answer 8

Approximately 2–3 mm.

Question 9

At what gestational age can pharyngeal swallowing be observed?

Answer 9

As early as 10 to 14 weeks.

Question 10

By what gestational age can some infants feed by mouth?

Answer 10

32 to 33 weeks.

Question 11

At what age can infants start eating pureed consistency from a spoon?

Answer 11

By 6 months of age.

Question 12

What are the phases of swallowing?

Answer 12

Phases include:
* Oral preparatory
* Oral
* Pharyngeal
* Esophageal.

Question 13

What is the role of the intrinsic laryngeal musculature during swallowing?

Answer 13

Important for airway closure.

Question 14

What is the duration of the esophageal phase transit time?

Answer 14

Between 3 and 9 seconds.

Question 15

What are common implications of untreated swallowing problems?

Answer 15

Implications include:
* Failure to maintain proper nutrition/hydration
* Aspiration pneumonia
* Long-term pulmonary complications.

Question 16

What structural abnormalities can affect the oral phase of swallowing?

Answer 16

Abnormalities include:
* Craniofacial syndromes
* Cleft lip
* Cleft palate
* Macroglossia.

Question 17

What neurologic conditions are associated with feeding and swallowing problems?

Answer 17

Conditions include:
* Cerebral palsy
* Vocal fold paralysis
* Arnold-Chiari malformation.

Question 18

True or False: Chronic reflux can lead to airway complications.

Answer 18

True.

Question 19

What are the effects of congenital subglottic stenosis?

Answer 19

Typically occurs with genetic syndromes or laryngeal malformations.

Question 20

What is the earliest age at which infants can sustain full nutrition and hydration orally?

Answer 20

34 weeks.

Question 21

Fill in the blank: The _______ phase of swallowing includes the relaxation of the upper esophageal sphincter.

Answer 21

[pharyngeal]

Question 22

What are the signs of respiratory compromise during feeding?

Answer 22

Signs include:
* Poor respiratory support
* Coughing
* Choking.

Question 23

What is ‘silent aspiration’?

Answer 23

Aspiration without overt signs of airway protection threat.

Question 24

What anatomical defects can lead to esophageal phase abnormalities?

Answer 24

Defects include:
* Laryngomalacia
* Laryngeal cleft
* Tracheoesophageal fistula.

Question 25

What is the significance of the nucleus tractus solitarius (NTS) in swallowing?

Answer 25

It provides afferent input for swallowing.

Question 26

What are the roles of cranial nerves in swallowing?

Answer 26

Cranial nerves primarily innervate oral, nasal, pharyngeal, and laryngeal structures.

Question 27

What are the potential outcomes of surgical reconstruction for airway protection?

Answer 27

Outcomes may include: * Alleviation of obstructive defects * Persistent phonation problems.

Question 28

What is the role of tactile receptors in the pharynx during swallowing?

Answer 28

Provide sensory stimulation to the medullary swallow center.

Question 29

What impact do movements during feeding have on swallowing?

Answer 29

Negative impact on the timing of swallowing and airway closure

Question 30

What physiologic changes during feeding are of concern?

Answer 30

* Decreased oxygen saturation * Increases in respiratory or heart rate * Increased stridor with feeding effort * Coughing, choking, or gagging * Color changes * Increased wet vocal quality

Question 31

What is 'silent' aspiration?

Answer 31

Aspiration without overt signs of airway protection threat, prominent in infants and children with neurologic impairment

Question 32

What are CXR and HRCT used for in relation to aspiration?

Answer 32

Provide information regarding lung disease and its progression or resolution over time, but are not diagnostic for aspiration

Question 33

What is the primary purpose of a Videofluoroscopic swallow study (VSS)?

Answer 33

To assess swallowing function and view sequential swallow sequences

Question 34

What are the indications for using a Fiberoptic endoscopic evaluation of swallowing (FEES)?

Answer 34

* Known or suspected structural abnormality * Assess secretion ability * Patients with minimal oral intake * Patients with brainstem or cranial nerve involvement * Congenital or surgical upper airway anomalies * Patients too fragile for VSS

Question 35

What abnormalities can be detected during a Video fluoroscopic swallow study?

Answer 35

* Premature or inefficient oral bolus transfer * Delayed initiation of swallowing response * Inadequate pharyngeal clearance * Penetration of the bolus into the larynx * Aspiration of the bolus into the airway

Question 36

What compensatory strategies can be assessed during a VSS?

Answer 36

* Positioning adjustments * Increasing liquid viscosity * Texture alteration * Altering the bolus delivery system * Postural strategies

Question 37

What are the disadvantages of the Video fluoroscopic swallow study?

Answer 37

* Radiation exposure * Barium in food may decrease willingness to eat * Compensatory strategies add to overall radiation exposure time

Question 38

What does FEES allow for in swallowing assessment?

Answer 38

Direct visualization of pharyngeal and laryngeal structures, function, and management of secretions

Question 39

What is assessed during the interpretation of swallowing parameters in FEES?

Answer 39

* Timeliness of swallowing onset * Laryngeal penetration * Aspiration before or after the swallow * Adequacy of hypopharyngeal clearance

Question 40

What are the contraindications for FEES?

Answer 40

* Choanal atresia * Nasal stenosis * Nasal obstruction * Pharyngeal stenosis

Question 41

What is the gold standard for motility testing?

Answer 41

Esophageal manometry

Question 42

What is the initial step in the diagnosis of dysphagia?

Answer 42

Clinical oral motor feeding assessment

Question 43

What professionals are typically part of a multidisciplinary team for dysphagia management?

Answer 43

* Otolaryngologists * Gastroenterologists * Pulmonary medicine specialists * Speech pathologists * Occupational therapists * Dietitians * Behavioral psychologists * Social workers

Question 44

What clinical signs may indicate swallowing dysfunction?

Answer 44

* Gagging * Coughing * Choking * Color changes * Increased noise during feedings * Apnea or bradycardia associated with feeding

Question 45

What are some treatment strategies for dysphagia?

Answer 45

* Direct rehabilitative maneuvers/exercises * Compensatory strategies * Sensory stimulation * Diet modifications * Positioning alterations * Specialized feeding equipment

Question 46

Fill in the blank: The modified supraglottic swallowing sequence assists with achieving _______ during swallowing.

Answer 46

compensatory airway closure

Question 47

What innovative feeding practice can decrease gagging after fundoplication surgery?

Answer 47

Giving pureed foods into the gastrostomy