Feeding (Week 6) Flashcards
3 parasympathetic nerves involved in feeding
- vagus (CN X)
- Trigeminal (CN V)
- Glosspharyngeal (CN IX)
How does stress affect the parasympathetc NS? (4)
- sympathetic NS turns on
- increases HR, RR, BP
- decreases taste receptors
- makes swallowing difficult
What will some kids do if they have lack of sensation in their mouth?
put too much food in their mouth
Problems w/oral motor control could be due to: (5)
- abnormal tone
- postural or respiratory compromise
- GI concerns
- lack of sensation
- lack of practice
Causes of feeding disorders can be (3 broad terms)
- physiological
- developmental
- behavioral
What is suckle and when should it develop?
- anterior/posterior wave-like tongue motion
- 12-14 weeks GA
why do premature babies have feeding difficulties?
- the suck swallow reflex begins at 28 weeks but is not fully coordinated 32-34 weeks GA
non-nutritive pacifiers help coordinate which reflex
suck-swallow-breath
T/F
Need jaw stability before tongue motility
True
What is an up/down motion with more dissociation b/w tongue and jaw? When does it start?
- suck
- 4-6 months (can start eating solid foods)
If kids have trouble crossing midline which feeding development will they struggle with most likely?
grind and chew
Why does swallowing require less throat control in kids vs. adults?
kids larynx and hyoid are higher
What mvmt requires a rotary component, starts at 9 months, and matures around 2 yrs old?
grind and chew
What mvmt appears around 6 months, uses more lateralization of tongue, and uses a bite and release of jaw?
munch
If baby does not have suck-swallow-breath what might occur?
gag aspiration
4 phases of degluitition
- oral preparatory
- oral propulsive
- pharyngeal
- esophageal
If individual has negative feeding experience which phase might they not get past?
pre-oral phase
- this is the anticipatory phase before oral prepartory
What phase of deglutition is when tongue moves bolus toward oropharynx?
- oral propulsive phase
What phase of degluition is when the bolus forms, taste, manipulation, and mastication occurs?
- oral preparatory
What phase of degluition moves the bolus from pharynx to esophagus?
- pharyngeal
What phase of degluition is when peristalsis occurs, LES relaxes and bolus enters stomach?
- esophageal
What is velum? If there is an issue w/valve what happens?
- soft palate
- Issues with this will get food up your nose
An issue w/this valve will cause aspiration (food into larynx).
oropharyngeal
Problems w/these 2 valves can cause reflux
LES
UES
What structure has dual function as a route for air and the bolus?
pharynx
6 ways a kid differs from an adult anatomically w/respect to feeding pathway.
- larger tongue
- smaller oral cavity
- more retracted jaw
- hyoid and larynx higher
- trachea more pliable and narrow
- eustachian tubes more horizontal (prone to ear infections)
T/F
If hips and pelvis are off center it does not affect the position of shoulders, neck, and jaw.
False
-alignment/posture is very important for feeding
What comes first, sensory aversion or behavior?
- aversion
- probably had trouble in pre oral phase
5 causes of sensory aversion
- orally defensive (physical)
- hypersensitive (physical)
- sensory processing concerns on other body areas (physical)
- hyperactive gag reflex (neurological)
- associate food w/pain and discomfort (emotional)
Major impact of sensory aversion
may interfere w/growth and development
dysfunction w/any stage in the process of eating
dysphagia
8 immature and atypical oral patterns
- maintain suckle
- nipple compression vs. suction
- jaw thrusting
- tongue thrust
- tonic bit reflex
- lip retraction
- tongue retraction
- nasal regurgitation
atypical oral pattern usually due to a problem of tone when not brining lips forward to collect food
lip retraction
Is tongue retraction due to high or low tone?
- either one
- cannot control tongue or neck
Why does nasal regurgitation occur?
the soft palate/velum is not functioning properly
30-80% kids w/developmental delays also have this problem with eating
pediatric dysphagia
What stage has greatest chance of aspiration occuring?
pharyngeal stage
What do these signs indicate?
- arching
- pocketing food
- weight loss
- taking long time to eat
- drooling
- frequent respiratory infections and congestion
- breathing difficulties during eating
pediatric dysphagia
What is the breathing swallowing pattern of adults?
exhale-swallow-exhale bc larynx descended vs infant
What is the breathing swallowing pattern of infants?
typically swallow when they inhale
3 aspiration gate keepers
- epiglottis
- arytenoid cartilage
- vocal folds
What is it called when secretions (saliva, liquid, food) enter the airway and potentially the lungs in a kid?
pediatric aspirations
splits or openings in the lip or palate that occur very early in pregnancy
cleft
Clefts interfere with (4)
- Sealing the oral cavity
- Ability to produce negative pressure
- Creating a bolus
- coordination of swallowing and breathing
Congenital disorder where the esophagus ends in a pouch instead of connection to the stomach
Esophageal Atresia
Congenital or acquired abnormality where the esophagus connects to the trachea
Tracheoesophageal Fistule
- Backflow of stomach acid into esophagus
- Immature LES
GERD
4 signs of failure to thrive
- <20% below weight
- delayed milestones
- constipation
- less eye contact and engagement
Delivers liquid nutrients through a tube directly into GI tract
Enteral Tube Feeding
Major types of enteral tube feed (2)
- NG tube
2. G tube (more intense and long term)
