FINAL: FEEDING Flashcards

1
Q

How do OT’s work in feeding?

A

oral aversion

tube to oral transition

poor oral motor skills

poor hand to mouth coordination

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2
Q

Development of chewing: phasic bite, munching, tongue lateralization, vertical/diagonal/circular chewing

A
  • phasic bite: birth - 3-5 mos
  • munching: 6 mos
  • tongue lateralization: emerges, 6 mos
  • vertical chewing: 12 mos
  • diagonal chewing: 18 mos
  • rotary chewing: 18-36 mos
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3
Q

Why is tongue retraction important?

A

Retraction is needed:

  • to place food from center of mouth onto teeth (retraction w/ lateralization)
  • to drink properly from cup/straw
  • for articulating every sound in the English language except “th”
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4
Q

Three common feeding issues:

A
  • dyphagia: difficult swallowing (broad term)
  • aspiration: food/drink/secretion enters lungs
  • gastro esophageal reflux disease (GERD): stomach acid comes up instead of staying down and burns the lining of the esophagus
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5
Q

Signs of dysphagia:

A

MANY:

  • frequent refusal to eat or drink
  • irritable behavior during eating
  • difficulty controlling saliva; drooling
  • multiple swallows to get food down
  • drinking often while eating (to help swallow)
  • food left on tongue or pocketed in cheek
  • frequent gagging, spitting, vomiting
  • takes >30-40 minutes to eat
  • weight loss of unclear origin; failure to gain well
  • chin tuck during swallow
  • congestion in nose (with babies - b/c milk goes up into nose during 3rd phase of swallow)
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6
Q

Signs of aspiration:

A

concrete signs: rise in temp. and/or Pulsox after eating

observational signs:

  • coughing, hiccuping, burping during/after eating or drinking
  • watery eyes during/after (“silent aspiration”)
  • frequent pneumonia/respiratory infections
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7
Q

Signs of GERD:

A
  • frequent refusal to eat/drink
  • irritable behavior while eating
  • finished eating before they are full
  • arching back, turning head (trying to lengthen esophagus)
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8
Q

3 P’s of assessment:

A
  • past medical hx (NOTE: if child is below 15th percentile for growth, get weight on first, then address feeding)
  • pain (think GERD)
  • poop (should be soft, daily)
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9
Q

what to do first:

A
  • 1-week log to track child’s eating and pooping
  • then interview: how is child fed? how much? how often? what do they eat? etc.
  • DON’T JUDGE. Listen mostly. No more than 1-2 suggestions at first.
  • Main goal: Build rapport.
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10
Q

good ORAL MOTOR assessment

good ORAL MOTOR tx program

A

Beckman Oral Motor assessment looks at:

  • lip strength
  • cheek strength
  • sensory issues
  • tongue ROM
  • more…

Talk Tools Therapy by Sarah Rosenphal Johnson builds oral motor skills; great for kids who are cognitively able to follow directions

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11
Q

Intervention guidelines:

A
  • base on assessed weaknesses
  • help pt get comfortable and relaxed
  • work your way to mouth, don’t dive right in!
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12
Q

sample interventions for lip closure, awareness, strength:

A
  • closure: kiss “Z-Vibe,” blow through straw to move cotton ball, drink through straw
  • awareness: vibrate lips w/ Z-vibe, place Z-vibe or baby spoon in ice water before putting on pt lips, fish faces in mirror w/ frosting on lips
  • strength: “Talk Tools” bubble Heirarchy or button pull, blow whistles, plastic pinwheels, party blowers, noise makers (harder), etc
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13
Q

jaw strength interventions:

A
  • Beckman resistive chew tube
  • bite and hold with bite blockers or twizzlers
  • put anything in polyester organza so they can chew it without choking
  • (lots more “Lip Prints” items)
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14
Q

interventions for tongue awareness, lateralization, retraction, elevation

A

awareness: spicy foods (also helps control wt.), lick sour flavors (also faciliates pucker) fun dip or fire balls
lateralization: “hard munchable” like celery or carrot stick, mirror for silly faces, facilitate w/ Z-vibe, tongue “tag” w/ lollipop
retraction: Talk Tools straw program (develops a harder suck, so more retraction) or horn program
elevation: Z-vibe to facilitate, “tag,” Talk Tools Cheerio Hold Up

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15
Q

interventions for cheek strength:

A
  • Z-vibe to inside or outside of cheek
  • Beckman cheek stretches
  • Vital Stim (need certification; but tell parents, so they can find someone else if they want)
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16
Q

sensory assessment:

A
  • What will child let you touch? Hands, arms, cheeks, lips, mouth?
  • what child eats now, always, sometimes, jags
  • is there tactile sensitivity all over?
  • hx of NG tube?
17
Q

massage as intervention:

A

massage improves:

  • wt gain
  • circulation
  • immune system (by moving lymhp)
  • digestion/metabalosm
  • bonding
18
Q

3 thoughts re: tx planning

A
  1. ID your target food.
  2. Where will child allow the food to be? on table, placement, plate? Will child touch it with hand, nose, lip, tongue?
  3. Show progress thru proximity.
19
Q

good intervention for sensory issues

A

Sequential Oral Sensory (SOS) is great for children w/ oral aversion and picky eaters. (by Dr. Kay Toomey)

20
Q

Food chaining:

A

One at a time, change just one feature of an “accepted” food, i.e. if child eats pancakes:

  • change shape by using cookie cutter
  • change color w food dye
  • change taste w vanilla or cinnamon, etc.
21
Q

positioning checklist for feeding:

A

Normal guidelines for positioning, but also:

  • Can the child move? Being strapped in tightly limits mobility needed for feeding and eating. (ALSO: if trying new and potentially chokeable food, DO NOT strap child in. You may need to pull them out quickly.)
  • Can child interact w/ feeder and/or family and peers? Can child reach any assistive devices?
  • Is feeder comfortable? Mind those body mechanics!
22
Q
A