Functional feeding for the older child Flashcards
T or F. feeding behaviors of a child are driven by a combination of physical responses (i.e. motor and sensory development) and learned behaviors from family and environmental interaction
True
normal muscle tone
normal level of tension or slight contraction of a resting muscle. in every resting muscle, there are always some muscle fibers that are contracting. this is a muscles tone
what is the purpose of muscle tone?
stabilizes the position of our bodies (specifically joints and bones)
what is the function of muscle tone?
makes voluntary contraction of a muscle (to close the jaw) easier and smoother since some of the muscle fibers are already taught
what is muscle tone controlled by?
central nervous system cannot be changed by volitional control or improved by exercise
what does muscle tone do for feeding?
orofacial muscle tone affects all aspects of feeding and swallowing.
-adequate muscle tone allows the oral and pharyngeal structures to function properly and generate sufficient strength and control for synchronous muscle contractions.
T or F abnormal muscle tone negatively affects feeding and swallowing.
True
what are the 2 types of abnormal muscle tone?
hypertonia
hypotonia
what does hypo mean?
low or insufficient
what does the term hypotonia mean?
low muscle tone
explain hypotonia?
muscle is flaccid and appears weak
-muscle fibers are slow to react to stimuli and fatigue or relax before reaching maximal contraction
hypotonia does what to a childs appearance?
makes them look droopy
-
what are some common disorders that hypotonia is associated with
- down syndrome
- prader wili
- shaken baby syndrome
what does the term hypertonia mean?
high or increased muscle tone
what does hyper mean?
high or excessive
what happens to the muscles when they are hypertonic?
muscles appear excessively contracted held taught, tense
what are some common disorders associated with hypertonia?
- cerebral palsy (caused by bleeding on the brain)
- CNS infections (meningitis)
- infantile stroke
- anoxic event
what are the extrinsic muscles of the tongue?
styloglossus, genioglossus, hyoglossus, palatoglossus
what do the extrinsic tongue muscles do?
they stabilize posterior oral tongue and base of tongue in oropharyngeal cavity
-movers of the tongue
-
What can happen to the tongue of children with poor trunk control?
children with poor trunk control or respiratory difficulties will contract these extrinsic tongue muscles to help stabilize the head and neck
-this results in tongue retraction and shortening of tongue musculature–>difficulty using tongue in a functional way
what are body support and stability provided by: 4
- core strength
- base of support
- head and neck control
- body positioning
what does core strength do?
stabilizes body for good trunk control
what does base of support help with?
when hips are in neutral position
- -body structures line up
- -back is straighter
- -shoulders are up and aligned
- -rib cage and respiratory system are open
what are problems associated with bad base of support?
poor base of support may result in jaw and tongue tensing to help stabilize head and neck
–tongue and jaw do not have free movement in oral motor function
what does good head and neck control help with?
- when neck is aligned and head is in midline
- -jaw is freer to function independently
- -airway is better protected
- —-posture for head, function for breathing, function for swallowing
what are the neck muscles responsible for?
- -posture for head
- -function for breathing
- -function for swallowing
what is the best positioning for body?
90 degrees for all
ankles knees and hip flexion
T or F. the body should have contact with surface (either chair or held by adult)
True
sensory processing of stimuli is a huge factor in what?
a child’s acceptance, enjoyment, success and safety dyring feeding
the brain must do what things with sensory input?
receive
control
interpret
The brain must: receive sensory input from the body
yes
the brain must control sensory input by doing what?
limiting the amount of info that is being processed (tune out extraneous stimuli)
during feeding the brain controls sensory info:
the brain processes and filters out background or extra stimuli in order to prevent sensory overload
T or F. the brain must interpret sensory input=pain, pleasure, noxious touch soothing, alerting
True
During feeding the brain interprets sensory info:
interprets taste and other stimuli as good or bad
- -based on that the brain decides whether or not to allow that stimuli again or to respond negatively to it..
- -it also contributes to normal oral-motor manipulation of that stimuli or bolus
explain sensory development in infants
- mouth is a very sophisticated tactile system
- ability to accept and reflexively respond to tactile stim to the cheeks, lips, gums, and tongue is critical for their survival (nutrition and airway protection)
- negative stimulation early in life significantly affects development of a normal oral sensorium (i.e intubation, feeding tubes, surgeries, force feedings)
sensory development with older children=
initially uses mouths more than any other system to explore the world
- pleasure received helps child to progress through the food hierarchy
- exploration of a variety or oral movements also contributes to speech abilities
if you cannot breathe can you eat/
no
what is the body’s firs priority?
breathing maintaining 02 levels
the respiratory system and what other system share a portion of the same tract?
digestive system oropharynx
–resp system will always win!
T or F many children who have respiratory problems will also have feeding difficulties…
true
why are infants obligate nose breathers?
bc the velum rests up against the epiglottis for extra protection of the airway
T or F. ability to breathe adequately and with ease can be greatly affected by body position
True
what position is the best for breathing?
sidelying—allows chest and belly to fall to gravity
what is one of the first things you assess when assessing feeding?
respiratory system
–breath support, rib cage mobility, and rate/ease of breathing is always one of the first skilld you assess
how many breaths need to happen for a safe swallow?
<60 breaths per minute
Always remember that GI problems can cause the infant to have disordered feeding
yeppp
what are the common abnormalities (craniofacial) that affect feeding?
- facial paralysis/paresis
- cleft lip
- cleft palate
- macroglossia
- micrognathia
- glossoptosis
what problems can arise from facial paralysis/paresis?
oral seal–anterior loss of bolus
- -can help with pushing cheeks extra support
- -will affect chewing sublingual residue not a great rotary pattern due to lack of structure
what is macroglossia?
big tongue
- -down syndrome
- -can cause breathing problems
- -problems with bot retraction
- —does the tongue block airway
- –can they use their tongue functionally how does it affect tongue elevation/retraction etc..
what is micrognathia? rectrognathia
small jaw/retracted jaw
- -pierre robin
- -bc jaw is so far back the tongue can block airway
- -tongue is normal
- –most important question can they maintain a Peyton airway
feeding experiences can be conditioned or learned?
- -pleasure sensory–child will want to accept bolus again negative they will not
- -if child aspirates often they will not want to eat
–praise is given when a child tries something new –this will become a learned behavior
-can learn bad behaviors too
food allergies and intolerance can lead to what 6 things?
- potentially negative experiences if food causes gi pain/discomfort
- diet may be severely limited with multiple food allergies
- often leads to food refusal and food aversion
- always ask about current / former food allergies
- infants under 18 mos: ask probe questions about how they tolerate different foods
- allergy weight rule ????
