Infant Anatomy & Physiology for Feeding Flashcards
5 key elements of infant oral assessment
1) Observe orofacial anatomy
2) Identify any deviations and consider how those deviations may contribute to feeding behaviours
3) Observe feeding reflexes and note any abnormalities
4) Observe effectiveness of feeding (suck-swallow-breathe)
5) Observe “fit” between mouth and nipple
Describe typical lip presentation
Bow-shaped upper lip with well-defined philtrum, neutral position, closed at rest, seal smoothly around breast during feeding
*both hyper- and hypo- tonic presentations are abnormal
Key role of buccal pads in feeding
Provide structural support, assist in maintaining adequate suction for feeding
3 steps to assessing cheeks
1) Place finger in mouth and thumb outside. With think cheeks, they will nearly touch
2) observe shape of the cheeks at rest (look for dimpling when feeding and creases under the eyes)
3) Observe overall efficiency of the feeding
4 steps to assess jaw
1) Observe for asymmetry
2) Identify micrognathia or retrognathia
3) Observe feeding and watch for jaw grading, clenching or tremors
4) Insert a pinkie finger in the corner of the mouth between posterior gums to elicit reflexive bites
Describe key role of tongue in breastfeeding
Draw nipple into oral cavity, seal the cavity to maintain suction, provides central groove to channel milk and aids swallow coordination
List abnormal presentations of the tongue
- Ankyloglossia (tongue-tie) both anterior and posterior attachmen
- Bunched or retracted tongue
- Tongue protrusion
- Tongue tip elevation (especially preterms)
- Tongue asymmetry
Hard palate role in breastfeeding
Assists with positioning and stability of the nipple within the mouth
Soft palate role in breastfeeding
Creates the posterior seal of the oral cavity (in conjunction with the tongue)
Sometimes mistaken for thrush
Epstein pearls (benign cysts on hard palate, will self resolve)
Classifications of clefts
- Unilateral or bilateral, partial/incomplete or complete
- Involve hard palate, soft palate or both
What can a bifid or absent uvula indicate?
Possible abnormal formation of soft palate (assess for cleft)
When are cleft palates usually corrected?
Typically not until at least 10 months of age
How to elicit rooting reflex? When does it appear and when does it integrate/disappear?
Touch or stroke infant cheek. Appears at 32 weeks, typically disappears between 4-6 months but sometimes longer.
How to elicit sucking reflex? When does it appear and when does it integrate/dissapear?
Light touch of nipple or fingers to lips or tongue. Appears between 15-18 weeks gestation, integrates between 6-12 months
How is swallowing reflex elicited? When does it appear/disappear?
Bolus or fluid contacting the sensory receptors of the soft palate, tongue and back of the mouth. Appears 9-14 weeks gestation, persists into adulthood.
List 2 protective reflexes related to feeding
Gag and cough. Gag is present 18 weeks gest, however fully functioning cough often is not observed until 1-2 months of age
Other newborn reflexes that persist up to 6 months
1) Stepping reflex (used for breast crawl)
2) Palmar grasp
3) Moro
4) Hand movements (predictable) used to stimulate, move and shape the breast
What is the optimal position of the nipple within the oral cavity?
6-8mm from the hard and soft palate junction
3 main phases of swallowing
Oral, pharyngeal, esophageal