Infant Anatomy & Physiology for Feeding

Question 1

5 key elements of infant oral assessment

Answer 1

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

Question 2

Describe typical lip presentation

Answer 2

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

Question 3

Key role of buccal pads in feeding

Answer 3

Provide structural support, assist in maintaining adequate suction for feeding

Question 4

3 steps to assessing cheeks

Answer 4

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

Question 5

4 steps to assess jaw

Answer 5

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

Question 6

Describe key role of tongue in breastfeeding

Answer 6

Draw nipple into oral cavity, seal the cavity to maintain suction, provides central groove to channel milk and aids swallow coordination

Question 7

List abnormal presentations of the tongue

Answer 7

• Ankyloglossia (tongue-tie) both anterior and posterior attachmen
• Bunched or retracted tongue
• Tongue protrusion
• Tongue tip elevation (especially preterms)
• Tongue asymmetry

Question 8

Hard palate role in breastfeeding

Answer 8

Assists with positioning and stability of the nipple within the mouth

Question 9

Soft palate role in breastfeeding

Answer 9

Creates the posterior seal of the oral cavity (in conjunction with the tongue)

Question 10

Sometimes mistaken for thrush

Answer 10

Epstein pearls (benign cysts on hard palate, will self resolve)

Question 11

Classifications of clefts

Answer 11

• Unilateral or bilateral, partial/incomplete or complete
• Involve hard palate, soft palate or both

Question 12

What can a bifid or absent uvula indicate?

Answer 12

Possible abnormal formation of soft palate (assess for cleft)

Question 13

When are cleft palates usually corrected?

Answer 13

Typically not until at least 10 months of age

Question 14

How to elicit rooting reflex? When does it appear and when does it integrate/disappear?

Answer 14

Touch or stroke infant cheek. Appears at 32 weeks, typically disappears between 4-6 months but sometimes longer.

Question 15

How to elicit sucking reflex? When does it appear and when does it integrate/dissapear?

Answer 15

Light touch of nipple or fingers to lips or tongue. Appears between 15-18 weeks gestation, integrates between 6-12 months

Question 16

How is swallowing reflex elicited? When does it appear/disappear?

Answer 16

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.

Question 17

List 2 protective reflexes related to feeding

Answer 17

Gag and cough. Gag is present 18 weeks gest, however fully functioning cough often is not observed until 1-2 months of age

Question 18

Other newborn reflexes that persist up to 6 months

Answer 18

1) Stepping reflex (used for breast crawl)
2) Palmar grasp
3) Moro
4) Hand movements (predictable) used to stimulate, move and shape the breast

Question 19

What is the optimal position of the nipple within the oral cavity?

Answer 19

6-8mm from the hard and soft palate junction

Question 20

3 main phases of swallowing

Answer 20

Oral, pharyngeal, esophageal