Infant feeding Flashcards
make sure you take in consideration these 6 things (whats natural and normal) (chart very important)?
age (Chronological and adjusted age) positioning medical diagnoses swallowing and GI health respiratory status functional
Feedings should never take longer than ____ minutes?
30
less than 6 months old what drives the swallow
the suck
what is the most natural way for an infant to feed?
breastfeeding
sidelying, head and neck alignment with body, slight chin tuck as jaw is opened wide to accept nipple, infants body is fully supported by and pressed into mothers body
0-3 months the infant relies on us to give him/her postural stability
True
What is the normal feeding position for 0-4-6 mos?
- overall flexion
- head and neck alignment through midline!! ( Most important for feeding)!
- hips flexed at 45-90 degree angle
- body bordered on sides and back (physical containment)
after 3 mos the infant uses postural stability…
stability is provided intrinsically through muscular, tonal and postural strength
what is en face postural position?
baby facing adult with adult fully supporting head and neck
sidelying
most common in breastfeeding
-pressed up against mothers body most natural and safest position for newborn
cradle
still able to provide full borders and support for infant
propped
baby is propped on lap or pillow and bottle is held for baby, adult has no control of head or support of trunk
what is the rooting reflex and the purpose and when is it integrated by?
it is elicited when oral area is touched, he turns his head in the direction of touch and vigorously opens mouth
- purpose: allows infant to locate source of food
- integrated by 3-4 mos:
what are the 6 oral-motor reflexes?
- rooting
- sucking
- gag
- tongue thrust
- transverse tongue reflex
- phasic bite reflex
what is the sucking
- it is elicited by the light touch to the lips or tongue from nipple or finger initiates sucking response
- =-purpose= it insures infant will obtain nourishment
3-6 mos: an infant younger than 3-4 mos that still has a strong sucking reflex cannot always cease sucking on the nipple when they are overwhelmed
what is the gag reflex?
it is elicited mid tongue area: older baby and adult at the posterior tongue or pharyngeal wall area
- purpose: to protect the person from ingesting items that are too large for the digestive tract or protect the airway from blockage
- -present through adulthood
tongue thrust reflex?
elicited when contact is made to the infants tongue or intraoral cavity
- purpose-protective response that prevents anything other than a nipple in the infants mouth bc the infant cannot handle anything else
- integrated 4-6 mos
phasic bite reflex?
elicited-rapid, rhythmical up and down movement of the jaw for a bite-and-release pattern
- purpose-aides in development of chewing
- integrated-by 7-8 mos
what are the states of alertness?
- sleeping
- drowsy-eyes open but dull and heavy-lidded, may look dazed and unavailable movements are smooth and mild startles
- quiet alert-strongly focused on a stimulus, focus of attention is steady but can change easily after a brief delay, motor activity is minimal (good time to feed)
- active alert: considerable motor activity, thrusting of extremities, brief “fussy” periods
(good time to feed infant) - crying=crying intensely it is difficult t break through crying with any stimulus
what is the normal gestational period of a infant?
38-40 weeks
when is a baby considered premature?
if it is born before 38 wks
when does sucking seen in utero?
15-18 weeks of gestation
when can sucking be seen in extrauterine enviornment and sucking is still random with no coordination of breathing?
28 weeks gestation
when do you begin to see the SSB coordination but it is still inconsistent and random?
32 weeks gestation
when do infants establish and coordinate sucking and breathing pattern?
34-35 weeks gestation
When can we start introducing oral feedings if a baby is premature?
32-34 weeks because at 34 weeks they start to really coordinate their swallow
what is the difference btwn chronological age and adjusted age?
chronological age is their exact age calculated from the babies DOB
-adjusted age is the babies CA minus the weeks born premature
Yes or no…babies who are premature are considered developmentally appropriate if their skills match their adjusted age?
Yes
what age do premature babies have until to catch up developmentally (when we stop correcting for prematurity)?
2nd birthday
what is a mature sucking pattern consist of?
it consists of bursts and pauses
each burst contains multiple suck:swallow:breath patterns
what does an immature swallow look like?
burst pause
in each burst just a suck swallow they do not breathe
the baby breathes on the pause
what are the 14 signs and symptoms of aspiration?
- coughing choking
- wet breath sounds
- “crackles” during exhalation
- throat clearing
- stressful facial expression (nasal flaring, wide eyes, general look of panic/fear)
- pulling head back and arching into extension but infant may still be latched and sucking
- pulling off nipple with possible head turn/crying
- rapid breathing (tachypnea)
- color changes around lips or face
- decreased 02 saturation
- frequent sneezing
- constant low grade fevers
- upper respiratory infections or pneumonia
- red flag: frequent need for nebulizer or other pulmonary treatments
what are the 5 categories of abnormal sucking patterns (nutritive)?
- high suck/swallow ratio
- prolonged sucking or feeding-induced apnea
- short sucking bursts
- disorganized sucking
- special circumstance–cleft lip & or palate
what is a high suck swallow ratio?
more than 3 sucks per swallow
1-2 is normal
what are signs/symptoms of a high suck swallow ratio
- more than 3 sucks/swallow
- inefficient sucking pattern causing the baby to exert more effort with increased # of sucks
- feeding lasting longer than 30 minutes or infant fatigues prior to completion of feeding
what are the possible causes of a high suck swallow ratio?
most common nipple rate too slow
- neurological disorganization
- poor proprioceptive awareness of the amount of liquid in the mouth
- ankyloglossia
what are the signs and symptoms of prolonged sucking or feeding-induced apnea?
- long suck swallow bursts without stopping to breath
- leads to feeding induced apnea
- described as difficulty pacing sucking and swallowing with breathing seen more often in beginning of feeding when vigorous, strong, rapid sucking is more likely
what are the signs and symptoms of short sucking bursts?
<10 sucks/burst
what can cause a short sucking burst?
respiratory difficulties
- fatigue or decreased endurance
- infant compensating for pharyngeal phase dysphagia
what are the signs and symptoms of disorganized sucking?
-uneven and disorganized burst/pause pattern and S:S:B pattern
-coughing and choking frequently noted
-high risk for aspiration bc of oral discoordination
-
what are possible causes of disorganized sucking?
- general neurological deficits
- mild resp. problems
- incompatible nipple flow
what are some feeding problems and strengths with babies who have cleft lips only?
- few feeding problems
- able to breast feed
- occasional problems: excessive air ingestion
- -anterior liquid bolus loss
what can cleft lip babies feedings be aided by?
- labial taping
- wide-based bottles
- breastfeeding (bc the breast fills the cleft
what are some strengths and problems babies with cleft palate can have when feeding?
- majority of babies are normally intact–> WNL sucking/swallowing reflex
- provided cleft palate bottle, adequate support –> efficient normal feedings
- aspiration is NOT typical
- unable to create oral seal/negative pressure bc they cannot get full suction
- must use compression only bottle
- excessive air ingestion–>increased GE reflux, uncoordinated SSB
- nasal congestion–> difficulty coordinating respiration during SSB (obligate nose breathers)
- burden on care giver for positioning, pacing, and aided extraction–>requires education
- extended feeding times and inefficient feedings-FTT
What are some common cleft palate baby dysphagia symptoms?
- nasopharyngeal regurge ( can cause aspiration)
- pharyngeal residue (bc lack of seals no pressure)
what are the feeding expectations for cleft palate babies (normal developing full term)?
- full po feedings within 1 week
- feedings completed in less than 30 min
- WFL airway protection during MBS
- increased air ingestion (more burp breaks)
- nasal congestion (NOT laryngeal)
What are the three kinds of Cleft palate feeders?
- haberman/special needs
- pigeon
- cleft palate nurser (squeezable)
when is the nutritive suck become integrated as simple, rhythmical motor reflex?
3-6 mos
What are the components of a nutritive suck?
- compression
2. suction
what happens during the compression phase of a suck?
(positive pressure) tongue pushes against nipple, increased compression on breast vs. bottle
what happens during the suction phase of a suck?
negative pressure jaw and tongue depresses creating a negative space which draws the milk out of the nipple to fill the open space
what is a burst?
period of time of repetitive and continuous sucking, swallowing and breathing (S:S:B)
what is the pause period of the burst pause pattern?
period of time when infant is still latched to the nipple and is just breathing (not sucking)
what is the normal SSB ratio?
1-2:1:1
1-2 sucks per 1 swallow per 1 breath
T or F. there are multiple SSB patterns in a burst.
True
what is a mature sucking pattern?
10-30 sucking cycles per burst
-continuous sucking burst
-respiration occurs as part of the triad SSB pattern so there is a breath after each swallow
then catch up during the pause
what is the immature sucking pattern for premature infants?
3-5 suck: swallow per burst
respiration occurs only during pause periods
suck suck suck suck: swallow suck: suck: suck: swallow, suck suck suck: swallow again and again until they pause to breath
Is the immature sucking pattern normal for premature infants?
yes that is why it is called immature
Explain the non-nutritive suck…
- purpose=comfort, state regulation, sucking desire, exploration
- rhythm-repetitive pattern of equal bursts and pauses
- rate twice as fast as the nutritive suck ( about 2 sucks/second)
- we can use this as a therapy tool
T or F. a sign a baby is neurologically intact is when the sucking rate changes from non-nutritive to nutritive suck bc they can tell that there is nothing to swallow so the sucking rate is faster.
True
