Infant feeding and evaluation Flashcards
major considerations
smaller physical structures
develop around 11 or 12 weeks in eutero
infants are less likely to show outward signs of swallow dysfunction (coughing and choking)
Normal newborns
Suck-swallow: Suck documented from 11-15 weeks gestation. Sucking reflex is present at 29-30 weeks.
Rooting: begins at 28-30 weeks gestation and integrates at 4 months.
Gag: survival response, protects the airway. Often not present until 32 weeks gestation.
Suck, swallow, and breathe often doesn’t combine until 34 weeks
Self protection reflexes come at 32 wks.
If too much comes from breastfeeding it can make it a bad experience for the infant and may effect volition of infant when it comes to feeding. Can make it a bad experience. Can also be good with good breastfeeding and reinforce the feeding experience down the road.
Suck, suck, swallow, and take a breath. (2 to 8 sucks then swallow and breath).
Postural control of Newborn
Physiological flexion helps provide stability for the oral movements
Posture provides them with muscle strength helping to build their proximal control and stability in order to do complex tasks down the road.
Do a lot of swaddeling to help infants and provide some of that postural stability.
Postural control continued
Physiologic flexion causes a tight chest wall
Cervical and thoracic spinal areas are underdeveloped: head appears to rest on the thorax
Upper chest is flat and narrow with no expansion during breathing (belly breathing)
Ribs are horizontally aligned with no intercostal spacing
Respiratory rate increase with increased activity (because they are belly breathers)
Normal respiratory rate 38-60 /minute
Influences of upright gravity and motor development should change the ribcage. Ribs angling downward. The motor development is trunk development. Mainly abdominals. Most important oblique’s- insert lower ribs to iliac crest. Activating these pull the ribcage down which allows the intercostal to activate, which help advance the breathing pattern and allow complete head flexion.
Activate intercostals Achieve full head control Stabilize hyoid Advance respiratory pattern Sound production
Difference between kids
Older- can get some posterior pelvic tilt.
Tummy time- helps them to learn how to breathe not from their abdomen. Kids who have a hard time orally feeding initially, tummy time helps them breathe better and then can help them develop a suck swallow ability. Helps to use intercostals to help them breathe.
Etiology of feeding difficulties in infants and children
Neuromuscular conditions: SMA, Muscular dystrophy
Gastro: constipation reflux, poor motility,
Trauma: surgery or intubation- vocal cord paralysis
Congenital Anatomical defects
Tongue and lip ties Cleft lip and or palate Laryngomalacia Tracheomalacia Micrognathia Vascular ring Tracheoesophageal Fistula Pyloric stenosis Laryngeal Cleft
Tongue and lip ties-
frenulum to upper lip is too tight and they cant use upper lip
Cleft lip and or palate
tough, palate affects feeding a lot more. Cleft palate- trying to drink from a straw with a hole in it. Not able to extract liquid efficiently. (cant breastfeed, have to bottle feed with a special bottle. (Dr. brown specialty feeder)- small one-way valve so that milk can get into nipple but cannot get back out. Kid doesn’t have to build up such a positive suction. Every time they squeeze /compress nipple and milk will come out. (baby may have a strong latch but cannot build pressure .
Laryngomalacia
Laryngomalacia- some floppiness/ low tone inside larynx (just above trachea or trachea itself) baby will sound like a dog chew toy. Like drinking a milkshake and the more you suck the more the straw collapses (trying to breathe in a patterned response and when they try to suck hard their airway collapses). Have a collapsed airway and then have the reflex of needing to take a breathe when airway has milk in it.
Pyloric Stenosis
Pyloric stenosis- projectile vomiting- super quick ultrasound to rule it out. Sphincter in stomach isn’t working correctly.
Neurological Differences
Seizures- need medications but make babies very sleepy and can effect how well they feed.
Chiari Malformation- A lot higher rates of silent aspiration. (not shown to be effective to surgically decompress malformation) damage to nerves done already.
Gastrological Conditions
- Infant reflux
- Gastroesophageal reflux
- Poor motility
- Short guy
- Constipation
Reflux- stomach content comes back up from the stomach. (issue when suffer from it) bloody diapers, cannot gain weight, when an actual disease process.
Poor motility- GI test can help see what is causing it. Do symptoms lead to a decline in skill development and feeding ability.
Cardiac conditions
- vocal cord paralysis
- poor perfusion to GI tract
- Often do not have early opportunities for eating.
- poor endurance
- Higher rates of aspiration/Penetration
Comorbidities
- Down Syndrome
- Digeorge
- Midline defects
Cleft palate and cleft lip can have other heart defects because things just didn’t close completely all the way.
Prematurity
- Lack of physiological flexor tone
- Negative experience to oral cavity.
This kids needs a ton of external support. Also focus on preventing skin break down. Support the premature infants.
Reflexes may not have emerged yet.
Tongue may be further back in their throat
tube feeding
Tube feeds - nasogastric tube or a G tube- straight in to the stomach, or feed kids straight into their jejunum(pass by the stomach) or tube from nose to the jejunum. (jejunum- 22 hours a day the kid is getting a continuous feeding to the intestine). Can take away hunger cycles- not a normal functional feeding experience. Want to try and get on bolus feedings to work on oral feedings. Gravity vs. Pump Bolus vs. Drip Time length of each bolus Volume Tube feeding schedule Day vs. night Color changes (dusky or cyanotic) Retractions Tachypnea Nasal flaring Diaphoresis (perspiration) Stridor Chronic congestion
Families are so important to the process of feeding kids. Fed by the mom attending to her kid or someone who is on their phone and not paying attention?
Most kids eat their bottles within 10 to 20 minutes and if it takes longer than 30 minutes then it may be hard for the child to gain weight.
