L11 Pediatric Dysphagia Flashcards
What are the 4 main types of factors that influence feeding development
- structural/anatomical development
- neurological development
- cognitive development
- social and emotional development
How do the buccal pads aid in swallowing?
help stabilize the cheeks, no muscle action required during feeding
Describe structural development from birth - 3months
- presence of sucking pads
- smaller and retracted mandible
- high anterior hyoid and larynx
- close approximation of tongue, cheeks, hard and soft palate
- close approximation of uvula and epiglottis
From birth - 3 months, which reflexes are present?
- rooting
- suckling
- tongue protrusion
- transverse tongue
- phasic bite
- santmyer
- gag reflex triggered by contact to post 2/3 of tongue
- swallowing reflex
Describe the functional oral/pharyngeal skills of a baby 0-3months
- obligate nose breathers
- suckling liquids by bottle or breast
- pause-burst swallow pattern
Describe the self feeding/positioning in a 0-3month old
- brings hands and toys to mouth
- generally fed in semi-recline position
- begins to recognize food source
What structural changes occur at 3-6months?
- sucking pads absorbed
- mandible grows downward and forward
- hyoid and larynx shift down
- increased distance between uvula and epiglottis
- greater distance between oral and pharyngeal structures
Why might we start to see feeding difficulties around 3-6 months?
structural changes lead to greater potential for things to enter into the airway, so if baby doesn’t have good neural control or muscle control this is where we start seeing difficulties
What neurological/cognitive changes occur at 3-6months?
- integration of rooting & tongue protrusion reflex
- increased control of mandible
- increased active mobility of tongue, lips & cheeks
- *Improved timing, rhythm, and coordination of suckling, swallowing and breathing **
Describe functional oral/pharyngeal feeding skills at 3-6months?
- intro of purees by spoon
- no active lip movement
- suckling used for spoon and bottle
- sequences > 20 sucks
- some spillage from lips
Describe self feeding and positioning at 3-6months?
- places hands on bottle
- recognizes and anticipates food
- fed purees in more upright position
In general, spoon feeding should coincide with baby’s ability to ________ on their own
sit upright
What structural changes occur at 6-12 months?
- continued elongation of aerodigestive tract
- mandibular incisors erupt (6-8mos)
- increases in saliva production
What neurological/structural changes occur at 6-12 months?
- continued increase in motor control and coordination
- integration of transverse tongue, suckling and phasic bite reflexes
- gag reflex less sensitive
What functional oral/pharyngeal feeding skills occur at 6-12 months?
- gradual development of sucking (more vertical movement)
- holds tongue & jaw stable for spoon
- active lip movement
- phasic bite develops into bite and stable hold
- munching used for solids that break off in mouth
- tongue moves laterally, ONLY if food placed on side
- swallows with tongue tip elevation
Describe self-feeding/positioning at 6-12 months?
- finger feeds dissolvable and soft solids
- begins to hold spoon and cup
- fed in upright position
It is really important that babies explore food through all their senses, or they might develop ___________
aversion or hypersensitivities to food
What structural changes occur at 12-24 months?
-continued elongation of the aerodigestive tract
What neurological/cogntivie changes occur at 12-24 months?
- development of food preferences
- integration of santmyer reflex
Describe functional/oral pharyngeal feeding skills at 12-24 months?
- diagnoal rotary chewing pattern
- less spillage from lips
- tongue tip elevates independently of jaw
Describe self feeding positioning at 12-24 months?
- refines independent spoon feeding and cup drinking skills
- food may fall off spoon
- begins to use fork for solids
List the typical causes of breakdown in feeding and swallowing development
- Abnormal persistence of primitive reflexes
– Anatomical abnormalities
– Structural changes in the absence of adequate development of neurological control
– Conditioned dysphagia
– Abnormalities of muscle tone
– Tactile sensitivity
– Vision impairment
– Pathological reflexes (i.e. bite reflex)
What info do we need from a case history for children?
- client/caregiver concerns
- general medical history
- chest history
- feeding history (from birth to onset)
- typical diet
- typical feeding positions and feeders
- developmental history
- therapies involved
- social/cultural issues around feeding
List the components of a clinical feeding exam for children
- case history collection
- OME
- Respiration
- Feeding observation
- Cervical auscultation?
- VFS?
