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663 Pediatric Swallowing > Lecture Slides: Pediatric Swallowing > Flashcards

Lecture Slides: Pediatric Swallowing Flashcards

1
Q

newborn-infant tongue

A

smaller mandible so takes up more space in oral cavity; solely in oral cavity; posterior third of tongue descends at 2-4 years and completes by 9 years

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2
Q

newborn-infant pharynx AND larynx

A

pharynx-larynx elevated in the neck (aspiration is more difficult); with age, pharynx elongates and larynx descends in the neck

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3
Q

newborn-infant hard and soft palate

A

hard palate : short, no arch, and has folds of mucosa (facilitates latching) :: soft palate : grows in length (by age 4-5) and thickness (by age 14-16)

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4
Q

newborn-infant mandible

A

mandible is not fused, begins to fuse at age 1; mandible is small (reduces size of oral cavity); rami of jaw angles more with age

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5
Q

newborn-infant larynx

A

at birth larynx is 1/3 length of adult; pyriform sinuses more shallow; larynx and hyoid more elevated at birth; larynx descends at 2-4 years (C7 by adulthood)

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6
Q

newborn-infant epiglottis

A

proportionately larger in an infant; makes direct contact with the soft palate

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7
Q

newborn-infant pharynx

A

angle of the relationship between the nasal and oral cavities moves from oblique to 90 degrees by age 5; as the tongue descends, the posterior aspect becomes the anterior wall of the pharynx

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8
Q

swallowing differences in infants: mouth

A

tongue fills mouth; cheeks with sucking pads; small mandible proportionate to cranium

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9
Q

swallowing differences in infants: pharynx

A

nasopharynx gently curves to hypopharynx (oropharynx is not definite or distinguished); pharynx sits at C3

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10
Q

swallowing differences in infants: larynx

A

located at C3-C4; arytenoids nearly mature in size compared to laryngeal structures (which are a third of adult size)

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11
Q

infant volume per swallow

A

0.2 ml (+/- 0.11 ml)

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12
Q

infant swallows per day

A

600 to 1000

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13
Q

___ is “head to toe”

A

motor development

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14
Q

postural control is important because it affects ___

A

feeding success and airway protection

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15
Q

problems with ___ may interfere with the normal patterns of breathing and swallowing

A

muscle tone or coordination

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16
Q

which respiratory tract issues may disrupt feeding

A

reduced patency; hypo pharyngeal compression due to position of structures; normal neck flexion; mandibular retraction that reduces pharyngeal space; small laryngeal vestibule

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17
Q

breast feeding requires nipple contact ___

A

between the tongue and hard palate; lip seal creates negative pressure in the oral cavity

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18
Q

suckling

A

0-6 months; loose lips, reduced lip seal; wide mandibular excursions; tongue moving in and out

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19
Q

sucking

A

6-9+ months; tight lip seal, reduced tongue seal; reduced mandibular excursions; tongue moving up and down

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20
Q

non-nutritive suck(l)ing

A

advantages: calming; valuable to medically fragile kiddos; NNS along with tube feeds is good for the kiddo

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21
Q

for non-nutritive suck(l)ing, breathing is ___

A

continuous

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22
Q

whether or not a child can produce a normal non-nutritive suck(l)ing reveals their ___

A

readiness to feed

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23
Q

assessment procedures

A

bedside swallow eval; FEES; MBSS

**same strengths and weaknesses as adult versions of these assessments

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24
Q

pediatric dysphagia symptoms

A

failure to thrive; sudden change in feeding; bx changes before / after feeding; weak / dysfunctional suck; coughing / choking during feeding; unexpected physiological changes after meals

25
Q

components of clinical exam

A

hx; bx / state / sensory integration; general posture control / tone; respiratory function / endurance; oral-motor / CN evaluation; feeding / swallowing evaluation

26
Q

clinical exam: hx

A

current status / dx; social hx; medical hx; feeding and swallowing hx

27
Q

clinical exam: bx / state / sensory integration

A

stage of alertness before, during, or after feeding to help determine optimum degree for feeding; note stress cues (indicates difficulty during feeding)

28
Q

clinical exam: general posture control / tone

A

assess muscle tone / posture / movement abnormalities; evaluate head / neck / trunk alignment; evaluate head support; note abnormal compensatory bxs

29
Q

clinical exam: respiratory function / endurance

A

observe respiratory patterns at rest and during activity; observe for: belly breathing, gulp breathing, reverse breathing, irregular / shallow breathing

30
Q

clinical exam: oral-motor / CN evaluation

A

oral primitive reflexes that may interfere with feeding; oral structures and function; CN screening

31
Q

clinical exam: feeding / swallowing evaluation

A

bottle feeding: NS vs NNS

position on the nipple; initiation of suckle / suck; mandibular excursion; feeding endurance; cup / straw / spoon feeding; biting / chewing solids (soft and hard)

32
Q

when to recommend MBSS

A

similar reasons to adults (signs / symptoms of aspiration, reduced oral intake, prolonged period of time to complete meal); signs of distress (for severely cognitively impaired); DO NOT recommend MBSS until sucking bx has developed around 38th week

33
Q

who is on the disciplinary team

A

SLP; RN; lactation consultant; dietician; pediatrician; PT; gastroenterologist; social worker

34
Q

adult dysphagia vs pediatric dysphagia

A

anatomy and physiology are different; infant has primitive reflexes and different promoter and feeding abilities; because of fast development, more follow-up required

35
Q

what do we train the parent / caregiver on?

A

positioning; setting the environment; selecting feeding choices and methods; understanding the feeding problem

36
Q

management options

A

nutritional considerations; how to modify environment and impact on feeding; position of child and parent; appropriate feeding methods based on child’s skills, age, and needs; appropriate timing and amount of food; meal scheduling; supporting parents’ needs and skills; oral exercises and oral / facial support

37
Q

nutritional considerations

A

coordinate time to feed and nutritional needs with the child’s swallowing ability; full oral feed for infants is ~ 30-45 minutes; look for fatigue during feeding; determine whether supplementation is needed (small, frequent meals; adding calories, vitamins, minerals; NGT or PEG)

38
Q

feeding environment

A

calm setting without distractions; rhythmical elements (music, rocking)

39
Q

positioning and seating

A

relaxed, comfortable seating arrangement; sustainable posture / position; balance, stability, mobility; efficient and safe swallow; promoter control; inhibition of abnormal reflexes; independent feeding

40
Q

for ___, proper posture / seating is essential in order to promote safe feeding

A

kiddos with neurological impairments

41
Q

a posture should decrease ___, not increase it

A

fatigue

42
Q

greater stability = greater ___

A

mobility / control

43
Q

when considering positioning and seating, take a ___ approach

A

whole body

44
Q

positioning and seating: what affects what

A

feet and leg instability : affects trunk stability :: trunk instability : affects shoulder girdle stability :: shoulder girdle instability : affects head and neck stability :: head and neck instability : affects jaw, lip, tongue control

45
Q

positioning principles: pelvis and hips

A

newborns may need to be flexed into a curled position with hips bent and knees flexed; hips should be flexed in a good sitting position

46
Q

positioning principles: trunk

A

symmetrical and not rotated; upright unless a slight recline helps stability

47
Q

positioning principles: legs

A

should be still; bent in order to inhibit extension in hips

48
Q

positioning principles: shoulder girdle

A

slightly forward to assist forward arm position and general flexion; may be assisted by swaddling

49
Q

positioning principles: head and neck

A

head in slightly forward posture with chin tucked, assist swallow efficiency and safety, inhibit abnormal extensor patterns (be careful not to collapse airway)

50
Q

to breastfeed or not?

A

ask: will it provide adequate nutrition? is it physically possible for the child? what are the child’s positioning needs? will it be safe? does the mother want to breastfeed?

51
Q

mother promotes breastfeeding by ___

A

supporting infant’s head, neck, and trunk; shaping breast to form a teat; eliciting rooting reflex at the breast; bring baby to the breast (rather than breast to baby)

52
Q

breastfeeding

A

can be facilitated by careful positioning and stimulating early primitive oral reflexes; children with macroglossia or related conditions (micrognathia) will do better i na prone feeding position where the tongue is brought forward and doesn’t risk blocking the airway

53
Q

preparing for feeding

A

modifications to the feeding environment; ensuring appropriate positioning; oral desensitization before feeds for hypersensitive kids; oral stimulation before feeds for hypotonic kids; kids with delayed feeding skills may benefit from mouthing / chewing activities before meals

54
Q

characteristics of oral hypersensitivity

A

avoidance of mealtimes; refuses the breast; refuses or gags on teats; refuses the dummy; rejects mouthing toys; refuses range of textures; avoids tastes / textures; no preference for self-feeding

55
Q

characteristics of oral hyposensitivity

A

poor sucking and chewing; diminished response to sensory input; drooling; inclined to overfill mouth; enjoy foods of strong flavors and increased textures

56
Q

benefits of oral stimulation in infants / newborns

A

improved head position; improved mouth opening to accept breast / bottle; forward tongue posture over the gum line; reduction of gag; sucking initiation; lip closure

57
Q

facilitative approaches

A

establishing a nutritive suck; external pacing (establish an internal rhythm); oral stimulation programs; reducing oral aversions; develop chewing skills; address behavioral feeding disorders; oral-motor tx (same concerns as adults)

58
Q

compensatory strategies

A

establishing optimal infant state / feeding readiness; altering environment to support feeding; establish optimal position; alter consistency, temperature, volume, and taste of food; change feeding utensils

663 Pediatric Swallowing (1 decks)

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