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SPCH3206 > Management of Paediatric Feeding > Flashcards

Management of Paediatric Feeding Flashcards

1
Q

What are the goals of feeding management and intervention?

A
  • Safety (hydration, aspiration)
  • Nutritional adequacy
  • Efficiency
  • Age-appropriate developmental skills
  • Parent-child interaction/ positive mealtime experiences
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2
Q

List some principles your management decisions will depend on

A
  • anatomy and physiology
  • the child’s underlying skill and deficits identified in assessment
  • multidisciplinary team goals
  • child’s progress
  • child’s developmental stage
  • child’s pre-morbid feeding status
  • child’s cognitive status and ability to learn new skills
  • child’s level of independence/ physical status
  • family resources (physical, financial, emotional)
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3
Q

Why is supporting families important in PFD?

A
  • critically important to include families in goalsetting and as a part of the therapy time
  • this is regardless of the child’s needs
  • including the family increases the likelihood of successful therapy generalisation
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4
Q

What is some general advice for families of children with feeding difficulties?

A
  1. set up a predictable mealtime routine
  2. understand the division of responsibility
  3. provide good modelling of desirable behaviours
  4. set up a supportive mealtime environment
  5. set up clear and attainable goals, with clear expectations and outcomes for the child
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5
Q

What is parent training?

A
  • critically important
  • should include information about nutrition and behaviour
  • will assist with carryover of work with the child to the home environment
  • parents will be invested in the treatment and goals
  • involvement of the parent and alleviates parent stress
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6
Q

What are the types of parent training

A
  • theoretical
  • guided commentary
  • practical/immersion
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7
Q

Explain ‘theoretical’ parent training

A
  • educational literature
  • educational group programs
  • hands-on educational program with several parents
  • generally aimed at changing inconsistent parenting practices
  • useful for fussy eaters
  • commercial education programs
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8
Q

Explain ‘guided commentary’ parent training

A
  • explanation of the session progress in terms of child and therapist actions to the parent
  • parent may be observing from another room with a second therapist
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9
Q

Explain ‘practical/immersion’ parent training

A
  • parent has the opportunity to practice applying the principles taught in a session with their child
  • opportunity for feedback and troubleshooting is then applied, either after the session or via a ‘bug in the ear’ method
  • associated with increased generalisation to the home environment in language therapy
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10
Q

What if I treat a child with an aspiration risk?

A
  • parents need to understand the risks
  • important to educate families with regard to anatomy and physiology
  • parents should know the signs of aspiration
  • review VFSS together/review report
  • parents are not on the same page as you with regards to management may not follow
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11
Q

What are some practical tips for engaging parents?

A
  • involve the parent in therapy goal-setting and planning from the beginning
  • talk through any handouts to help them understand
  • where possible, involve two therapists in session
  • otherwise, video the session and provide parent with a copy
  • handwrite a summary at the end of each session with 1-2 simple goals for the parent to try at home
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12
Q

Discuss ‘extra slow flow’ teats, including a description and the population they suit

A
  • usually a standard drip teat
  • fragile infants, premature infants
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13
Q

Discuss ‘slow flow’ teats, including a description and the population they suit

A
  • standard drip teat with hole suggested for infants 0-3 months
  • infants requiring slower flow, infants having difficulty with suck-swallow breath coordination
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14
Q

Discuss ‘medium flow’ teats, including a description and the population they suit

A
  • standard drip teat with hole suggested for infants 3-6 months
  • infants with a weak suck but good suck-swallow-breath coordination
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15
Q

Discuss ‘fast flow’ teats, including a description and the population they suit

A
  • standard drip teat with hole suggested for infants 6 months
  • infants with a weak suck but good suck-swallow-breath coordination
  • infants on a medium flow teat requiring thickened fluids
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16
Q

Discuss ‘cross cut’ teats, including a description and the population they suit

A
  • non-drip teat with Y or X cut that only opens when teat is compressed
  • minimises chance of oral flooding
  • infants who are on thickened fluids as has a larger opening
17
Q

Discuss ‘variable flow’ teats, including a description and the population they suit

A
  • the teat is twisted to alter the flow rate allowing the feeder to pace the feed
  • infants who fatigue easily, infants who require pacing
18
Q

What are the different types of pacing?

A
  • strict/prescriptive
  • responsive pacing
19
Q

How can you promote successful cup drinking?

A
  • sit upright
  • wide-lipped clear cup
  • familiar and preferred fluid
  • thickener might help
  • rest cup in lower lip corners
  • support jaw if required
  • single sips
  • full is sometimes easier
20
Q

How can you promote successful spoon feeding?

A
  • sit at eye level
  • flat spoon - small volume
  • wait for mouth opening
  • don’t scrape
  • pause for lips
  • guide lips if required and tolerated
  • try sideways presentation
  • go gradual - small texture changes
21
Q

What does oral phase dysphagia treatment involve?

A

Generally:
- sensory skills
- motor skills

22
Q

What does pharyngeal phase dysphagia treatment involve?

A
  • teaching the child to modify feeding strategies
  • teaching the child to modify the bolus
23
Q

What are some things to consider when managing paediatric dysphagia?

A
  • fatigue
  • alertness
  • positioning
  • feeder
  • time
  • communication
24
Q

What does good oral care aim to achieve?

A
  • remove bacteria from mouth
  • remove food debris without damaging gingiva
  • keep oral mucosa clean, soft, moist and intact
  • decrease risk of oral and systemic infection
  • alleviate pain/discomfort
  • prevent halitosis
  • increase general wellbeing
25
Q

What might a child with restricted-diet present with?

A
  • disruptive behaviours that are affecting mealtimes
  • poor weight gain/poor nutrition/ excessive weight gain
  • parents that have a high degree of stress
  • other developmental delays/disorders/medical conditions
  • sensory processing disorder/oral motor skills delays
26
Q

What are the goals of therapy for a child with a restricted diet?

A
  • increase desirable behaviour
  • decrease undesirable behaviour
27
Q

What behaviour modification therapy types can be used in the management of a child with a restricted diet?

A
  • systematic desensitisation
  • operant conditioning
28
Q

What is ‘responsive feeding’?

A
  • new area
  • child-led ‘facilitated mealtimes’
  • based on building trust around food and following child’s lead
  • no prompts or rewards
  • aim is to create healthy mealtime interactions and dietary intake
29
Q

What are some must haves of operant conditioning?

A
  • shaping
  • fading of prompts
  • thinning reinforcement
  • effective reinforcers
30
Q

What are the must haves for systematic desensitisation?

A
  • ideas for exposure and progression at each level of the hierarchy
  • an understanding of the sensory properties of different foods
  • a sense of play
  • an understanding of when it is and isn’t an appropriate tool to use
31
Q

What is the basic premise (in a play context) of systematic desensitisation?

A

Tolerates -> Interacts with -> Smells -> Touches -> Tastes -> Eats

32
Q

When might systematic desensitisation not worl?

A
  • parents who don’t cope with food play idea
  • can take longer, so more likely to drop out
  • if the child is not intrinsically motivated enough to actually eat the food
33
Q

What are some at-risk populations in PFD?

A
  • ex-premature
  • CP
  • DS
  • cleft lip/palate
  • tracheostomy
  • ASD

SPCH3206 (12 decks)

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