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Medically Based Pediatrics > Medically Based Peds (Feeding) > Flashcards

Medically Based Peds (Feeding) Flashcards

Test

1
Q

Feeding: Childs physical structures are

A

Smaller (these smaller structures offer innate protection)

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2
Q

Feeding skills are initiated by______ but is a ______ ______

A 
Reflexes (start to develop at 11-12 wks)
Learned Behavior (volitional, as motor learning and sensory experiences occur right after birth
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3
Q

At what age do liquids make up all the calories in a childs diet?

A

Under the age of 1

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4
Q

Bottle and breast feeding requires_________

A

More frequent swallowing in a specific suck-swallow pattern

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5
Q

Infants are less likely to show ________ signs of suck swallow dysfunction

A

outward

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6
Q 
Structures of the newborn vs adult
Tongue is \_\_\_\_\_\_\_\_
Pharynx is \_\_\_\_\_\_\_\_
Epiglottis is \_\_\_\_\_\_\_
Larynx is \_\_\_\_\_\_\_\_
Narrowest at \_\_\_\_\_\_\_
Trachea is \_\_\_\_\_\_\_\_\_
A 
Tongue is bigger
Pharynx is smaller
Larynx is more anterior and superior
Epiglottis is bigger and floppier
Narrowest at cricoid
Trachea is more narrow and less rigid
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7
Q

Epiglottis and soft palate offer innate protection and are touching at rest to protect from aspiration, this changes around

A

4 months of age

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8
Q

How many Mm involved with swallowing

A

48

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9
Q

Reflexes: Suck documented at ________

A

11-15 weeks gestation

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10
Q

Suck reflex is present at _________

A

29-30 weeks gestation

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11
Q

Rooting begins at __________ and integrates at ______

A

28-30 weeks gestation

4 mos

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12
Q

Gag, survival response, protects airway is present at ____

A

32 weeks gestation

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13
Q

Suck, swallow, breathing often does not combine until ______

A

34 weeks gestation

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14
Q

typical infant breathing pattern during feeding is _____

A

suck 2-8 times between breathing

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15
Q

Do not try to orally feed if _________

A

preemie, before 34 weeks

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16
Q

posture that helps provide stability for oral movements with infant feeding

A

physiological flexion
need good proximal stability to feed b/c it is so complex
use swaddling to provide postural stability

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17
Q 
Infant postural control:
physiological flexion causes\_\_\_\_\_\_\_\_
cervical and thoracic spinal area are \_\_\_\_\_\_\_\_\_\_\_
upper chest is\_\_\_\_\_\_\_\_\_
ribs are \_\_\_\_\_\_\_\_\_\_\_\_
respiratory rate \_\_\_\_\_\_\_\_\_ with activity
normal respiratory rate \_\_\_\_\_\_\_\_\_\_\_
A

a tight chest wall
underdeveloped (head appears to rest on thorax)
flat and narrow with no expansion during breathing (belly breathing)
horizontally aligned with no intercostal spacing
increases
38-60 breaths per minute

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18
Q

what physiological change advances the breathing pattern and allows for complete head flexion?

A

Obliques insert lower ribs to iliac crest, activating these pull the ribcage down and allows the intercostals to activate which advances the breathing pattern and allows for complete head flexion

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19
Q

why is tummy time good

A

it teaches children to use accessory Mm for breathing rather than just belly breathing and this allows better suck-swallow patterns

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20
Q

Name one disease that can cause higher rates of silent aspiration

A

Chiari Malformation (Spina Bifida)

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21
Q

stroke in utero can cause problems with

A

autonomic stability

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22
Q

list some congenital anatomical defects

A

tongue and lip ties
cleft lip or palate
laryngomalacia = floppiness or low tone inside larynx
tracheomalacia = cartilage that keeps trachea open is flaccid, trachea partly collapses
micrognathia = smaller jaw, can’t use bottom lip to seal
vascular ring
tracheoesophageal fistula
pyloric stenosis
laryngeal cleft

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23
Q

neurological defects

A

seizure
strokes
Chiari malformation
low tone

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24
Q

list some gastrological conditions

A

infant reflux
gastroesophageal reflux disease (GERD) = becomes disease process when kids are suffering from it, can be caused by poor motility, sometimes kids will not eat or over eat.
short gut
constipation

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25
Q

list some cardiac conditions

A

vocal cord paralysis = during cardiac procedure, left pharyngeal nerve is put at risk b/c surgical tools press down on arch, these children have problems with silent aspiration

poor perfusion to GI tract
often do not have early opportunities for eating
poor endurance
higher rates of aspiration /penetration

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26
Q

prematurity conditions that affect feeding

A

lack of physiological flexor tone
depending on PMA, their reflexes may not have emerged
weaker muscle tone around mouth and less tongue strength
retracted/tip elevated tongue
negative experience to oral cavity

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27
Q

Prolonged Sucking

A

lengthy sucking bursts without appropriate amount of breaths (10-15 sucks in a row)

infant not able to pace respirations with swallow

pauses with rapid, panting respirations

leads to cyanotic and/or bradycardic especially in preemies

usually at beginning of feeding when most hungry
more in preterm especially in 34-38 wk gestation

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28
Q

Short Sucking Bursts (SSB)

A

appropriate suck swallow breath ratio but pauses too frequently and long (could be a sign of swallow delay)

efficiency and intake compromised

usually related to swallowing or respiratory difficulties
maybe poor oral motor control affecting bolus formation and speed of swallow reflex
respiratory distress
observe retractions in sternal and clavicular

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29
Q

signs of swallowing defect

A

OBVIOUS: coughing, choking, desaturation during feeding, gagging and increased work of breathing

SOFT SIGNS: frequent respiratory illnesses, poor weight gain, refusal to eat or very picky eater and wet sounding voice which gets worse as they eat or after eating

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30
Q

Video Fluoroscopic Swallow Study (VFSS)

A

Sometimes called Barium swallow study
Completed in lateral view
Requires two staff members
Radiation

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31
Q

Fiberoptic Endoscopic Evaluation of Swallow (FEES)

A

Not tolerated well in children with scope at the same time
Structures are smaller, so it can be difficult to assess
Unable to see below level of vocal cords

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32
Q

Penetration

A

Goes into trachea but pulls back out

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33
Q

Aspiration

A

Goes into trachea and does not come back out

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34
Q

Environmental feeding treatments

A

decrease distractions
allow adequate time but keep feedings to 30mins
don’t make multiple changes within one day
feed infant when fully alert and cueing
(IDF) infant driving feeding

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35
Q

Postural feeding treatments

A

Swaddling to promote physiological flexion
Provide appropriate trunk and head control
tummy time to promote head and trunk control

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36
Q

Feeding treatment positions

A

Semi-elevated
Elevated side lying = keeps babies from having huge vital sign swings, if child has vocal cord paralysis, put vocal cord that is working toward the ground. Babies were able to stay on thin liquids longer in this position

37
Q

Feeding treatment facilitation techniques

A

Oral stimulation
Tongue support
Chin support
Unilateral cheek support

38
Q

Feeding treatment for external pacing

A

For infants who have difficulty managing the flow

poor suck-swallow breathe coordination

39
Q

Feeding treatments thickened liquids

A

Typically only used if indicated on VFSS

40
Q

Feeding treatment goals

A

Positive and consistent feeding experiences promote strong neural pathways and motor learning
Use teach back and return demonstration for parents

41
Q

Feeding

A

The process of setting up, arranging, and bringing food or fluid from the plate or cup to the mouth, sometimes referred to as “self-feeding”

42
Q

Eating

A

The ability to keep and manipulate food/fluid in the mouth and swallow it; eating and swallowing are often used interchangeably

43
Q

Swallowing

A

A complicated process in which food, liquid, medication, and saliva pass through the mouth, pharynx and the esophagus into the stomach

44
Q

Feeding disorder

A

A medical diagnosis in which an infant or child is not able to achieve adequate nutrition

45
Q

What can feeding disorders result from

A

Varied etiologies
poor oral motor skills
oral sensorimotor impairments
maladaptive behaviors during eating

46
Q

Failure to thrive

A

A medical diagnosis in which the infant child is not meeting his or her nutritional needs

47
Q

Pocketing food in mouth

A

possible oral motor deficit

48
Q

Gagging, retching, and vomiting associated with eating and drinking

A

Poor pyloric sphincter (lower esophageal sphincter) closing (GERD)
Gastroesophageal Reflux Disease

49
Q

Feeding disorder criteria

A

1) Lack of adequate eating with significant weight loss or failure to gain weight, lasting one month or longer
2) Behavior is not attributable to a gastrointestinal or other medical condition
3) Behavior is not better explained by lack of available food or another mental disorder
4) Onset is before age 6

50
Q

Gastrostomy tube (G-tube)

A

Helps to increase caloric intake
less visible
could be for a child who needs a more permanent option
there is not an uncomfortable feeling in nose or throat

51
Q

Naso-Gastrostomy tube (NG-tube)

A

Helps to increase caloric intake
more visible
lots of area for infection (nose)
more temporary solution that does not require surgery
does not feel good down nose and throat
easy to pull out
may not be able to actively participate in childhood occupations

52
Q

Sensory Processing Evaluations

A

Caregiver Sensory Profile-2 (Dunn model oral motor)
Infant Toddler Sensory Profile-2 (Dunn model oral motor)
Sensory Processing Measure or SMP-preschool (Ares model of sensory integration)

53
Q

Oral tactile sensory processing reminders

A

eating is not just the inside of our mouth
allergies
proprioceptive is almost always calming

54
Q

behaviors to assess during feeding evaluation

A 
general temperament
ability to self-sooth or calm
attachment
coping skills
interaction with caregiver (very important)
interaction with therapist
eye contact
ability to follow commands
avoidant behaviors (what is parent doing when child is displaying the "no moments"
55
Q

Oral motor skill evaluation

A 
Lips: ROM and strength
         symmetry
Cheeks: ROM and strength
               symmetry
Jaw: Strength
         Chewing pattern with food and non food items
         Resting posture
Tongue: Lateralization to molars
               protrusion and retraction
               elevation
Palate: Shape/Vault
            Abnormalities
56
Q

Feeding intervention strategies

A

Sensory-based
Oral motor (FOR = biomechanics and NDT)
Behavioral

57
Q

Oral Motor Treatment Strategies

A 
ROM/strength
Beckman stretches
Rona Alexander Facial wrapping
Clearing spoon with lips
Overland tongue bowling exercise
58
Q

Sensory-Based feeding intervention

A

Expose child to new sensory experiences in a non-threatening play based manner first before presenting them in a feeding session

Allow child to have some choice

measured by assistance level or aversion level

pretend play for self feeding = have child feed a doll or stuffed animal

scooping food or non food items

59
Q

sensory treatment with hypo-sensitive child

A 
(under responsive) 
increase oral awareness with Nuk brush, vibration, chewy tubes
use foods that will give input
hot/cold
salty/bold
spicy
crunchy
60
Q

sensory treatment with hyper-sensitive child

A

(over responsive)
activities that will decrease the childs sensitivity
nuk brush, vibrations, chewy tubes, calming environment

61
Q

Sensory based progression for the non-oral eater

A 
dry spoon
wet spoon
spoon with water
spoon with flavored water
spoon with thickened water
puree
62
Q

sensory based feeding treatment

A 
increase variety
around the bowl (Marcia Dunn, get permission approach)
increase texture (crumbs, dippers)
63
Q

Steps to eating

A 
stair step progression:
tolerates
interacts with
smells
touch
taste
eating
Must always work at their level, never ask a client who is at tolerates to put food in mouth
64
Q

Behavioral Modification Approach to Feeding

A

Behavioral Modification = Psychological approach that attempts to change or alter an individuals reactions to stimuli through reinforcement of adaptive behavior or extinction of a maladaptive behavior through punishment.

If decreased intrinsic motivation to eat, a behavioral modification FOR may be appropriate

weigh food before and after meal (scientific)

let child play with toy 1-2 minutes initially

set a time limit for meal (20-30mins)

consistency is crucial

65
Q

Positive Reinforcement

A

Addition of something positive to increase the likelihood that a behavior will occur in the future. (2-3mins)

66
Q

Negative Reinforcement

A

Taking away something to increase the likelihood that a behavior will occur in the future
(rarely used in feeding strategies)

67
Q

Punishment

A

Addition or removal of something to decrease the likelihood that a behavior will occur in the future

68
Q

Compliance training

A

System of reinforcement where verbal, gestural, and physical cues are given and positive reinforcement is given when child complies

69
Q

Planned/active ignoral

A

positive reinforcement is consistently withheld for non-dangerous, non-destructive problem behaviors

70
Q

Behavioral Modification Approach Protocol (Feeding)

A

Keep neutral voice and facial expression when offering bites

Actively ignore negative behavioral reactions

begin with 1 to 1 ratio of bites to opportunities to play

increase ratio reinforcement system when child is consistently taking bites

begin building volume, then increase variety (VERY IMPORTANT)

71
Q

Deglutition

A

the normal consumption of solids and liquids

72
Q

Birth to 6mos oral motor behaviors

A

Suckling and Sucking
Sucking is a more nutritive process
Sucking patterns: 1 suck/per second = nutritive suck
2 sucks/per second = non-nutritive

73
Q

6-30 months oral motor behavior

A

Munching = flattening and spreading of tongue, combines with up and down jaw movements (primitive motion)

Chewing = spreading and rolling movements of the tongue, tongue lateralization and rotary movements

Tongue lateralization = movement of the tongue to the sides of the mouth to propel food between the teeth for chewing

Rotary Jaw Movements = smooth interaction and integration of vertical, lateral, diagonal and eventually circular movements of jaw used in chewing

Controlled sustained bite = easy, gradual closure of teeth on the food, with an easy release of the food for chewing

74
Q

Food Texture Development

A

1 yr = pureed, blended, strained foods
1 1/2 yr = ground, lumpy foods
1 1/2 - 2 yr = cut up chunky diced foods
2 1/2 - 3 yr = all textures of table foods

75
Q

Self feeding development (Finger feeding)

A

2 mos = brings fisted hand to mouth (supine and prone)
3 mos = hand to mouth with object
3 1/2 mos = recognizes bottle
5-6 mos = mouths and gums meltable crunches (baby crackers or puffs)
6-7 mos = feeds self a cracker
9 mos = independent finger feeding

76
Q

Spoon and fork skills

A

9 mos = will bang a cup
9 1/2 mos = will stir spoon in imitation
12-14 mos = will bring filled spoon to mouth (but turns it over in route, more pronated grasp
15 - 18 mos = scoops food and will bring spoon and fork to mouth, spilling some
24 mos = brings food to mouth with utensil (palm facing up)
4 1/2 - 5 yrs = uses knife to butter bread or cut soft food

77
Q

Cup drinking skills

A

Birth to 4 mos = accepts liquid from breast or bottle
4-6 mos = able to drink by cup held by a caregiver, poor lip seal, most of the liquid will spill
9 mos = able to hold and drink from bottle independently, able to drink from a cup, may spill, independent with sippy cup with valve
18 mos = can skillfully drink from a cup with lid using two hands
24 mos = can drink from an open cup with minimal spilling or liquid loss, by 30 mos should be able to skillfully drink by open cup with one hand
4-4/12 yrs = can pour liquid from carton or pitcher

78
Q

Growth expectations

A

6 mos = weight doubles
12 mos = weight triples and length increases from 5-10 in
Second year = weight gain 4-6 lbs, length gain 4-5 in
Third year = 3.5-5.5 lbs, length 2-2.5in

79
Q

What are the major principles of the Get Permission approach to feeding?

A

1) Adult sets goals

2) Child sets pace

80
Q

What are “yes” behaviors or moments a child demonstrates during feeding?

A

1) Reaching forward
2) Leaning forward
3) Opening mouth

81
Q

What are the “no” behaviors or moments a child demonstrates during feeding?

A

1) Pausing
2) Closed mouth
3) Turned head
4) Pushing food away

82
Q

Describe a positive tilt during feeding

A

Parent leans toward child (physically or emotionally), child leans forward openly

83
Q

Describe a negative tilt during feeding

A

Child pulling away from the meal

84
Q

Pre-oral phase

A

Moves food or liquid to mouth

85
Q

Oral preparatory phase

A

The oral structures form the bolus by tasting, chewing, manipulating and containing (Create Bolus)

86
Q

Oral phase

A

Begins when the bolus is in the mouth and ends when the bolus enters the pharynx

87
Q

Pharyngeal phase

A

Begins when the bolus enters the pharynx and ends when the bolus enters the esophagus

88
Q

Esophageal phase

A

Begins when the bolus enters the esophagus and ends when the bolus enters the stomach

89
Q

The order to address feeding importance

A

1) safety
2) nutrition/growth
3) feeding skill development

Medically Based Pediatrics (5 decks)

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