midterm Flashcards
Phasic bite reflex:
: Pressure/stimulation to gums = rhythmic open/close of jaws
Neonatal breathing and swallowing coordination
- NNS burst = 6-8 sucks, then pause to swallow
- Breathing is interrupted to swallow
- As child ages, NNS bursts increase
- 20-30 cycles of suck-swallow-breathe, followed by a pause of about 5 seconds of “catch-up breaths”
- Type of nipple and rate of flow influence the cycle
- Most often 1:1:1, increasing to 2:1:1 at end of feeding
- Most important to develop and maintain a rhythmic pattern.
When pharyngeal swallow happen in utero
One of the first motor responses seen in pharynx at 10-11 weeks
Swallow has been observed at 12.5 weeks
Primitive sucking in utero seen 15-18 weeks
When should a baby start eating by mouth (oral feeding)
Oral feeds not recommended until infants reach 32-33 weeks gestation, when buccal suck pads come in, although may need supplemented by tubes.
Suck pads and muscles involved
An encapsulated mass of fat in the cheek on the outer side of the buccinator muscle, especially marked in the infant; supposed to strengthen and support the cheek during the act of sucking.
Difference infant & adult anatomy
Tongue fills mouth (sits between lips and rests on palate), edentulous, suck pads, small mandible, no distinct oropharynx, narrow/vertical epiglottis
The Pharyngeal Phase:
• Velar elevation/retraction: Closure of the velopharyngeal port, Enables pressure to build in pharynx, A functional swallow is possible without velopharyngeal closure
Pharyngeal Phase: (cranial nerves involved)
• CN involved: IX, X, XI
• Voluntary/Involuntary stage
Gag by 9, puke by 10
Upper Aerodigestive Tract
2 tubes: oral cavity and pharynx with valves with a variety of functions
Lips: keep food in mouth
Oral tongue: push food against palate
Velopharyngeal region: closes to keep food from nose
Larynx: prevent food from going into airway
Tongue base/pharyngeal wall: squeeze bolus through the pharynx
CP region (UES): allows bolus into esophagus
LES: muscular sphincter, keeps food in stomach
functional swallow
possible without velopharyngeal closure
• Velopharyngeal port closes and hylolaryngeal moves up and forward
• UES opens and airway closes
APGAR → what is a good/bad score
to determine whether a newborn needs help breathing or is having heart trouble.
A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health
Any score lower than 7 is a sign that the baby needs medical attention. The lower the score, the more help the baby needs to adjusting outside the mother’s womb.
When to start spoon feeding a baby
4-6 months • Initially sucking off spoon • Opening mouth in anticipation • Tolerance of spoon pressed down at mid tongue • Closing lips around spoon • Lateral tongue movements minimal • Minimal loss of food around lips • Jaw stability (external control as needed
Calming techniques for an infant
- Swaddle #1
- Firm, gentle pressure
- NNS
- Change environment
- Change position
- Containment
- Tucked, midline position
- Create nesting
Alerting techniques for an infant
- Unwrap
- Massage
- Change diaper
- Change position #1?
- Elicit rooting #1
- NNS
- Face to face interaction
- Smooth, gradual transitions
How to facilitate infant feeding
- Rooting
- Non Nutritive suck
- Cheek support- increases flow
- Chin/jaw support- increases flow
- Pacing- brief breaks (external pacing=caregiver imposed, self-pacing= infant imposed)
- Change nipple flow
- Positioning
- Alertness
Describe the suckle pattern “in-out” tongue movement
Suckling the earliest intake phase for food and liquids, is charachterised b a definite backward and forward movement of the tongue, with the backward phase more pronounced. Tongue protrusion does not extend beyond the border of the lips.
Generic problem that cause GERD
retrograde flow of gastric secretions from stomach into the esophagus (and possibly airway)
What is considered full term for a baby
Early Term, between 37 weeks and 38 weeks 6 day
39 weeks is full term
Goals positioning for hypertonic child
Inhibition of excessively increased tone
Inhibition of proximal fixation
Facilitation of end range of movement
Prevention of further physical deformity
Goals positioning for hypotonic child
Promotion of alignment and stability
Maintenance of upright posture for feeding
Promotion of symmetry and midrange control
Anticonvulsant→ what it cause as far as dysphagia
- Dry mouth, sweating, hypotension, and tremor
- Ataxia, slurred speech and dystonia,
- Glossitis, stomatitis, dry mouth
Signs of aspiration-adult
Coughing or choking while or shortly after eating
Throat clearing while or shortly after eating
“Wet” or “gurgly” voice while or shortly after eating
Swallowing more than one time for each bite
Clear nose or sneezing while eating
Inability to handle own secretions
Failure to thrive (define)
term used to describe a child’s abnormal growth in which weight drops below 5th percentile; also used with adult population
Oral aversion
could be sensory, a response to treatment
Negative association with or response to anything placed in or near the mouth
