Oral Motor Feeding Lecture Flashcards
Swallowing: Oral Phase
- Reflexive in young infants and voluntary in older children.
- Oral manipulation results in a bolus being formed
- Mouth prepares food or liquid for swallowing
- Jaw, lips, cheeks, tongue, hard and soft palate work together
* Draw milk from nipple
* Develop a bolus - Tongue moves bolus toward back of the mouth where swallow reflex is triggered
- This phase terminates with the trigger of the swallow.
Swallowing: Pharyngeal Phase
-Back of tongue lifts to prevent bolus from returning to the mouth
-Soft palate lifts so that bolus does not enter nose
-Muscles in throat move bolus toward the esophagus
-Epiglottis covers the trachea (wind pipe)
-Vocal cords close to give added protection to the trachea
-The swallow is initially voluntary during the Pharyngeal Phase.
-Swallow in infants is ½ sec
-The glottis closes to protect the airway with movements
-Further protection is offered when the false and true vocal folds adduct
-Structural deficits or poor coordination due to neurological
deficits can impair this protective process, resulting in aspiration
○ Aspiration can occur before, during, and after a swallow.
Swallowing: Esophageal Phase
- Reflexive
- Bolus moves safely pass the airway
- Duration 6 to 10 seconds.
- Muscles at the top of the esophagus open to let milk/food pass and then close
- Peristaltic wave action of esophagus propels bolus to stomach
- Valve at entrance of the stomach that prevents reflux
○ It ends with allowing food to enter the stomach
Newborn Feeding
● Rooting reflex allows latching on to nipple
● Has gag and cough to protect the airway
● Can usually feed in 20-25 minutes
● Rhythmic, sustained, and efficient, strength
diminishes with satiation
● Suck-swallow-breathe at one month
Sucking
● Non-nutritive Sucking – rapid and rhythmic, two sucks per second
● Nutritive Sucking – consists of a burst and pause, with breathes during the pause. Rate and rhythm of
sucking varies with age of the infant.
Two characteristics of sucking that are most important for feeding are:
● Rhythm of sucking
● Type of suction on nipple
0-4 Months sucking
● This is the first sucking pattern
● Characterized by forward and backward movement of the tongue (as in a licking motion), combined with jaw opening and closing.
● Lips are together, but loosely approximated
● Suck-swallow-breathe pattern of 3-4 month old is 20 sucks before a pause
● Swallowing occurs after 4-5 sucks without pausing
6 months sucking
● Strong up and down movement of the tongue (raising and lowering)
● As jaw stability increases better control of tongue movement emerges
● The tongue moves more independently of the jaw
● Lip seal is strong
9 months sucking
● Better cup drinking
● Jaw is not stable on rim so there is liquid loss and mess which is normal
● Jaw moves up and down in fairly wide excursions and it is jaw movement that is primarily responsible for liquid intake
● Suck –swallow-breathe on a cup is one to three sucks from the cup, then swallow and breathe
12 month sucking
● Better cup drinking
● Tongue elevates to bring liquid into mouth
● begins tongue tip elevation in swallow
● suck –swallow-breathe on a cup– swallow follows suck without pausing and there are three continuous sucks before pausing
Cup Drinking:
● May bite on cup to achieve jaw stability (this is normal)
● Upper lip closes on edge of cup to
provide seal for drinking
● Child can usually take liquids from a
sippy cup at this age by self
● On a bottle or breast, long sucking
sequences are present
15-18 Months sucking
● Period of development of jaw stabilization
● Excellent coordination of suck-swallow- breathe
● Swallow follow sucking without pauses
18-24 Months sucking
18 months
● Up and down movement of tongue with tongue tip elevation
● Internal jaw stability, jaw appears to be relatively still
● Child can control intake of liquid from cup with lips rather than teeth
● Tongue is then more active during swallow 24 months – mature cup drinking
● Easy swallow with lip closure
● No liquid loss
● Child can drink by self from a cup without a lid by self without spilling
● Can drink from a straw – requires a good seal and strong suction
Development of Chewing
● Bite reflex is present birth to 3-5 months and this is normal. Rhythmical bite and release
with jaw opening and closing is seen when gums are stimulated.
5 months
● Beginning of munching pattern,
● There is spreading and flattening of the tongue (called extension and retraction) combined with up and down motion of the jaw.
● Tongue may elevate and touch the hard palate, but makes no lateral movement to move the food sideways. Food is mashed against the hard palate.
● This pattern seems to be a combination of sucking and a bite reflex.
6 months
● Gradual change to chewing pattern begins with gross lateral tongue movements when food is placed on the side between the gums.
● Tongue transfers food placed in the center to the side, then moves food from one side to the other, across the midline.
● Jaw movements in chewing are first vertical then later, lateral, then rotary.
7-8 months
● Variable up and down movement of the jaw; some diagonal movement when the texture requires it.
9 months
● Child manages pureed and soft solids
● Munching with diagonal jaw movement
● Child is able to transfer food presented at the center to the side using lateral tongue movement.
● Lips make contact as jaw moves up and down.
● Finger foods usually presented at this time.
12 months
● Rotary chewing is possible as child gains jaw stability and mobility
● Well graded bites on cookies
● Tongue is active, moving food from center of the mouth to the side, licking food from the lips. Tongue
tip elevation demonstrated.
18 months
● Well-coordinated rotary chewing for soft meats and various table foods
● Can control bite of hard cookie or pretzel.
24 months
● Child can chew most meats and raw vegetables
● Grade and sustain bite
● Circular jaw movements
● Tongue moves from side to side
● Tongue clears lips and gums
● Lip closure during chewing
Early Motor Development: Feeding
0-3 months
* Bottle/breast fed
* Using reflexes to find, latch onto a nipple, & suck/swallow
* Coordinating a continuous suckle-swallow-breath pattern (rhythm!)
* Strong protective gag reflex
4-6 months
* First foods introduced (usually smooth purees, cereals)
* Generalized mouthing (hands, feet, objects)
* Can use tongue to move food back to swallow
* From suckling to sucking
* Emerging vertical jaw movements
7-9
* Lumpy mashed foods
* Discriminative mouthing
* Uses lips to strip food from spoon
* Can move food from middle to either side
* Drinks from straws, cups with assistance
* Front teeth erupt, able to take crunchy meltable solids
* From munching to more controlled, sustained bites
10-12
* From vertical to diagonal chewing
* Can move food from one side to the other without stopping in middle
* From self-feeding with fingers to utensils
* More independence with cup drinking
* Can eat mixed consistencies
12-18
* Can handle coarsely chopped table foods including meats, raw veggies
* From diagonal to rotary chewing
* May show preferences and language skills support their ability to choose/refuse
* Uses cheeks and tongue together to keep control food during chewing
* Controls saliva/No drooling except when teething
What can infants eat?
● 1-4 months: liquids
● 5 months: liquids and pureed foods
● 8-9 months: soft, mashed foods
● 12 months: easily chewed foods including soft meats
● 18 months: coarsely chopped table foods, some raw fruits, cooked meats.
● 24 months: most table foods use caution with skins, tough meats, or small round foods that cause choking.
Feeding Problem?: Warning Signs
● Limited advancement in food texture tolerance
● Dependent on single form of calories
● High rates of resistive behavior during mealtime
● Consecutive months of weightless
● Crossing major weight percentiles
● Poor/slowed growth
