Paediatric Feeding Flashcards
Signs and symptoms of dysphagia/feeding difficulty in babies
- Difficulty latching with BF or bottle feeding
- Significant nipple pain or damage
- Weak or uncoordinated suck
- Significant fatigue with feeds
- Coughing, spluttering, gagging while feeding
- Frequent, large gulping swallows
- Biting or chomping on the breast or bottle
- Bottle/breastfeeding refusal/oral aversion
- Collaborative work with Dietitians around poor growth/ failure to thrive (FTT) as well as tube fed babies/children
Signs and symptoms of dysphagia/feeding difficulty in children
- Refusal to eat solids
- Difficulties with cup drinking
- Difficulties with the textures of food (gagging on lumpy foods or finger foods)
- Fussy eating
- Food refusal/ oral aversion
- Inappropriate textures for developmental age
- Challenging mealtime behaviours
- Coughing/aspiration on fluids/foods
- Collaborative work with Dietitians around poor growth/ failure to thrive (FTT) as well as tube fed babies/children
Factors for consideration in paediatric feeding assessment
- Obtain medical history
- Obtain feeding history
- Obtain developmental history
- Feeding observation (informal and formal)
- Feeding plan (including MDT considerations)
How would you conduct a feeding assessment?
OMA
* Oral muscle assessment - Allows you to look at the structure and function of the:
- Cheeks
- Lips
- Jaw
- Tongue
- Palate
- Teeth and gums
**Oral Motor assessment – reflexes
* Gag
* Rooting
* phasic bite
* transverse tongue
* tongue protrusion
* sucking
* swallowing
Infant feeding assessment tips
Always observe a full feed so you can assess how the baby is before, during and after a feeding.
You can feel a non-nutritive suck by placing a gloved finger in the baby’s mouth during your OMA.
You can see the bubbles in a baby bottle and hear swallows in both bottle- and breast-fed babies. These smaller cues will help your suck assessment.
Breastfeeding: exclusive BF is recommended until around 6 months of age. Speech Pathologists working in this area are advanced level so please seek support.
Informal feeding ax in toddlers & children
* Always do an OMA
* Try to observe in a natural setting (home is ideal) or clinic – ideally around a feed time
* Ensure supportive seating (highchair, foot rest, tripp trapp/Mocka chair etc)
* Caregivers should feed their child, but you can demonstrate strategies
* Ask caregivers to organise the following
* 2 foods the child is eating well e.g., smooth puree
* 2 foods they are struggling with e.g., banana (finger food), mashed meat and vege (mixed texture) + bite dissolve
* A drink (+ sippy cup, straw or open cup)
* Blue book for growth (Dietitian support)
* 24 hour food diary is useful
* Observe structure and function of oral muscles when eating solids
* Observe chewing skills (up-down, diagonal, rotary chewing)
* What else can you see with their feeding?
- spitting of food
- storing of food
- gagging on any textures
- self-feeding of food and drinks (age dependent)
* Observe swallowing coordination of food and fluids
* Note the
- overall time taken to eat
- volume of intake eaten
- Consider sensory exploration willingness
- Observe the caregiver’s response to child’s feeding cues
- Ask the caregivers about what a “typical feed” looks like at home
Management strategies to support safe and effective intake for infants - how does this link to the clinical presentation?
- Feeding strategies recommended (always practice with the caregivers)
- Follow up plan by the speech pathologist
- Any referrals (check with your supervisor)
- Instrumental swallow assessments
- Multidisciplinary team referrals
Considerations of positioning
Management strategies to support safe and effective intake for toddlers/children - how does this link to the clinical presentation?
Firstly Explore:
Why is this toddler struggling?
- Is the current method safe?
- Is feeding adequate?
- Is feeding efficient?
- Is feeding developmentally appropriate?
- Is feeding positive (child and caregiver)?
Always think about the multidisciplinary aspects of feeding
Strategies for babies
* pacing
* thickener
* change in bottle (diff shaped teat, diff flow rate)
* change in position
* cue based feeding
* reviewing feeding regime
Strategies for toddlers
* texture change
* positioning of food
* bite dissolved finger foods
* texture of finger foods
* spoon or cup change
* highchair positioning
* reviewing feeding regime
Strategies for children
* Mealtime structure (when is food offered?)
* plating preferences (eg pre-plating or buffet style)
* Where food is being offered. eg dining table, sitting on the floor, while watching tv)
* how they’re sitting (OT support might be needed)
* feeding equipment (OT support might be needed)
* family-child mealtime enjoyment
* reviewing feeding regime (dietitian support might be needed)
Prioritisation for intervention
- Safety
- Volume – how much are they eating
- Efficiency - are they getting enough food to ensure their growth and development? (General norms are 15-20mins for snacks, 30-40 mins for meals) babies that are taking too long to eat may actually be burning more calories through the process than taking in what they need
- Family stress eg family member opinions, chaos/disharmony in the home/at meal times
- Developmental level – eg still having puree pouches at 18 months
- Difficult behaviours – eg sensory related, oro-motor delays
- Child distress – often linked to family stress, often associated with preparation for meals. Such as toddler starts crying as soon as mum puts them in high chair. (known as oral aversion)
