Paediatrics

Question 1

What is paediatric feeding disorder

Answer 1

impaired oral intake that is not age appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction

Question 2

Importance of paediatric dysphagia treatment

Answer 2

• Assess safety of the child to commence or continue to feed (swallow safety) to prevent aspiration of food or liquid into the lungs
• To modify elements of the meal to maximise swallow safety
• To provide intervention to support oral motor skill development to enable progression of textures

Question 3

Why is it difficult to work with children?

Answer 3

• they are continually changing and developing
• they are sometimes unaware of their difficulties
• working with 2 patients (parent and child)

Question 4

Factors involved in paediatic feeding disorders

Answer 4

• medical factors
• feeding skill factors
• psychosocial factors
• nutritional factors

Question 5

Infant mouth anatomy

Answer 5

infants: tongue fills mouth at rest
tongue is anteriorly placed, ideal for sucking
swallow is triggered in the valleculae
tip of soft palate sits close to the tip of epiglottis
the pharynx is short

Question 6

Adult mouth anatomy

Answer 6

tongue and jaw move independently
adults hard palate is arched while infants is flatter
swallow triggered at tongue base
larynx sits lower for greater laryngeal excursion
vocal folds are longer

Question 7

OM development at 3 - 6 months

Answer 7

• spitting out food
• sucking action on spoon
• sucking on nipple

Question 8

OM development at 6 - 9 months

Answer 8

more vertical tongue tip movement
biting by holding between gums and breaking
munching begins
sucking on cup

Question 9

OM development at 9 - 12 months

Answer 9

Lips remove food from spoon
Lateral tongue movement increased
Sustained bite through soft mechanical food (e.g. sandwich) by 12 months
Finger foods
Plays with spoon
Jaw more stable for cup drinking
Tongue may rest beneath cup for drinking or remain in mouth

Question 10

OM development at 12 - 18 months

Answer 10

Rotary jaw movements
Efficient lateralisaton
Lip closure increasing when chewing
Sustained bite on harder foods
Adequate jaw stability to hold cup
Less tongue protrusion

Question 11

OM development 18 - 36 months

Answer 11

Controlled, sustained bite
Chewing with lips closed
May still lose food of saliva when chewing
Ability to swallow only part of mouthful
Less need to bite on a cup to stabilise
Minimal loss of liquids

Question 12

When is maximal tongue strength reached?

Answer 12

8 years

Question 13

Problems that occur if a baby sucks but doesn’t swallow

Answer 13

wet aspiration, milk coming out the sides of mouth, colour changes, wet and gurgly voice

Question 14

Why is feeding positioning so important?

Answer 14

assists with postural control which encourages self regulation, assists with coordination of feeding and therefore enables participation in mealtimes

Question 15

Developmental indicators of when to introduce solids

Answer 15

steady head control @ 2.5-3.5 month
beginning hand to mouth play @ 4-6 months
increased oral exploration 4-6 months
interest in food/reaches for spoon