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Dysphagia Steph > Paediatrics Lecture 1 > Flashcards

Paediatrics Lecture 1 Flashcards

1
Q

Which three areas does a paediatric feeding assessment consist of?

A
  1. Assessment considerations
  2. Clinical examination
  3. Instrumental assessment
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2
Q

What are assessment considerations?

A 
Referral information (age, diagnosis, medical history, current weight, primary concerns)
Environment - where will the assessment take place
Tools - what equipment do you need? Food, thickener, torch, gloves, tongue depressor etc.
Preassessment case history - food diary (start/finish time, who fed, amount eaten, behaviours), video of mealtime, "always sometimes never" food lists, parent goals/concerns
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3
Q

What does the clinical examination consist of?

A
  1. Case history (birth, medical, daily intake, feeding history, mealtime setup)
  2. Oromotor assessment
  3. Oral trials/observations
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4
Q

OME: General observations

A
  • Facial symmetry at rest and when smiling
  • Posture (is he/she “floppy”?)
  • Weight (nourishment?)
  • Breathing - quiet/effortful/wheezing
  • Mouth or nose breather?
  • State - agitated/distressed?
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5
Q

OME: Oral anatomy

A
  • Look into baby’s mouth for size and shape of tongue in relation to the oral cavity (any indication of oral thrush?)
  • Lift baby’s tongue. Observe the range of movement and whether the frenulum is strongly holding tongue to floor of mouth
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6
Q

OME: Reflexes
Rooting
Protrusion
Sucking

A

Eating is a REFLEXIVE process in infants

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7
Q

OME: Suck swallow breathe. How do we assess? What should we look for?

A

Milk feed = best opportunity to assess.

  • Do baby’s lips form a tight seal around the nipple/teat?
  • Does milk eject from the mouth during swallowing?
  • Are swallows audible? Loud/gurgly?
  • Does baby breathe comfortably between swallows?
  • Can baby pause between suck bursts without losing attachment?
  • Changes in breathing from pre- to post-feed
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8
Q

Oral trials: What do we look for?

A 
Positioning
Equipment
Fluid/food consistency/texture
Who is feeding?
Rate of feeding
Amount taken
Oral movements (lips, tongue, jaw)
Swallow
Signs of aspiration
State (calm, alert, drowsy etc.)
Behaviour (of child and carer)
Reason for feed finishing
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9
Q

What should we look out for during Cervical Auscultation?

A
  • Oral transit time
  • Delay of swallow trigger
  • Range of laryngeal elevation
  • Describe swallow sound (coordinated?)
  • Cough quality/timing/strength
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10
Q

Signs of aspiration in paediatric clients

A
  • Recurrent chest infections
  • Choking/coughing during swallowing
  • Wet/gurgly voice quality post-swallow
  • Breath changes
  • Facial colour changes
  • Signs of distress
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11
Q

Which three areas does a paediatric feeding intervention consist of?

A
  1. Therapy
  2. Service delivery
  3. Ongoing education and support
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12
Q

What may paediatric feeding therapy consist of?

A 
Oral motor treatment
Behavioural interventions
Pacing
Positioning
Diet modification
Equipment/utensils
Environmental modifications
Alternative feeding
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13
Q

Basic intervention principles: Paediatric feeding

A
  • Every child and family is INDIVIDUAL
  • Developmental approach (based on normal development of feeding)
  • Child-centred treatment (cooperative)
  • Developing AUTONOMY at mealtimes for the child
  • Children learn through PLAY
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14
Q

What intervention is available for breathing-swallowing coordination?

A
  1. Positioning - keep child still with trunk supported
  2. Equipment - flow rate of milk (dependent on teat)
  3. Pacing - providing baby with breaks between swallows
  4. Limit fatigue - limite feeding time to 20-30 minutes
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15
Q

What intervention is available for positioning?

A
  • Being swaddled
  • Support trunk/midline
  • Feet supported
  • Chin tuck
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16
Q

Which three areas of intervention are available for oral motor coordination?

A

Oral phase:

  • Equipment (bottles/teats/cup)
  • Modified textures (bite and dissolve, puree, soft cubes) - how quickly does the bolus move once it is in the mouth?
  • Bolus size (control)
17
Q

What ways can we treat sucking?

A
  • “Suck training” dummy work (tug of war)
  • Adapt teat (softer, wider, narrower)
  • Toys
  • Baby toothbrushes
  • Slow down milk flow but make it easier to extract
18
Q

How can we manage/treat oral motor coordination?

A 
Practice tongue tip lateralisation
Using molars to chew
Develop bite strength
Develop chewing stamina
Lip closure
Bite size
19
Q

How can we practice tongue lateralisation?

A
  1. Demonstrate to child
  2. Place food off to the side
  3. Use stick shaped foods
  4. Competition - hold food inside one cheek with tongue
  5. Use hard mouthing foods
  6. Practice silly faces in the mirror
20
Q

How can we practice bite size?

A

Talk about mouse bites v kid bites v dinosaur bites

21
Q

How can we practice bite strength?

A

Theratubing
Foods that make noise
Practic breaking foods with hands first

22
Q

How can we practice chewing with molars?

A 
Talk about front and back teeths (with model)
Squash foods with fingers and then hands
Use a mirror
Tooth brushing
Chew with mouth open
Use fingers to assist placement

Dysphagia Steph (6 decks)

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