Ped Feeding & Swallowing Flashcards
Difficulties in the Oral Stage of eating include
1) Chewing
2) Bolus Manipulation
Difficulties in the Pharyngeal Stage include
Related to timing of swallowing.
1) Laryngeal Penetration (food enters laryngeal vestibule)
2) Aspiration (food passes vocal cords)
Silent aspiration =
aspiration without clinical signs
May present as recurrent airway infections, or oral aversions
Feeding disorders definition
Trouble eating due to taste, texture etc.
+/- Dysphagia (swallow)
Found in 80-90% of children with developmental disabilities
Reasons kids refuse food
Trauma response/Safety
Grazing (lack of hunger cues)/Distractions
Sensory aversion
Medical Reasons (GI, Resp, Neuro)
Clinical Feeding Evaluation assesses
Oral Motor skills
Sensory response
Instrumental Assessment includes
Assess Pharyngeal swallow via:
Video Fluoroscopic Swallow Study (VFSS)
Modified Barium Swallow (MBS)
Flexible Endoscopic Exam of Swallowing (FEES)
Video Fluoroscopic Swallow Study (VFSS) or Modified Barium Swallow (MBS)
Gold standard
Uses radiation
can’t assess breastfeeding
Flexible Endoscopic Exam of Swallowing (FEES)
Can assess before/after breastfeeding
cannot assess oral or pharyngeal phase
When does the rooting reflex appear?
28th fetal week
When does the Suck Swallow Breath (SSB) pattern mature?
37-40 fetal week
Pacifier Pros & Cons
Pros: Protect against SIDS, learn oral motor patterns
Cons:
Altered Canine relationship
Changes myofunctional characteristics (hard palate, tongue, lip, swallow)
Ideal Suck Swallow Breath (SSB)
1:1:1
alterations can lead to altered bolus, pharyngeal pooling, delayed swallow
Disorganized vs Dysfunctional Sucking
Disorganized: poor rhythm, latch, or organization
May improve with compensatory strategies
Dysfunctional: tongue problems, persistent or learned non-nutritive problem
Will NOT improve with compensatory strategies
Goals of Oral Feedings
Safety - pulmonary
Efficiency - 20-30, more energy gained
Sufficiency - 25-30g/day gain in 4mo
Benefits of elevated side lying feeding
Reduces gravity
Supports breathing mechanism
Slow flow of bolus
How should infant diet be selected?
Based on skill to avoid the formation of maladaptive responses
Transitioning to a cup
Can start as early as 6-8mo
May improve swallow
=/= to drinking from bottle
TABBY tongue assessment scale
8 = normal tongue
6-7 = wait and see
<5 = impaired tongue, need to assess effects on breastfeeding
What are Orofacial Myofunctional Disorders
atypical, adaptive patterns that emerge in the absence of normalized patterns within the orofacial complex
Thumbsucking
Tongue thrust
Premature children tend to have
narrow palate, poor SSB that improves
Bronchopulmonary dysplastic patients tend to have
poor SSB that does not improve, reflux
Cleft Palate tend to have what kind of feeding problems?
no suction, require special bottles
Pierre Robin Sequence tend to have
cleft palate, fallen back tongue, small jaw
Down Syndrome tend to have what feeding considerations?
poor SSB, hypotonia (poor positioning), dysphagia
infection risk, heart problems
Diabetic infants tend to have
poor feeding cues
GERD infants tend to have
feeding refusal, GI upset
Recommendations for Cleft kids
inability to suck –> start cup usage earlier
Obturators can help with feeding efficiency, but DO NOT provide suction
CPalsy kids tend to have what sort of feeding problems?
dysphagia, reflux, speech delay
Dental concerns Down Syndrome and Cerebral palsy
Delayed tooth eruption
Malocclusion
Gum disease
High palate
Cariogenic nutrition
Aspiration risk
Dental Concerns ASD
~70% do not want to try new foods
Prolonged bottle use
self-injurious behaviours
–> try food chaining?
