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2nd Repetition > Pedia 2 > Flashcards

Pedia 2 Flashcards

1
Q

PEDIATRIC SWALLOWING CONDITIONS, ASSESSMENT & INTERVENTION

A
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2
Q

QUESTION

A

ANSWER

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3
Q

At what age is dysphagia expected to be observed?

A

65 years old but can be evident in those as young as 45

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4
Q

What factors of respiration indirectly affect swallowing as people age?

A

Loss of elasticity in lung tissue plus decreased respiratory capacity and control may indirectly affect swallowing

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5
Q

What factors of aging can affect the oral phase of swallowing?

A
  1. Tongue Hyperatrophy
  2. Sensory changes- decrement in smell and taste
  3. Ill-fitting dentition
  4. Jaw biting force decreased
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6
Q

What factors of aging can affect the pharyngeal phase of swallowing?

A
  1. Decrease in the connective tissue in the suprahyoid musculature- poor laryngeal excursion
  2. Duration of airway closure is longer
  3. Decreased sensitivity in the protective reflexes in the upper airway
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7
Q

It is characterized by the abnormality in the transfer of bolus from the mouth to the stomach and/or interruption in either pleasure of the maintenance of nutrition and hydration.

A

Dysphagia

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8
Q

What are some signs and symptoms of dysphagia? (Give 5)

A
  1. Difficulty in placing food in the mouth
  2. Inability to control food or saliva in the mouth
  3. Coughing before/during/after swallow
  4. Frequent coughing in the end or immediately
    after a meal
  5. Recurring Pneumonia
  6. Weight loss
  7. Wet and gurgly voice
  8. Increase in secretions in the pharynx or chest
  9. Complains of swallowing difficulty
  10. Restricted volume of oral intake
  11. Limite range of food in a diet
  12. Prolonged mealtime duration
  13. Problems/battles during mealtime
  14. Family stress due to eating problems
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9
Q

What is the entry of food or liquid or bolus into the airway below the true vocal folds?

A

Aspiration

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10
Q

What is the entry of food or liquid into the larynx at some level down to but not below the true vocal cords. Entry in the Laryngeal Vestibule?

A

Penetration

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11
Q

What is the food that is left behind in the mouth or pharynx after the swallow?

A

Residue

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12
Q

What is the movement of bolus from the esophagus into the pharynx and or from the pharynx into the nasal cavity? What is it its other term?

A

Backflow (Reflux)

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13
Q

What do you call when the airway closes over and fails to reopen in time for regular breathing to continue after swallow; in infants, this may occur in response to the presence of a material near of the center of the larynx

A

Prolonged Swallow Apnea

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14
Q

What happens when solid bolus physically blocks the airway which prevents the person from inhaling and exhaling

A

Choking

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15
Q

How can dyspahgia be classified as?

A
  1. By phase
  2. By etiology
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16
Q

What are common respiratory and cardiac conditions with dysphagia?

A
  1. Apnea of the newborn
  2. Respiratory distress syndrome
  3. Heart defects
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17
Q

What are common gastrointestinal conditions with dysphagia?

A
  1. Tracheoesophageal fistula and esophageal atresia
  2. Esophagitis
  3. Food allergies and intolerances
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18
Q

What are common neurologic conditions with dysphagia?

A
  1. Microcephaly
  2. Hydrocephalus
  3. Birth asphyxia
  4. Cerebral palsy
  5. Acquired Brain Injury (Stroke, TBI)
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19
Q

What are common congenital abnormalities with dysphagia?

A
  1. CLAP
  2. Down Syndrome
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20
Q

What are common maternal and perinatal issues with dysphagia?

A
  1. Jaundice
  2. Diabetes
  3. Fetal Alcohol Syndrome
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21
Q

What is oral nutrition?

A

Eating through the mouth

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22
Q

What does NPO mean?

A

“nil per os” or “nothing by mouth”

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23
Q

What are the reasons for a patient to be considered for tube feeding?

A
  1. Patient’s inability to sustain nutrition orally although swallow response is safe
  2. Requirement for sufficient calories on a short-term bases to overcome an acute medical problem
  3. Risk for tracheal aspiration if the patient is allowed to feed orally
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24
Q

What is entereal nutrition?

A

Method of supplying nutrients directly into the gastrointestinal tract

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25
Q

What type of feeding tube is inserted through the nose and into the stomach?

A

Nasogastric Tube (NGT)

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26
Q

What type of feeding tube is placed directly into the stomach with the assumption that digestive processes are intact and if stomach is not function, it is placed directly into the jejunum of the small intestine?

A

Gastrostomy (PEG) and Jejunostomy Tube

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27
Q

How does NGT and PEG differ in terms of insertion?

A

NGT is easy and quick, PEG is invasive

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28
Q

How does NGT and PEG differ in terms of replacement?

A

NGT is often replaced while PEG is infrequent

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29
Q

How does NGT and PEG differ in terms of tube life?

A

NGT is up to 1 month, PEG is up to several months

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30
Q

How does NGT and PEG differ in terms of patient acceptance?

A

NGT has poor patient acceptance while PEG has good patient acceptance

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31
Q

How does NGT and PEG differ in terms of procedure related mortality?

A

NGT is very low while PEG is 0-2.5%

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32
Q

What is parenteral nutrition? When is it used?

A
  1. Bypasses the normal digestion in the stomach and bowl. It is a special liquid food mixture given into the blood through an intravenous (IV) catheter
  2. Used when gastrointestinal tract cannot be used due to medical complications
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33
Q

What is Peripheral Parenatal Nutrition (PPN)? How long is it used?

A

● Form of nutritional support delivered through the vein
● Used up to 7-10 days

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34
Q

What is Total Parenatal Nutrition (TPN)? How long is it used?

A

● A special intravenous (IV) catheter is placed in a large vein in the chest or arm
● Can be used up to 4-6 weeks as necessary

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35
Q

Swallowing therapy is superimposed on _______?

A

Swallowing therapy is superimposed on continuously adequate nutrition and hydration

*Goal is to outline the best program to maintain nutrition and increasingly improve the patient’s swallowing function

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36
Q

What are the 3 questions that need to be answered for Dysphagia Management?

A
  1. What type of nutritional management is necessary?
  2. Should therapy be initiated and what type (compensatory or exercises, direct or indirect?)
  3. What specific therapy strategies should be used?
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37
Q

After maintaining nutrition what is the second important factor in dysphagia management? What should be kept at minimum?

A

Ensuring safety of patient during oral feedings when appropriate; Aspiration should be kept at minimum

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38
Q

What clinical swallow exam can be used for the assessment of safety and efficiency of
swallow?

A

Massachusetts General Hospital-Swallow Screening Tool (Cohen, 2009)

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39
Q

What are the pre-requisites of oral feeding in Part 1 of MGH-SST that should be observed in a patient?

A

○ Adequate level of alertness
○ Stable breathing status
○ Ability to sit upright
○ Acceptable oral hygiene

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40
Q

When can the screening progress to part 2 in MGH-SST?

A

If all parameters in Part 1 are present. Otherwise, NPO

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41
Q

What are the parameters in the second part of MGH-SST? How many points are assigned to each?

A

○ Tongue movement (1 point)
○ Volitional Cough (1 point)
○ Vocal Quality (1 point)
○ Pharyngeal Sensation (1 point)
○ Water Swallowing (2 points)

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42
Q

What is the passing score for MGH-SST Part 2? What happens when patient receives a failing score?

A

Pass = 5 or 7 points
If the patient received a point that is below 5,
then he/she’ll continue with NPO

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43
Q

What does IDDSI mean?

A

International Dysphagia Diet Standardization Initiative

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44
Q

What is the lowest IDDSI level?

A

Level 0

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45
Q

What are the IDDSI levels and their equivalent consistencies?

A

Level 0: Thin Fluids
Level 1: Slightly thick fluid
Level 2: Mildly thick (sippable liquid)
Level 3: Moderately thick (Liquidized diet)
Level 4: Extremely Thic Fluid (Pureed diet)
Level 5: Minced and Moist Food
Level 6: Soft & Bite-sized food
Level 7: Normal, regular diet

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46
Q

What are the materials that is used in IDDSI Flow Test?

A

● 10 mL syringe
● Stopwatch

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47
Q

IDDSI Flow Test Protocol:
1. What should be removed from the syringe?
2. What should you cover the nozzle of the syringe with?
3. The syringe should be filled up to the __ line
4. What should be done simultaneously with starting the stop watch?
5. How long before the nozzle of the syringe is covered again?

A
  1. Remove the plunger from the syringe
  2. Cover the nozzle of the syringe with your finger, making a seal
  3. Fill the syringe up to the 10 mL line.
  4. Remove your finger from the nozzle end and start the stopwatch
  5. At 10 seconds, replace your finger over the nozzle, stopping the liquid flowing
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48
Q

A post-extubation complains of odynophagia (pain) when swallowing liquids. What is the etiology of this condition?

a. Iatrogenic
b. Neurogenic
c. Gastrointestinal
d. Respiratory and Cardiac

A

Iatrogenic

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49
Q

Which of the following procedures will confirm the presence of clinical aspiration?

a. Swallowing Therapy
b. Clinical Swallowing Evaluation
c. Dysphagia Screening
d. Instrumental Evaluation

A

Instrumental Evaluation

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50
Q

As a speech-language pathologist, what should be your utmost priority in facilitating oral intake of a patient with dysphagia?

a. Safety and Efficiency
b. Feeding and Diet
c. Compensation and Rehabilitation
d. Nutrition and Hydration

A

Safety and Efficiency

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51
Q

What source of nutrition can provide long-term supplement to a patient who is feeding orally but cannot meet the daily nutritional intake requirements?

a. PEG Tube
b. TPN
c. J Tube
d. NGT

A

PEG Tube

52
Q

Which of the following statements is TRUE about gastrostomy and jejunostomy tubes?
a. Both tubes require a functional stomach
b. Both tubes require a functional esophagus
c. Both tubes require a functional oropharyngeal swallowing
d. Both tubes require a functional intestine

A

Both tubes require a functional intestine

53
Q

An infant frequently aspirates due to laryngomalacia. What type of oropharyngeal dysphagia does the patient have?
a. Neurogenic
b. Functional
c. Myogenic
d. Structural

A

Structural

54
Q

Based on the MGH Swallowing Screening Tool (Part 1), which of the following parameters will preclude a patient from oral intake?

a. Absent Pharyngeal Sensation
b. Weak Volitional Cough
c. Low Oxygen Saturation
d. Hoarse Vocal Quality

A

Low Oxygen Saturation

55
Q

Which among the following is NOT a sign/symptom of dysphagia?
a. Refusal to consume liquids other than soft drinks?
b. Inability to produce the word eat
c. Crying and shouting during mealtime
d. Frequent fever and pneumonia

A

Inability to produce the word eat

56
Q

All of the following sources of nutrition require a functioning stomach EXCEPT:

a. Peripheral Parental Nutrition
b. Oral Feeding
c. Gastrostomy Tube
d. Nasogastric Tube

A

Peripheral Parental Nutrition

57
Q

Identify the dysphagia sign/symptom being described in this scenario: During videoendoscopy, post-swallow traces of the bolus were observed in the valleculae and pyriform sinuses

a. Residue
b. Aspiration
c. Penetration
d. Backflow

A

Residue

58
Q

What are the roles of SLP in the dysphagia team?

A

● Management of patients with poor oral and pharyngeal swallowing mechanisms
● First professional to perform case history and physical examination
● Coordinate and consult team members
● Obtain clearance from attending physician
● Integrate rehabilitative components

59
Q

What are the roles of an otolaryngeologist (ENT) in the dysphagia team?

A

● Significant information in the assessment of upper digestive tract
● Facilitates use of endoscopy
● Provide medical and surgical intervention
● Provide referral for clinical assessment

60
Q

What are the roles of a gastroenterologist in the dysphagia team?

A

● Special interest in problems in the esophagus
● Management of gastroesophageal reflux disease (GERD)
● Does esophageal endoscopy to rule out structure or cancer as a cause for dysphagia
● Placement of Percutaneous Endoscopic Gastrostomy (PEG) tube

61
Q

What are the roles of a radiologist in the dysphagia team?

A

● Provide dynamic (videofluoroscopic) and static (plain films) imaging
● Helps in videofluoroscopic swallowing study (VFSS) or the Modified Barium Swallow (MBS)

62
Q

What are the roles of a neurologist in the dysphagia team?

A

● Initial identification and subsequent management of swallowing problems
● Provides an explanation if the dysphagia and prognosis for future complication
● Differentiate neurogenic vs structural vs psychogenic symptoms
● May provide referral for assessment

63
Q

What are the roles of a physiatrist/rehab doctor in the dysphagia team?

A

● Attending physician
● Act as team leader in a rehabilitation facility

● May provide referral for assessment

64
Q

What are the roles of a dentist and prosthodontist in the dysphagia team?

A

● oral stage manifestations of swallowing disorders particularly dental disorders, tongue tie, or lip tie
● Prosthodontist is skillful at making prostheses for the oral cavity

65
Q

What are the roles of a nurse in the dysphagia team?

A

● 24-hour responsibility for monitoring
● Administering tube feeding and maintaining oral hygiene
● Can be trained
● Dysphagia Screening

66
Q

What are the roles of a nutritionist-dietitian in the dysphagia team?

A

● Assesses the nutritional and hydration needs and monitors the patient’s response
● Communicates with food service
● Provides guidelines for the amount and rate of tube feeding

● Work together with SLP during transition to oral feeding

67
Q

What are the roles of an OT in the dysphagia team?

A

● Retaining or training the patient to self-feed
● Work with SLP in NICU
● May serve as the swallowing therapis
● Addresses sensory processing issues

68
Q

What are the roles of an PT in the dysphagia team?

A

● Ensure trunk and head stability
● Optimal seating for the patient

69
Q

What are the roles of a Pulmonologist and Respiratory Therapist in the dysphagia team?

A

● Special interest in patients with tracheostomy and ventilatory support
● Work toward decanulation
● Improvement of respiration is a prerequisite to better swallowing response

70
Q

What is an Advance Directive?

A

A legal document containing Statement made by a person with decision-making capacity indicating his or her
preferences for receiving medical treatment

71
Q

What is the significance of an Advance Directive?

A

● End-of-life decisions or circumstances when an individual’s medical condition is futile (ex. DNR- Do Not Resucitate)
● Need for a surrogate to act on patient’s behalf on end-of-life or irreversible conditions
● Needed for patients with terminal and progressive diseases

72
Q

What does a omprehensive clinical evaluation of dysphagia involve?

A

a. Review of Family, Medical, Developmental and Feeding History
b. Physical Examination
c. Observation of a typical meal

73
Q

What are the things that is needed to be observed during an oral assessment for dysphagia?

A

✓ Posture and Position of the Patient during feeding
✓ State of Alertness and Airway Status
✓ Neonatal Milestones of the Patient
✓ Communication (Language Assessment)
✓ Articulation Assessment, Voice, Motor Speech, OPM Assessment
✓ Oral Sensory Motor Status
✓ Body Sensory Awareness
✓ Neurocognitive Functioning

74
Q

What responses should be observed in a child during pre-feeding examination?

A

○ Hypoactive Responses (high threshold)
○ Hyperreactive Responses (low threshold)
○ Oral Sensory Defensiveness (Sensitivity in oral region)

75
Q

How is cranial nerve functioning tested in children?

A
  • reflex testing
  • mostly observation in playing and eating
  • parent report
76
Q

During nonnutritive sucking assessment, how should be an infant positioned? How is the assessment done?

A
  1. Infant should be in a slightly elevated 45 degree position
  2. To initiate suck and swallow reflex = glove finger/ index/ pinky until mid-tongue region of the tongue only
77
Q

What is being observed during nonnutritive sucking?

A

Observation of (1) the tongue (elevate or depress), (2) cheek movement (there’s air during swallowing) (3) cupping of the lips (of the child) over the finger to see if its enough for the nutritive sucking (4) rhythmic movement of the jaw (up and down during sucking)

78
Q

What is deemed to be bad sucking in an infant?

A

little movement, no rhythmic movement, no sequence of sucking, breathing (inhalation) and swallowing

79
Q

During nutritive sucking assessment, how long should the infant be observed?

A

15-20 minutes

80
Q

What are the signs to look out for during nutritive sucking?

A

○ Gagging
○ Spitting
○ Tongue Thrusting
○ Squirming, Withdrawing
○ Arching of Back or Neck
○ Falling Asleep

81
Q

In premature infants, oral feeding is to be postpone when their resting respiratory rate prior to feeding is greater than___?

A

70 bpm

82
Q

In terms of respiratory function of premature infants, oral feeding should be stopped if__?

A

Respiratory rate goes higher than 80-85 bpm during oral feeding

83
Q

According to Alexander (1987); Glass & Wolf (1998), what is the optimal feeding posture?

A
  1. Neutral head position with balance flexion and extension
  2. Neck elongation
  3. Symmetrical shoulder girdle stability and depression
  4. Symmetrical trunk elongation
  5. Pelvis stability, with child’s hips symmetrical and neutral position
  6. Hips, knees, ankles at 90° with neutral base of abduction and rotation
  7. Symmetrical and stable positioning of feet in neutral with slight dorsiflexion supported by firm surface
84
Q

What cranial nerves are invloved in gag reflex? What is its age of disappearance?

A
  1. CN IX, X
  2. Gag reflex persists through adulthood
85
Q

What cranial nerves are invloved in phasic bite? What is its age of disappearance?

A
  1. CN V
  2. 9-12 months
86
Q

What cranial nerves are invloved in tongue protrusion and transversion? What is their age of disappearance?

A
  1. CN XII
  2. Protrusion (4-6 months); Transversion (6-9 months)
87
Q

What cranial nerves are invloved in rooting reflex? What is its age of disappearance?

A
  1. CN V, VII, XI, XII
  2. 3-6 months
88
Q

How is CN V tested for transitional feeders and the expected response?

A

Stimulus: Food on tongue
Normal Responce: Mastication initiated

89
Q

How is CN VII tested for transitional feeders and the expected response?

A

Stimulus: (1) Sucking, (2) Food on lower lip, (3) Smiling
Normal Responce: (1) Lips pursed to latch on to nipple, (2) Lip closure, (3) Retraction of lips

90
Q

How is CN IX, X tested for transitional feeders and the expected response?

A

Stimulus: Food on posterior portion of mouth

Normal response: Swallow (<2 seconds), soft palate elevation and retraction

91
Q

How is CN XII tested for transitional feeders and the expected response?

A

Stimulus: Food on tongue
Normal Responce: Tongue shape, point, and protrude

92
Q

What are the common tools used to assess feeding

A

● Pacifiers
● Nipples
● Bottles
● Cups
● Straw
● Spoon
● Orofacial stimulation Materials (ex. teether)

93
Q

The following are possible concerns that can be identified when screening pediatric patients with dysphagia EXCEPT:

a. Coughing during meal time
b. Excessive drooling from being unable to close his mouth
c. Reduced posterior tongue election during swallowing
d. The child only consumes cold food from the refrigerator

A

Reduced posterior tongue election during swallowing

94
Q

A patient was brought for dysphagia assessment and upon observation, you noticed that the child has reduced respiratory rate, uncoordinated suck-swallow-breathing sequence, and hypotonic tongue and cheeks. Which area in the ICF are these characteristics considered to be part of?

a. Body Structure and Function
b. Environmental Factors
c. Activities
d. Participation

A

Body Structure and Function

95
Q

Which of the following is not a criteria for referral for pediatric patients with dysphagia?

a. The child’s weight gain is measured up to 0.3 kg every month since turning into a toddler
b. Excessive energy observed after feeding
c. Child suddenly does not consume previously enjoyed consistencies unlike before
d. Started to take liquids from a cup at 4 year and 8 months with excessive
anterior spillage

A

Excessive energy observed after feeding

96
Q

Suggestions to modify the child’s environment during feeding can provide the following benefits EXCEPT:

a. Adequate nutrition during mealtimes
b. Better posture during meal time
c. Provide variation in consistences the child is able to consume
d. Less tension between the caregiver and the child

A

Provide variation in consistences the child is able to consume

97
Q

Which of the following statements is true regarding sensitivity and reactivity issues in patients with dysphagia

a. A traumatic experience in the dentist will not contribute to the refusal to have anything put inside the child’s mouth
b. Drooling can be considered a sign of reduced reactivity to stimulus
c. Avoidance of specific textures may be caused by hyposensitivity to stimuli in oral cavity
d. Children with poor chewing skills may be due to an excessive amount of sensory stimuli received on their end

A

Drooling can be considered a sign of reduced reactivity to stimulus

98
Q

The following observations can be associated with Cranial Nerve VII function EXCEPT:

a. Lip Closure during Bolus Formation
b. Observed sucking motion on the child’s cheeks
c. Limited mobility in one side of the face during bolus formation
d. Up and down movement of the jaw during sucking

A

Up and down movement of the jaw during sucking

99
Q

Upon delivery, the infant was observed to be reddish in color of the skin and with 85 beats per minute of pulse rate. Upon hearing a metal tray accidentally drop the floor the infant was absurd to present a short cry as his arms and legs moved slightly towards him. Compute for APGAR score.

A
  • NINE (9)
100
Q

Choose which of the following statements is false regarding observation of the child/infant during feeding

a. Suggestions in the assessment should be done on the second day of the evaluation session
b. Expect that there may be a need for recommendations for additional testing
c. Observing the primary caregiver giving food to the infant should be done
d. Feeding assessment may be postponed at a later date should the infant’s respiratory rate reaches 80 breaths per minute

A

Suggestions in the assessment should be done on the second day of the evaluation session

101
Q

The following statements are true regarding non-nutritive sucking EXCEPT:
a. Reflexes may be checked as the clinician facilitates non-nutritive sucking
b. Facilitation of non-nutritive sucking can show if the infant can extend and retract the tongue
c. It can be stimulated using a gloved finger
d. Infant’s head should be placed in a 90-degree position during facilitation

A

Infant’s head should be placed in a 90-degree position during facilitation

102
Q

Swallowing and sucking are expected to be coordinated at around 24 weeks inside the mother’s womb. Feeding specialists should perform assessments on infants in the NICU if they are medically and surgically stable. The use of a pacifier to facilitate non-nutritive sucking is not recommended for infants in the NICU.

a. Only the first statement is true
b. Only the second statement is true
c. Only the third statement is true
d. The first statement and second statements are true and the third statement is false
e. All statements are true
f. All statements are false

A

Only the second statement is true

103
Q

What are the primary goals of intervention for pediatric dysphagia according to ASHA?

A

➔ Support safe and adequate nutrition and
hydration
➔ Determine the optimum feeding methods and
techniques to maximize swallowing safety and
feeding efficiency
➔ Collaborate with family to incorporate dietary
preferences
➔ Attain age-appropriate eating skills in the most normal setting and manner possible
➔ Minimize the risk of pulmonary complications
➔ Maximize the quality of life
➔ Prevent future feeding issues with positive feeding related experiences to the extent possible, given the child’s medical situation.

104
Q

What are the (4) management approaches for dysphagia?

A
  1. Medical (pharmacologic and/or surgical)
  2. Behavioral
  3. Oral-Motor Treatments
  4. Prosthesis and appliances
  5. Tube (Enteral Feeding)
105
Q

This positioning technique reduce the risk of aspiration by narrowing the airway entrance and widening the palate area

A

Chin Down / Chin Tuck

*This position increases space at the back of the throat where food and drink can wait before you swallow. This reduces the risk of it going down the wrong way before you are ready to swallow

106
Q

This positioning technique allows the bolus to move to the pharyngeal area with the help of gravity.

A

Chin Up

107
Q

This pisitioning tecnique allows for the propulsion of the bolus away from the weaker side.

A

Head Rotation

Head rotation toward the weak side can send the bolus to the opposite direction preventing tracheal aspiration and for safe swallowing

108
Q

What are the pointers for upright positioning for children?

A

✓ 90 degree angle (hips and knees)
✓ Feet has support (the child can’t sway around and it doesn’t promote instability)
✓ Better Trunk Control and Overall Body Position

109
Q

Where is head stabilization dependent on during upright position?

A

Trunk control

110
Q

This technique is done to support the cheek and jaw of the infants/children and to stabilize chewing.

A

Cheek and Jaw Assist (3-Point Jaw Control)

111
Q

What is the practice of altering viscosity, texture temperature, portion size, taste, or appearance of food and liquids to facilitate safe and easy swallowing?

A

Diet Modifications

112
Q

What equipments and utensils are used for children who have feeding problems to foster independence with eating and to increase swallow safety by controlling the bolus or achieving the optimal flow rate of the liquid ?

A

● Modified Nipples
Easier for the milk to flow; liquid flow is more regulated lessening the fatigue when sucking.

● Cut Out Cups
These are for better head and neck control so that the patient won’t tilt his/her head while drinking.

● Weighted Forks and Spoons, Angled Fork and Spoons
Used with assistance from the OTs. It increases
awareness, encourages to exert more force, and can better control the movement of the food.

● Sectioned Plates

● Non-Tip Bowls
Can better control the food and lessen the mess during feeding; facilitate better feeding time

113
Q

What are the passive oral-motor treatments?

A

○ Tapping or Vibration
○ Stroking or Stretching

*it is considered as passive as the child is not expected to do anything

114
Q

What are the active oral-motor treatments?

A

○ Range-of-Motion Exercises
Example: Asking the patient to move their tongue

○ Resistance Exercises
Ex. Trying to push the tongue depressor with the patient’s tongue.

○ Chewing or Swallowing Exercises
Chewing Excercise: Towel or a Gauze, dip it in a liquid (e.g., orange juice or milk) then facilitate chewing exercise.
Swallowing Exercise: Swallow two times continuously

115
Q

What prosthesis and appliances can be used for management of dysphagia?

A

● Palatal Obturator
–For patients with cleft palate / holes / palatal defect to assist the child to form the bolus and to prevent nasal regurgitation.

● Palatal Lift
–Lift the soft palate to close the oronasal area and to reduce nasopharyngeal reflux

● Feeding Plate
–This is meant to cover the fistula, usually seen on the alveolar ridge. It also makes sure that the fistula won’t be bigger and it prevents the food to go to the nasal cavity.

116
Q

What illness could thickening liquids cause to infants?

A

Necrotizing enterocolitis (NEC)
–life-threathening illness that inflames the tissues in the infant’s gut area (instestines) resulting in dying of muscles and tissues (may cause a hole). Avoid adding thickeners unless prescribed

117
Q

What should be done when child is exhibiting Jaw Thrust?

A

● Rule out medical, dental, or orthopedic concerns
● Work on Posture (position the child in a 90-degree for both upper torso and legs)
● Reduce Sensory Input
● Position on Prone (should not be done always.)
● Reduce Hypersensitivity
● 3-Point Jaw
● Introduce Toothbrushing
● Biting Tasks

118
Q

What should be done when child is exhibiting Clenching/Teeth Grinding/ Retraction?

A

● Posture (Make sure that the child’s base trunk and legs are stable.
● Reduce Hypersensitivity
Try to present the foods by playing with or touching them.
Reduce oral sensitivity as well by touching around the areas of the face so that the child won’t be aversive to touch.
● Brushing Teeth
● Deep Massage on the Masseter
● See reaction to environment

119
Q

What should be done when child is exhibiting Jaw Instability?

A

● Posture
● Tapping, Patting, Stroking the Cheeks
● 3-Point Jaw Control
● Biting Tasks

120
Q

What should be done when child is exhibiting Tonic Bite?

A

● Proper Posture
● Decrease Sensory Input
–Make the child familiar with the sensation around the oral musculature
● Introduce food at the lower lip, so lips move not the teeth
● Reduce Hypersensitivity
–Use index/little finger: Slide along the outer surface of the upper and lower gums, use firm sustained pressure; stop and stay inside the mouth if there is slight tension vs pulling out completely

121
Q

What should be done when child is exhibiting Tongue Retraction?

A

● Proper Posture
● Stimulate lips with food
● Tap upward under the chin at the base of the tongue
● Do gum desensitization moving towards the tongue

122
Q

What should be done when child is exhibiting Tongue Protrusion?

A

● Proper Posture
● Change Consistencies – move towards chewing laterally and centrally
● Jaw Stability
● Promote Lip Movement vs Tongue Movement in Sucking – put cup on lips

123
Q

What should be done when child is exhibiting low tone/ limited tongue movement/ assymetry?

A

● Posture
● Tap base of tongue
● INCREASE sensory input: explore sour, ice, textured toys/teethers, z-vibe
● Rapid or fine vibration or shaking on the tongue
● For asymmetry, place focus on less active side but still provide input on active side

124
Q

What should be done when child is exhibiting lip retraction?

A

● Proper Posture, Decrease Sensory Input
● Hold the cheek scissor fashion between index and middle finger and do rapid vibration; hold cheek and draw it forward
● Wipe or rub cheek or jaw towards
non-retracted (OPPOSITE direction)

125
Q

What should be done when child is exhibiting limited upper lip movement?

A

● Proper Posture
● Increases sensory input to lips and cheeks; lip tapping / massage
● Place fingers on side of nose and vibrate downwards toward the bottom of the upper lip slowly and evenly; sustained aspect of stretch and vibration
● Introduce straw drinking

126
Q

What should be done when child is exhibiting low-toned cheeks?

A

● Proper Posture
● Increase Sensory Input
● Put liquid on the side of the cheek to encourage SLURPING, hide food at cheek sulci to push
● Teach straw drinking

127
Q

What should be done when child is exhibiting reflux?

A

● Posture
● Improve cheek and tongue function for effective bolus manipulation (ex. tapping, vibrating, stroking, and stretching)
● Thicken Food / Liquids

2nd Repetition (13 decks)

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