Pediatric Condition And Assessment Flashcards
1
Q
PEDIATRIC SWALLOWING CONDITIONS, ASSESSMENT & INTERVENTION
A
2
Q
QUESTION
A
ANSWER
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
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
5
Q
What factors of aging can affect the oral phase of swallowing?
A
- Tongue Hyperatrophy
- Sensory changes- decrement in smell and taste
- Ill-fitting dentition
- Jaw biting force decreased
6
Q
What factors of aging can affect the pharyngeal phase of swallowing?
A
- Decrease in the connective tissue in the suprahyoid musculature- poor laryngeal excursion
- Duration of airway closure is longer
- Decreased sensitivity in the protective reflexes in the upper airway
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
8
Q
What are some signs and symptoms of dysphagia? (Give 5)
A
- Difficulty in placing food in the mouth
- Inability to control food or saliva in the mouth
- Coughing before/during/after swallow
- Frequent coughing in the end or immediately
after a meal - Recurring Pneumonia
- Weight loss
- Wet and gurgly voice
- Increase in secretions in the pharynx or chest
- Complains of swallowing difficulty
- Restricted volume of oral intake
- Limite range of food in a diet
- Prolonged mealtime duration
- Problems/battles during mealtime
- Family stress due to eating problems
9
Q
What is the entry of food or liquid or bolus into the airway below the true vocal folds?
A
Aspiration
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
11
Q
What is the food that is left behind in the mouth or pharynx after the swallow?
A
Residue
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)
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
14
Q
What happens when solid bolus physically blocks the airway which prevents the person from inhaling and exhaling
A
Choking
15
Q
How can dyspahgia be classified as?
A
- By phase
- By etiology
16
Q
What are common respiratory and cardiac conditions with dysphagia?
A
- Apnea of the newborn
- Respiratory distress syndrome
- Heart defects
17
Q
What are common gastrointestinal conditions with dysphagia?
A
- Tracheoesophageal fistula and esophageal atresia
- Esophagitis
- Food allergies and intolerances
18
Q
What are common neurologic conditions with dysphagia?
A
- Microcephaly
- Hydrocephalus
- Birth asphyxia
- Cerebral palsy
- Acquired Brain Injury (Stroke, TBI)
19
Q
What are common congenital abnormalities with dysphagia?
A
- CLAP
- Down Syndrome
20
Q
What are common maternal and perinatal issues with dysphagia?
A
- Jaundice
- Diabetes
- Fetal Alcohol Syndrome
21
Q
What is oral nutrition?
A
Eating through the mouth
22
Q
What does NPO mean?
A
“nil per os” or “nothing by mouth”
23
Q
What are the reasons for a patient to be considered for tube feeding?
A
- Patient’s inability to sustain nutrition orally although swallow response is safe
- Requirement for sufficient calories on a short-term bases to overcome an acute medical problem
- Risk for tracheal aspiration if the patient is allowed to feed orally
24
Q
What is entereal nutrition?
A
Method of supplying nutrients directly into the gastrointestinal tract
25
What type of feeding tube is inserted through the nose and into the stomach?
Nasogastric Tube (NGT)
26
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?
Gastrostomy (PEG) and Jejunostomy Tube
27
How does NGT and PEG differ in terms of insertion?
NGT is easy and quick, PEG is invasive
28
How does NGT and PEG differ in terms of replacement?
NGT is often replaced while PEG is infrequent
29
How does NGT and PEG differ in terms of tube life?
NGT is up to 1 month, PEG is up to several months
30
How does NGT and PEG differ in terms of patient acceptance?
NGT has poor patient acceptance while PEG has good patient acceptance
31
How does NGT and PEG differ in terms of procedure related mortality?
NGT is very low while PEG is 0-2.5%
32
What is parenteral nutrition? When is it used?
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
33
What is Peripheral Parenatal Nutrition (PPN)? How long is it used?
● Form of nutritional support delivered through the vein
● Used up to 7-10 days
34
What is Total Parenatal Nutrition (TPN)? How long is it used?
● 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
35
Swallowing therapy is superimposed on _______?
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
36
What are the 3 questions that need to be answered for Dysphagia Management?
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?
37
After maintaining nutrition what is the second important factor in dysphagia management? What should be kept at minimum?
**Ensuring safety of patient** during oral feedings when appropriate; Aspiration should be kept at minimum
38
What clinical swallow exam can be used for the assessment of safety and efficiency of swallow?
Massachusetts General Hospital-Swallow Screening Tool (Cohen, 2009)
39
What are the pre-requisites of oral feeding in Part 1 of MGH-SST that should be observed in a patient?
○ Adequate level of alertness
○ Stable breathing status
○ Ability to sit upright
○ Acceptable oral hygiene
40
When can the screening progress to part 2 in MGH-SST?
If all parameters in Part 1 are present. Otherwise, NPO
41
What are the parameters in the second part of MGH-SST? How many points are assigned to each?
○ Tongue movement (1 point)
○ Volitional Cough (1 point)
○ Vocal Quality (1 point)
○ Pharyngeal Sensation (1 point)
○ Water Swallowing (2 points)
42
What is the passing score for MGH-SST Part 2? What happens when patient receives a failing score?
Pass = 5 or 7 points
If the patient received a point that is below 5,
then he/she’ll continue with NPO
43
What does IDDSI mean?
International Dysphagia Diet Standardization Initiative
44
What is the lowest IDDSI level?
Level 0
45
What are the IDDSI levels and their equivalent consistencies?
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
46
What are the materials that is used in IDDSI Flow Test?
● 10 mL syringe
● Stopwatch
47
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?
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
48
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
Iatrogenic
49
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
Instrumental Evaluation
50
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
Safety and Efficiency
51
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
PEG Tube
52
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
Both tubes require a functional intestine
53
An infant frequently aspirates due to laryngomalacia. What type of oropharyngeal dysphagia does the patient have?
a. Neurogenic
b. Functional
c. Myogenic
d. Structural
Structural
54
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
Low Oxygen Saturation
55
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
Inability to produce the word eat
56
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
Peripheral Parental Nutrition
57
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
Residue
58
What are the roles of SLP in the dysphagia team?
● 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
What are the roles of an otolaryngeologist (ENT) in the dysphagia team?
● Significant information in the **assessment of upper digestive tract**
● Facilitates use of **endoscopy**
● Provide **medical and surgical intervention**
● Provide referral for clinical assessment
60
What are the roles of a gastroenterologist in the dysphagia team?
● 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
What are the roles of a radiologist in the dysphagia team?
● Provide dynamic (videofluoroscopic) and static (plain films) **imaging**
● Helps in **videofluoroscopic swallowing study (VFSS) or the Modified Barium Swallow (MBS)**
62
What are the roles of a neurologist in the dysphagia team?
● 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
What are the roles of a physiatrist/rehab doctor in the dysphagia team?
● Attending physician
● Act as team leader in a rehabilitation facility
● May provide referral for assessment
64
What are the roles of a dentist and prosthodontist in the dysphagia team?
● **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
What are the roles of a nurse in the dysphagia team?
● 24-hour responsibility for **monitoring**
● **Administering tube feeding** and maintaining oral hygiene
● Can be trained
● Dysphagia Screening
66
What are the roles of a nutritionist-dietitian in the dysphagia team?
● 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
What are the roles of an OT in the dysphagia team?
● Retaining or training the patient to **self-feed**
● Work with **SLP in NICU**
● May serve as the swallowing therapist
● Addresses **sensory processing** issues
68
What are the roles of an PT in the dysphagia team?
● Ensure trunk and head stability
● Optimal seating for the patient
69
What are the roles of a Pulmonologist and Respiratory Therapist in the dysphagia team?
● Special interest in patients with **tracheostomy and ventilatory support**
● Work toward **decanulation**
● Improvement of respiration is a prerequisite to better swallowing response
70
What is an Advance Directive?
A legal document containing Statement made by a person with decision-making capacity indicating his or her
preferences for receiving medical treatment
71
What is the significance of an Advance Directive?
● 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
What does a omprehensive clinical evaluation of dysphagia involve?
a. Review of Family, Medical, Developmental and Feeding History
b. Physical Examination
c. Observation of a typical meal
73
What are the things that is needed to be observed during an oral assessment for dysphagia?
✓ 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
What responses should be observed in a child during pre-feeding examination?
○ Hypoactive Responses (high threshold)
○ Hyperreactive Responses (low threshold)
○ Oral Sensory Defensiveness (Sensitivity in oral region)
75
How is cranial nerve functioning tested in children?
- reflex testing
- mostly observation in playing and eating
- parent report
76
During nonnutritive sucking assessment, how should be an infant positioned? How is the assessment done?
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
What is being observed during nonnutritive sucking?
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
What is deemed to be bad sucking in an infant?
little movement, no rhythmic movement, no sequence of sucking, breathing (inhalation) and swallowing
79
During nutritive sucking assessment, how long should the infant be observed?
15-20 minutes
80
What are the negative signs to look out for during nutritive sucking?
○ Gagging
○ Spitting
○ Tongue Thrusting
○ Squirming, Withdrawing
○ Arching of Back or Neck
○ Falling Asleep
81
In premature infants, oral feeding is to be postpone when their resting respiratory rate prior to feeding is greater than___?
70 bpm
82
In terms of respiratory function of premature infants, oral feeding should be stopped if__?
Respiratory rate goes higher than 80-85 bpm during oral feeding
83
According to Alexander (1987); Glass & Wolf (1998), what is the optimal feeding posture?
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
What cranial nerves are invloved in gag reflex? What is its age of disappearance?
1. CN IX, X
2. Gag reflex persists through adulthood
85
What cranial nerves are invloved in phasic bite? What is its age of disappearance?
1. CN V
2. 9-12 months
86
What cranial nerves are invloved in tongue protrusion and transversion? What is their age of disappearance?
1. CN XII
2. Protrusion (4-6 months); Transversion (6-9 months)
87
What cranial nerves are invloved in rooting reflex? What is its age of disappearance?
1. CN V, VII, XI, XII
2. 3-6 months
88
How is CN V tested for transitional feeders and the expected response?
Stimulus: Food on tongue
Normal Responce: Mastication initiated
89
How is CN VII tested for transitional feeders and the expected response?
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
How is CN IX, X tested for transitional feeders and the expected response?
Stimulus: Food on posterior portion of mouth
Normal response: Swallow (<2 seconds), soft palate elevation and retraction
91
How is CN XII tested for transitional feeders and the expected response?
Stimulus: Food on tongue
Normal Responce: Tongue shape, point, and protrude
92
What are the common tools used to assess feeding
● Pacifiers
● Nipples
● Bottles
● Cups
● Straw
● Spoon
● Orofacial stimulation Materials (ex. teether)
93
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
Reduced posterior tongue election during swallowing
94
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
Body Structure and Function
95
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
Excessive energy observed after feeding
96
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
Provide variation in consistences the child is able to consume
97
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
Drooling can be considered a sign of reduced reactivity to stimulus
98
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
Up and down movement of the jaw during sucking
99
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.
- NINE (9)
100
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
Suggestions in the assessment should be done on the second day of the evaluation session
101
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
Infant’s head should be placed in a 90-degree position during facilitation
102
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
Only the second statement is true
103
What are the primary goals of intervention for pediatric dysphagia according to ASHA?
➔ 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
What are the (5) management approaches for dysphagia?
1. Medical (pharmacologic and/or surgical)
2. Behavioral
3. Oral-Motor Treatments
4. Prosthesis and appliances
5. Tube (Enteral Feeding)
105
This positioning technique reduce the risk of aspiration by narrowing the airway entrance and widening the palate area
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
This positioning technique allows the bolus to move to the pharyngeal area with the help of gravity.
Chin Up
107
This pisitioning tecnique allows for the propulsion of the bolus away from the weaker side.
Head Rotation
Head rotation toward the weak side can send the bolus to the opposite direction preventing tracheal aspiration and for safe swallowing
108
What are the pointers for upright positioning for children?
✓ 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
Where is head stabilization dependent on during upright position?
Trunk control
110
This technique is done to support the cheek and jaw of the infants/children and to stabilize chewing.
Cheek and Jaw Assist (3-Point Jaw Control)
111
What is the practice of altering viscosity, texture temperature, portion size, taste, or appearance of food and liquids to facilitate safe and easy swallowing?
Diet Modifications
112
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 ?
● 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
What are the passive oral-motor treatments?
○ Tapping or Vibration
○ Stroking or Stretching
*it is considered as passive as the child is not expected to do anything
114
What are the active oral-motor treatments?
○ 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
What prosthesis and appliances can be used for management of dysphagia?
● 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
What illness could thickening liquids cause to infants?
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
What should be done when child is exhibiting Jaw Thrust?
● 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
What should be done when child is exhibiting Clenching/Teeth Grinding/ Retraction?
● 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
What should be done when child is exhibiting Jaw Instability?
● Posture
● Tapping, Patting, Stroking the Cheeks
● **3-Point Jaw Control**
● **Biting Tasks**
120
What should be done when child is exhibiting Tonic Bite?
● 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
What should be done when child is exhibiting Tongue Retraction?
● 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
What should be done when child is exhibiting Tongue Protrusion?
● 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
What should be done when child is exhibiting low tone/ limited tongue movement/ assymetry?
● 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
What should be done when child is exhibiting lip retraction?
● 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
What should be done when child is exhibiting limited upper lip movement?
● 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**
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What should be done when child is exhibiting low-toned cheeks?
● 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**
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What should be done when child is exhibiting reflux?
● Posture
● Improve cheek and tongue function for effective bolus manipulation (ex. tapping, vibrating, stroking, and stretching)
● Thicken Food / Liquids
