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Peds FAll 2024 > Pediatric Feeding > Flashcards

Pediatric Feeding Flashcards

1
Q

Feeding:

A

Setting up arranging, and bringing food or fluid from the vessel to the mouth (include self-feeding and feeding others)

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2
Q

Eating:

A

Keeping and manipulating food or fluid in the mouth, swallowing it (ie moving it from the mouth to the stomach)

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3
Q

Phases of swallowing
Oral Prep phase

A

Jaw, lips tongue, teeth, cheeks and palate manipulate food.

When you are forming the bollus of food.

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4
Q

Phases of swallowing
Oral Phase:

A

Begins when tongue elevates against alveolar ridge of the hard palate, moving bolus posteriorly. Ends with the onset of the pharyngeal swallow

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5
Q

Phases of swallowing
Pharyngeal Phase:

A

Hyoid and larynx move upward and anteriorly and the epiglottis retroflexes to protect the opening of the airway.

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6
Q

Kids who are low tone are at a high risk for

A

aspiration

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7
Q

Phases of swallowing
Esophageal Phase:

A

Muscles at the top of the esophagus open to allow food or liquid to enter.
parislosis

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8
Q

paristolsis is impacted by

A

tone.

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9
Q

Stages and ages of newborn for eating

A

Newborn - Breast or bottle fed, Reflex driven
Positioning: being held, swaddled.

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10
Q

What reflexes are good for eating

A

sucking, moro, gag, thenar eminance one.

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11
Q

Between 2 and 6 months - feeding

A

Breast or bottle fed, reflexes integrating

Positioning - reclined,

Skills - hands to midline

Soft, smooth solids introduced by spoon.

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12
Q

Feeding for kids 6-12 months- More advanced food textures

A

Positioning - sitting upright

Skills acquired - grasping skills, sitting upright, raking, index finger isolation, pincer grasp

Oral motor skills - Uses tongue to transfer foods from side to center and center to side of mouth

Types of food - Begins to eat ground or finely chopped food.

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13
Q

Feeding 12-24 months

A

More indepence with self feeding

Positioning - independent sitting
Skills acquired - , mature grasp, using utensils

Adult like chewing movements

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14
Q

factors influencing mealtimes

A

culture
social
environmental
personal

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15
Q

Feeding, Eating and Swallowing Difficulties reported numbers stats

A

10-25% of all health children have difficulties

40-70% of premature infants

70-80% of children with developmental disabilities

May be due to medical, oral, sensorimotor and behavior factors alone or combined.

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16
Q

ARFID
avoidant / restrictive food intake disorder

A

Slowed growth or weight loss

emotional reactions to food

avoids food due to fear or anxiety

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17
Q

ASD and how it relates to eating, feeding swallowing

A

mealtime rituals

sensory defensiveness

oral-motor coordination and planning

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18
Q

cerebral palsy - feeding and eating swallowing difficultues

A

tone issues (high, low or fluctuating)

postural instability

difficulty with suck, swalllow, breathe patterns,

sensory difficulty

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19
Q

sensory processing disorder

A

Oral-motor planning difficulties

Sensory defensiveness

Hyporesponsiveness to input

Poor or delayed skills due to limited interactions with food

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20
Q

Referral for Feeding Evaluation

A
  • Increased congestion and/or wet vocal quality
  • Frequent occurrence of respiratory illness
  • Difficulty weaning from oxygen
  • Significant neurological diagnosis and/or neuromotor involvement
  • Coughing or choking during mealtime
  • Oral motor dysfunction
  • Prolonged mealtimes (longer than 30 mins)
  • Reliance on G-tube but still willing to eat something by mouth and safety of feeding is questioned
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21
Q

Feeding evaluation
Initial Interview and Chart Review

A

Review chart:
Request completion of of feeding, developmental and/or nutritional questionnaire.

Information about family concerns and mealtime
- Obtain information about family cultural norms, social rules and mealtime routines.

Discussion of feeding problem from parent perspective (weight gain, length of time to eat, behavior etc.)

22
Q

Feeding evaluation overall

A

Consider the WHOLE system

Eating and swallowing are complex and involve more than just the mouth, throat and stomach

23
Q

Things to consider if a kid isn’t eating

A

Respiration
Digestion
Elimination
Structural alignment
Control
Sensory Input

24
Q

Clinical Assessment:

A

Muscle Tone

Sensory Processing

Movement and Transition patterns

Play

25
Q

Feeding Evaluation
structured observations

A

Oral structures and oral motor patterns - do they have teeth.

Child eating - what does typical eating look like?

Informed clinical opinion

26
Q

Diagnostic Evaluations

A

Upright Modified Barium Swallow Study (MBSS)

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

Upper Gastrointestinal (GI) series

Esophagogastroduodenoscopy (EGD)- endoscopy

27
Q

Dysphagia is

A

“dysfunction in any stage or process of eating. It include any difficulty in the passage of food, liquid or medicine, during any stage of swallowing that impairs the client’s ability to swallow independently or safely”

28
Q

Pediatric Dysphagia

A

Can occur in one or more of the phases of swallowing.

Results in aspiration.

Long term effects:
- Food aversion
- Aspiration pneumonia
- Dehydration
- GI complications
- Psychosocial impact

29
Q

Avoidant/Restrictive Food Intake Disorder (ARFID)

A

An eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:

Significant weight loss or faltering growth

Significant nutritional deficiency

Dependence on enteral feed or oral supplements

Marked interference with psychosocial functioning.

30
Q

Pediatric Feeding Disorder

Functional Profile of patients across 4 axis:

A
  • Medical dysfunction
  • Nutritional dysfunction
  • Feeding Skills dysfunction
  • Psychosocial dysfunction
31
Q

Eating and Drinking Ability Classification System
Measure eating and drinking ability including

A

safety, efficiency and amount of assistance a person with CP needs

32
Q

Ability for Basic Feeding and Swallowing Scale for Children - What ages?

A

Ages 2 months-14 years 7 months

33
Q

kids with down syndrome will do what when eating

A

overstuff their mouths due to underresponsiveness to sensory information

34
Q

Feeding intervention considerations

A

Occupational Therapist’s are continually considering:
Medical and nutritional problems
Prioritize areas of treatment
Collaborate with other professionals
Ensure carryover
Realistic recommendations
Overall plan for treatment

35
Q

Safety first considerations

A

Know person’s restrictions, food allergies, religious or cultural beliefs
– During first year avoid certain foods
* Monitor risk for aspirations
– Until age 4 children do not have molars for grinding foods—be cautious
* Consider ongoing nutritional status (Work with Dietitians when necessary)
* Use universal precautions
* Educate and train others to establish competency. Document this.

36
Q

Feeding intervention considerations

A

Environmental influences and adaptations
Positioning modifications
Adaptive equipment and oral motor techniques used in sessions
Behavior techniques
Developmental considerations (cognitive, motor and sensory)
Interprofessional collaboration
Inclusion of parents and caregivers

37
Q

Environmental Adaptations for feeding interventions

A

Schedule of meals
Location of meals
Length of meal periods
Sensory stimulation
Order of foods presented

38
Q

Positioning Adaptations for feeding interventions

A

Proximal support influences distal movement
External support
Positioning options
Stability

39
Q

Adaptive Equipment can

A

Improve oral motor control
Increase independence
Compensate for motor and/or sensory impairment

40
Q

Causes of self-feeding difficulty

A

Physical or neuromuscular deficits

Cognitive or behavioral

Visual

Sensory processing difficulties

41
Q

Delayed Transition of Textured Foods

A

Oral Sensitivity and Oral Motor Problems
Non nutritive oral motor activities

42
Q

Delayed transition -Bottle to Cup

A

Hypersensitive child
Structural

43
Q

Sensory based oral motor problems are never seen in isolation, but are part of the child’s total body sensory processing problems

A

True

44
Q

Sensory Processing Disorders

A

Hypersensitivity
- Difficulty with touch near or within the mouth
Play and Positive Experiences
Deep pressure/ calming activities
Low sensory regulation

45
Q

Food Chaining

A

Level I- Maintain and expand current taste and texture
Level II- Vary taste and maintain texture
Level III- Maintain taste and vary texture
Level IV-Vary taste and texture

46
Q

Feeding intervention suggestions.

A
  • Offer one new food with one snack and/or one meal a day.
  • Offer a new food with an accepted food (different from the new food). The child doesn’t have to eat it right away. You can model eating it, then let child approach it on own.
  • Keep offering new foods even if they have been rejected. It may takes multiple exposures. Typically-developing children can reject new foods 12-15 times before trying them.
  • Place food on plate next to (but not touching!) other food. Use a divided plate, if you wish.
  • Use transitional foods between bites of new foods (i.e. piece of accepted food, or drink of accepted fluid).
47
Q

Behavioral Interventions

A

Food refusal behaviors
Effects on caregivers
Offering choices and turn taking
Behavior management

48
Q

Food Refusal or Selectivity

A
  • Take into account Consultation from providers
  • Gradually Offering new foods
  • Environmental adaptations may be necessary
  • Sensory
49
Q

Sequential Oral Sensory (SOS)

A

Research based
Play with a Purpose
Detailed Steps to Eating

50
Q

Steps to Eating Sequential oral sensory

A

Tolerates
Interacts With
Smells
Touch
Taste
Eating

51
Q
A

Peds FAll 2024 (20 decks)

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