Pediatric Feeding Flashcards
Feeding:
Setting up arranging, and bringing food or fluid from the vessel to the mouth (include self-feeding and feeding others)
Eating:
Keeping and manipulating food or fluid in the mouth, swallowing it (ie moving it from the mouth to the stomach)
Phases of swallowing
Oral Prep phase
Jaw, lips tongue, teeth, cheeks and palate manipulate food.
When you are forming the bollus of food.
Phases of swallowing
Oral Phase:
Begins when tongue elevates against alveolar ridge of the hard palate, moving bolus posteriorly. Ends with the onset of the pharyngeal swallow
Phases of swallowing
Pharyngeal Phase:
Hyoid and larynx move upward and anteriorly and the epiglottis retroflexes to protect the opening of the airway.
Kids who are low tone are at a high risk for
aspiration
Phases of swallowing
Esophageal Phase:
Muscles at the top of the esophagus open to allow food or liquid to enter.
parislosis
paristolsis is impacted by
tone.
Stages and ages of newborn for eating
Newborn - Breast or bottle fed, Reflex driven
Positioning: being held, swaddled.
What reflexes are good for eating
sucking, moro, gag, thenar eminance one.
Between 2 and 6 months - feeding
Breast or bottle fed, reflexes integrating
Positioning - reclined,
Skills - hands to midline
Soft, smooth solids introduced by spoon.
Feeding for kids 6-12 months- More advanced food textures
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.
Feeding 12-24 months
More indepence with self feeding
Positioning - independent sitting
Skills acquired - , mature grasp, using utensils
Adult like chewing movements
factors influencing mealtimes
culture
social
environmental
personal
Feeding, Eating and Swallowing Difficulties reported numbers stats
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.
ARFID
avoidant / restrictive food intake disorder
Slowed growth or weight loss
emotional reactions to food
avoids food due to fear or anxiety
ASD and how it relates to eating, feeding swallowing
mealtime rituals
sensory defensiveness
oral-motor coordination and planning
cerebral palsy - feeding and eating swallowing difficultues
tone issues (high, low or fluctuating)
postural instability
difficulty with suck, swalllow, breathe patterns,
sensory difficulty
sensory processing disorder
Oral-motor planning difficulties
Sensory defensiveness
Hyporesponsiveness to input
Poor or delayed skills due to limited interactions with food
Referral for Feeding Evaluation
- 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
Feeding evaluation
Initial Interview and Chart Review
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.)
Feeding evaluation overall
Consider the WHOLE system
Eating and swallowing are complex and involve more than just the mouth, throat and stomach
Things to consider if a kid isn’t eating
Respiration
Digestion
Elimination
Structural alignment
Control
Sensory Input
Clinical Assessment:
Muscle Tone
Sensory Processing
Movement and Transition patterns
Play
Feeding Evaluation
structured observations
Oral structures and oral motor patterns - do they have teeth.
Child eating - what does typical eating look like?
Informed clinical opinion
Diagnostic Evaluations
Upright Modified Barium Swallow Study (MBSS)
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Upper Gastrointestinal (GI) series
Esophagogastroduodenoscopy (EGD)- endoscopy
Dysphagia is
“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”
Pediatric Dysphagia
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
Avoidant/Restrictive Food Intake Disorder (ARFID)
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.
Pediatric Feeding Disorder
Functional Profile of patients across 4 axis:
- Medical dysfunction
- Nutritional dysfunction
- Feeding Skills dysfunction
- Psychosocial dysfunction
Eating and Drinking Ability Classification System
Measure eating and drinking ability including
safety, efficiency and amount of assistance a person with CP needs
Ability for Basic Feeding and Swallowing Scale for Children - What ages?
Ages 2 months-14 years 7 months
kids with down syndrome will do what when eating
overstuff their mouths due to underresponsiveness to sensory information
Feeding intervention considerations
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
Safety first considerations
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.
Feeding intervention considerations
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
Environmental Adaptations for feeding interventions
Schedule of meals
Location of meals
Length of meal periods
Sensory stimulation
Order of foods presented
Positioning Adaptations for feeding interventions
Proximal support influences distal movement
External support
Positioning options
Stability
Adaptive Equipment can
Improve oral motor control
Increase independence
Compensate for motor and/or sensory impairment
Causes of self-feeding difficulty
Physical or neuromuscular deficits
Cognitive or behavioral
Visual
Sensory processing difficulties
Delayed Transition of Textured Foods
Oral Sensitivity and Oral Motor Problems
Non nutritive oral motor activities
Delayed transition -Bottle to Cup
Hypersensitive child
Structural
Sensory based oral motor problems are never seen in isolation, but are part of the child’s total body sensory processing problems
True
Sensory Processing Disorders
Hypersensitivity
- Difficulty with touch near or within the mouth
Play and Positive Experiences
Deep pressure/ calming activities
Low sensory regulation
Food Chaining
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
Feeding intervention suggestions.
- 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).
Behavioral Interventions
Food refusal behaviors
Effects on caregivers
Offering choices and turn taking
Behavior management
Food Refusal or Selectivity
- Take into account Consultation from providers
- Gradually Offering new foods
- Environmental adaptations may be necessary
- Sensory
Sequential Oral Sensory (SOS)
Research based
Play with a Purpose
Detailed Steps to Eating
Steps to Eating Sequential oral sensory
Tolerates
Interacts With
Smells
Touch
Taste
Eating
