pediatric swallowing

Question 1

Swallowing by the developing fetus:
helps
helps develop
creates

Answer 1

regulate amniotic fluid volume

gastro-intestinal tract

neural pathways

Question 2

Patterns seen:
pharyngeal swallowing

true suckling:

• … movement of the tongue
• related to ?

efficient swallowing:

Answer 2

10-12 1/2 weeks

18-24 weeks

• backward and forward
• size of tongue in mouth

34-26+ weeks

Question 3

Infant versus adult anatomy:
connection between nasopharynx and oropharynx is a

tongue sits?

mandible is ?

epiglottis is ?
-sits at

soft palate touches ?

faucial arches touch ?

larynx is ?

trachea is ?

Answer 3

gentle slope

forward filling oral cavity

small and slightly retracted

omega shaped, flopy
-C3 - C4 level

touches top of epiglottis at rest

epiglottis on either side

funnel shaped; angled posteriorly

shorter and more narrow

Question 4

Infant versus adult anatomy:
connection between nasopharynx and oropharynx is at a ?

tongue begins to ? moves ?

mandible ? allowing tongue to sit in ?

epiglottis ? becomes ?
-sits at?

soft palate no longer touches ?
faucial arches do not ?

larynx ? becoming more

trachea is

Answer 4

90 degree angle

drop/ posteriorly

grows/neutral resting position

flattens/ firmer
C5-C6 level

do not touch epiglottis at rest

column shaped

wider and longer

Question 5

TWO types of sucking patterns:

non-nutritive suck: 
-
-... movement of tongue 
jaw moves ? 
approx ? how many sucks 

nutritive suck:
-
-.. ratio 
-allows liquid to be ? 
initially ? 
swallow as ages may increase to ?

Answer 5

rapid
forward backward
up and down
6 sucks ; 6-8 sucks/swallow

slower
one to one 
drawn into mouth 
1 suck/swallow 
2-3 sucks/swallow

Question 6

4-6 months:

liquid and solid intake for ?

feeding/oral motor development: 
by the end of this period ? introduced
transfers food bolus from ? 
lips? 
... consistency of foods 
reflexes should be ? 

associated motor skill development:
feeding typically in a ?
hands on ? but may need ?
… control improves

Answer 6

spoon feeding is introduced 
front to back of mouth 
close to clear food from spoon
purees, smooth, creamy foods
diminished by end of this age 

semi-reclined position progressing to upright while supported

bottle/ help holding bottle while feeding

head, neck, shoulder, and pelvic control improve

Question 7

7-9 months:

liquid and solid intake for

increased ?

feeding/oral motor development: 
... tongue movement
... observed 
lips close to ? with ? 
... consistency INCLUDING

associated motor skill development:
feeding occurs in more ? with exception of

independently ?

reaches for and ?

can bring head ?

Answer 7

nutritional needs

solid intake

lateral and anterior-posterior tongue movement
bite/munching
clear food from spoon/greater coordination
purees, smooth, creamy/ pureed meats

upright position with exception of liquids
-holding bottle
brings objects to mouth with greater consistency

forward to meet spoon

Question 8

9-12 months:

liquid and solid intake for

feeding/oral motor development: 
lip closure while 
attempting ? 
liquid intake from ? 
straw ? 

associated motor skill development:
sitting
pincer grasp ?
overall

Answer 8

nutritional needs

swallowing liquids
self-feeding
supported cup
drinking introduced

upright during mealtime
pointer finger and thumb

refinement of gross and fine motor

Question 9

9-12 months:

liquid and solid intake for

feeding/oral motor development: 
lip closure while 
attempting ? 
liquid intake from ? 
straw ? 

associated motor skill development:
sitting
pincer grasp ?
overall

Answer 9

nutritional needs

swallowing liquids
self-feeding
supported cup
drinking introduced

upright during mealtime
pointer finger and thumb

refinement of gross and fine motor

Question 10

12-18 months: 
feeding and oral development: 
increased ? 
eating 
chewing skills still 
.. begins 

independently ?

.. what skills ? child begins to ?

Answer 10

variety of oral intake
diced table foods
developing thus the need for diced food presentation
rotary chew

feeding themselves

communication and speech skills asl for specific foods and drinks

Question 11

2-3

liquid and solid intake for ? via?

feeding/oral motor: 
.. refined 
increased 
increased 
meeting nutrition and hydration needs by

associated motor skill development:
holding:
… etc
overall gross and fine motor skills continuing to ?

Answer 11

nutritional needs/ cup straw, spoon, fork

rotary chew
oral intake
bite size
mouth

cup spook fork independently and can maneuver with limited diff.
become smoother and more coordinated

Question 12

Feeding disorders:
oral 
restricted 
.. preferences 
behavioral component due to ? 

swallowing disorders:

… component
… components
difficulty

Answer 12

oral aversion
diet
texture/food preferences
HX of difficulty

anatomical or physiological component (cleft palate, etc)
neurological component: CP, hypertonia

coordinating suck/sip swallow breathe

Question 13

Oral and motor feeding DX

observe

note

… preferences

Answer 13

oral structures and movement at rest and while feeding

asymmetry , preferred side for chewing

food/ reactions to food presentations by parent as opposed to clinician