Pediatric Swallowing

Question 1

True or False

The tongue takes up more space in the oral cavity due to a smaller mandible

Answer 1

True

Question 2

True or False

The pharynx and larynx are lower in the neck of an infant and makes aspiration easier

Answer 2

False

The pharynx and larynx are higher in the neck of an infant and makes aspiration more difficult

Question 3

True or False

With age, the pharynx elongates and the larynx descends in the neck

Answer 3

True

Question 4

1/3 of the tongue begins to descend between 2-4 years of age, but by when has it completely descended?

Answer 4

9 years

Question 5

True or False

The fat pads on cheeks fills up space and makes sucking easier

Answer 5

True

Question 6

Can you tell the difference?

Answer 6

Know the difference

Question 7

At birth the hard palate is ____ , not much of an arch, and has folds of ____, which makes holding on to nipple easier.

Answer 7

short / mucosa

Question 8

The mandible of a newborn is ___ ___, it is connected by a fibrous tissue and mandibular suture

Answer 8

not fused

Question 9

True or False

The fibrous tissue and mandibular suture will begin to fuse at the end of the first year

Answer 9

True

Question 10

True or False

The Rami of jaw (mandible) becomes more angled with age

Answer 10

True

Question 11

Fill in the blank:

At birth, the larynx is ___ the length of the adult

Answer 11

1/3

Question 12

True or False

The epiglottis is proportionately smaller in an infant

Answer 12

False

The epiglottis is proportionately bigger in an infant

*is in direct contact with soft palate

Question 13

Fill in the blank:

In an infant the pyriform sinuses are more ____

Answer 13

shallow

Question 14

As an infant the TVC are ____ to the base of tongue

Answer 14

closer

Question 15

How do you trigger the gag reflex?

Answer 15

touch to posterior tongue or pharynx

*present at 26-27 weeks of gestation (continues through adulthood)

CN IX & X

Question 16

The reflex that is triggered by touching the gums

Answer 16

Phasic Bite

*28 weeks of gestation

*precursor to mastication

*CN V

*diminishes by 9 - 12 months

Question 17

The reflex where the tongues moves toward the side of stimulation

Answer 17

Transverse Tongue Reflex

*28 weeks of gestation

*precursor to lateralization

*CN XII

*diminishes at 6 months

Question 18

Reflex where tongue protrudes from mouth

Answer 18

Tongue Protrusion

*touch anterior of tongue

*38-40 weeks at gestation

*diminishes by 6 months

*prepares infant to eat

*CN XII

Question 19

The reflex where infant turns head towards stimulation

Answer 19

Rooting

*stroke infant’s cheek

*32 weeks gestation

*diminishes by 3 months

*may be present longer in breast-fed babies

*CN V, VII, XI, XII

Question 20

Backward and forward tongue movement and up and down jaw movement

Answer 20

Suckling

*place nipple in mouth, stroke tongue or touch to hard palate

*18 weeks gestation

*Diminishes by 6-12 months

*movement should be rhythmical

*CN V, VII, IX, XII

Question 21

Up and down tongue movement, smaller vertical jaw excursion, jaw moves more independently

Answer 21

Sucking

*same stimulus as suckling

*6-9 months of age

*Diminishes by 24 months or older

*Lip seal around nipple is firmer

*CN V, VII, IX, XII

Question 22

True or False:

Postural control is important because it affects feeding success and airway protection

Answer 22

True

Question 23

True or False:

In the first 5-6 months, infants belly-breath, once postural control is established breathing becomes thoracic

Answer 23

True

Question 24

Lip seal around the nipple contributes to creating ____ ____ in oral cavity

Answer 24

negative pressure

Question 25

As the mandible ____ during feeding this ____ the size of the oral cavity and a drop in intra-oral pressure, causing the liquid to be sucked into oral cavity

Answer 25

drops, increases

Question 26

True or False: Suckling happens from 6 months onwards

Answer 26

False Suckling happens from 0-6 months \*loose lips, reduced lip seal, tongue seals around nipple \*wide mandibular excursions \*tongue moves in and out

Question 27

List the differences between suckling and sucking

Answer 27

Sucking: \*happens after 6 months and onwards \*tighter lip seal, reduced tongue seal \*reduced mandibular excursions \*tongue moves up and down

Question 28

What are some of the benefits for NNS (Non-Nutritive Suckling)?

Answer 28

\*calming \*increases feedinb behaviors \*improves O2 status \*have faster gastric emptying \*gain weight faster \*leave NICU sooner breathing is continous (no apnea)

Question 29

True or False: Any issue with the digestive system can affect feeding

Answer 29

True \*stomach: acids and other fluids partially digest foods \*duodenum: receives pancreatic juice and bile acids to break food down into sugars, lactose, proteins \*ileum: absorbs nutrients passes along waste to large intestine \*large intestine: leads to rectum for elimination

Question 30

True or False: Instrumental studies should not be conducted until 36 weeks post gestation

Answer 30

True

Question 31

What are some of the symptoms that may serve as a warning for an infant who has trouble feeding?

Answer 31

sudden change in feeding failure to thrive (lack of weight gain) behavioral changes before/after feeding weak/dysfunctional suck coughing/choking during feeding unexpected physiological changes after meals

Question 32

What are some of the preliminary things you should do when conducting a bedside or clinical evaluation on an infant?

Answer 32

Look at Medical history behavior/state/sensory integration general posture/tone repsiratory function/endurance oral-motor/cranial nerve evaluation feeding/swallowing evaluation

Question 33

Name some of the stress cues that are motor-related:

Answer 33

grimmacing, twitching, hyperextension of limbs \*any signs of these during feeding is bad

Question 34

When observing for posture control and muscle tone, what are some things that you should be on the lookout for?

Answer 34

assess muscle tone/posture/movement abnormalities evaluate head/trunk/neck alignment evaluate head support note abnormal compensatory strategies

Question 35

During the Feeding/Swallowing Eval, you should observe for:

Answer 35

position on nipple initiation of suckle/suck mandibular excursion feeding endurance

Question 36

What are some of the reasons of why you would recommend an MBSS on an infant?

Answer 36

similar to adult: - overt signs of aspiration - reduced oral intake - prolonged period of time to complete a meal - signs of distress \*!!!NO MBSS until 38th week

Question 37

Name some of the professionals involved in a Multidisciplinary approach to treatment:

Answer 37

SLP RN Lactation Consultant Dietician Pediatrician PT Gastroenterologist Social Worker

Question 38

What are some of the major differences in regards to swallowing treatment for adults and children?

Answer 38

anatomy and physiology are different infant has primitive reflexes and different oromotor and feeding abilities follow up needs to be frequent due to ongoing development parent/caregiver training is focus

Question 39

Part of the training we as SLPs give to parents in regards to feeding are:

Answer 39

positioning setting the environment selecting feeding choices and methods understanding the feeding problem

Question 40

What are some of the management options?

Answer 40

nutritional considerations environment and impact on feeding position of child and parent appropriate timing/amount of food scheduling of meal supporting parents' needs and skills oral exercises/oral facial support

Question 41

True or False: Full oral feed for young infants is 45 minutes

Answer 41

True \*30 mintues for 6+ months

Question 42

What are some strategies in adjusting the environment during feeding?

Answer 42

a calm setting without distractions add soothing music rocking

Question 43

Stability is a full body approach; delineate the hierarchy of how stability affects the entire body

Answer 43

movement/instability of legs --\> affects trunk stability --\> Trunk instability --\> affects shoulder girdle --\> shoulder girdle instability --\> affects head and neck stability --\> head and neck instability --\> affects jaw, lip and tongue control

Question 44

Fill in the blanks in regards to proper positioning priniciples: Pelvis and hips: may need to be ___ into a curled position w/ hips ____ and knees \_\_\_\_

Answer 44

flexed / bent / flexed

Question 45

Fill in the blanks in regards to proper positioning priniciples: Trunk: _____ and not rotated; ____ unless a slight recline helps stability

Answer 45

symmetrical / upright

Question 46

Fill in the blanks in regards to proper positioning priniciples: Legs: should be _____ ; ____ in order to inhibit extension in hips

Answer 46

still / bent

Question 47

Fill in the blanks in regards to proper positioning priniciples: Shoulder girdle: slightly ____ to assist forward arm position and general flexion; may be assisted by \_\_\_\_

Answer 47

forward / swaddling

Question 48

Fill in the blanks in regards to proper positioning priniciples: Head and neck: head in slightly _____ posture with chin _____ ; assist swallow efficiency and saftey

Answer 48

forward / tucked

Question 49

Answer 49

know the chart