Pediatric Swallowing Flashcards

1
Q

True or False

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

A

True

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2
Q

True or False

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

A

False

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

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3
Q

True or False

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

A

True

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4
Q

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

A

9 years

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5
Q

True or False

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

A

True

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6
Q

Can you tell the difference?

A

Know the difference

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7
Q

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

A

short / mucosa

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8
Q

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

A

not fused

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9
Q

True or False

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

A

True

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10
Q

True or False

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

A

True

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11
Q

Fill in the blank:

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

A

1/3

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12
Q

True or False

The epiglottis is proportionately smaller in an infant

A

False

The epiglottis is proportionately bigger in an infant

*is in direct contact with soft palate

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13
Q

Fill in the blank:

In an infant the pyriform sinuses are more ____

A

shallow

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14
Q

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

A

closer

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15
Q

How do you trigger the gag reflex?

A

touch to posterior tongue or pharynx

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

CN IX & X

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16
Q

The reflex that is triggered by touching the gums

A

Phasic Bite

*28 weeks of gestation

*precursor to mastication

*CN V

*diminishes by 9 - 12 months

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17
Q

The reflex where the tongues moves toward the side of stimulation

A

Transverse Tongue Reflex

*28 weeks of gestation

*precursor to lateralization

*CN XII

*diminishes at 6 months

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18
Q

Reflex where tongue protrudes from mouth

A

Tongue Protrusion

*touch anterior of tongue

*38-40 weeks at gestation

*diminishes by 6 months

*prepares infant to eat

*CN XII

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19
Q

The reflex where infant turns head towards stimulation

A

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

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20
Q

Backward and forward tongue movement and up and down jaw movement

A

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

21
Q

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

A

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

22
Q

True or False:

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

A

True

23
Q

True or False:

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

A

True

24
Q

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

A

negative pressure

25
Q

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

A

drops, increases

26
Q

True or False:

Suckling happens from 6 months onwards

A

False

Suckling happens from 0-6 months

*loose lips, reduced lip seal, tongue seals around nipple

*wide mandibular excursions

*tongue moves in and out

27
Q

List the differences between suckling and sucking

A

Sucking:

*happens after 6 months and onwards

*tighter lip seal, reduced tongue seal

*reduced mandibular excursions

*tongue moves up and down

28
Q

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

A

*calming

*increases feedinb behaviors

*improves O2 status

*have faster gastric emptying

*gain weight faster

*leave NICU sooner

breathing is continous (no apnea)

29
Q

True or False:

Any issue with the digestive system can affect feeding

A

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

30
Q

True or False:

Instrumental studies should not be conducted until 36 weeks post gestation

A

True

31
Q

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

A

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

32
Q

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

A

Look at Medical history

behavior/state/sensory integration

general posture/tone

repsiratory function/endurance

oral-motor/cranial nerve evaluation

feeding/swallowing evaluation

33
Q

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

A

grimmacing, twitching, hyperextension of limbs

*any signs of these during feeding is bad

34
Q

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

A

assess muscle tone/posture/movement abnormalities

evaluate head/trunk/neck alignment

evaluate head support

note abnormal compensatory strategies

35
Q

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

A

position on nipple

initiation of suckle/suck

mandibular excursion

feeding endurance

36
Q

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

A

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

37
Q

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

A

SLP
RN
Lactation Consultant
Dietician
Pediatrician
PT
Gastroenterologist
Social Worker

38
Q

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

A

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

39
Q

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

A

positioning

setting the environment

selecting feeding choices and methods

understanding the feeding problem

40
Q

What are some of the management options?

A

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

41
Q

True or False:

Full oral feed for young infants is 45 minutes

A

True

*30 mintues for 6+ months

42
Q

What are some strategies in adjusting the environment during feeding?

A

a calm setting without distractions

add soothing music

rocking

43
Q

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

A

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

44
Q

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 ____

A

flexed / bent / flexed

45
Q

Fill in the blanks in regards to proper positioning priniciples:

Trunk: _____ and not rotated; ____ unless a slight recline helps stability

A

symmetrical / upright

46
Q

Fill in the blanks in regards to proper positioning priniciples:

Legs: should be _____ ; ____ in order to inhibit extension in hips

A

still / bent

47
Q

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 ____

A

forward / swaddling

48
Q

Fill in the blanks in regards to proper positioning priniciples:

Head and neck: head in slightly _____ posture with chin _____ ; assist swallow efficiency and saftey

A

forward / tucked

49
Q
A

know the chart