PEDS-Feeding

Question 1

Prior to 33 weeks (8 mo) of gestation

Answer 1

An infant is fed by non-oral means

Question 2

35 weeks (8-9 mo) of gestation or after

Answer 2

Jaw and tongue movement are strong enough to allow for feeding

Question 3

40 weeks (10 mo) of gestation

Answer 3

rooting, gag, and cough reflexes are present for up to four months, protecting the airway and decreasing the chances of aspiration

Question 4

4-5 months

Answer 4

munching occurs, consisting of a phasic bite and release of a soft cookie;
upward and downward jaw movement and rhythmic” MUNCHING”

Question 5

6 months

Answer 5

strong up and down movement of the tongue

Question 6

7-8 months

Answer 6

beginning of mastication of soft and mashed foods with diagonal jaw movement

Question 7

9 months

Answer 7

lateral tongue movements make mastication of soft and mashed food effective, able to drink from a cup; however, jaw is not firm; able to eat more complex foods
-holds cup

Question 8

12 months, 1 yr

Answer 8

jaw is firm, there is rotary chewing allowing for a good bite on a hard cookie

Question 9

24 months, 2 yr

Answer 9

able to chew most meats and raw vegetables

Question 10

Evaluation of feeding

Answer 10

-Parent interview including parent’s concerns, feeding history, behavior during feeding, weight gain or loss.

-Medical and developmental history.

-Observation of feeding including postural control, oral sensitivity; motor control of the jaw, lip, tongue, and cheek; and coordination and endurance of all.

-Recommendation for videofluoroscopy swallow study especially if the child has a high rise of aspiration.

Question 11

____Appropriate positioning to allow for __________blank_____ and ______blank__________either in caregiver’s lap or chair (infant seat or w/c); avoid ___________blank___________ to prevent asphyxiation as a result of closing of the airway.

intervention of oral motor control

Answer 11

1. neutral pelvic alignment
2. trunk stability
3. head extension

Question 12

5-7 months

Answer 12

takes cereal or poured baby food from spoon

Question 13

6-8 months

Answer 13

attempts to hold bottle but may not retrieve it if it falls; needs to be monitored for safety reasons

Question 14

6-9 months

Answer 14

holds a bottle with both hands
uses a cup with help
grabs and bangs spoon

Question 15

9-13 months

Answer 15

finger feeding soft foods

Question 16

12-14 months

Answer 16

dips spoon in food, brings spoonful of food to mouth, but spills food by inverting spoon before it goes into mouth

Question 17

15-18 months

Answer 17

scoops food with spoon and brings it to mouth

Question 18

24- 30 months

Answer 18

demonstrates interest in using fork; may stab at food such as pieces of canned fruit; proficient at spoon use and eats cereal with milk or rice with gravy with utensil

Question 19

How should the caregiver position their hand when working on oral motor control?

intervention of oral motor control

Answer 19

-hand positioning of the caregiver: place the index finger longitudinally under the child’s lip, middle finger under the jaw, and place the thumb on the lateral end of the mandible

Question 20

How do you facilitate lip closure?

intervention of oral motor control

Answer 20

by applying slight upward pressure of the index finger under the child’s lip

Question 21

how do you facilitate jaw closure?

Answer 21

by applying upper pressure of the middle finger under the jaw

Question 22

Intervention of oral motor control

Answer 22

-appropriate positioning to allow for neutral pelvic alignment and trunk stability either in caregiver’s lap or chair (infant seat or w/c); avoid head extension to prevent asphyxiation as a result of closing of the airway

-hand positioning of the caregiver: place the index finger longitudinally under the child’s lip, middle finger under the jaw, and place the thumb on the lateral end of the mandible

-facilitate lip closure by applying slight upward pressure of the index finger under the child’s lip

-facilitate jaw closure by applying upper pressure of the middle finger under the jaw

-hand positioning of the index and middle finger to assist in inhibiting tongue thrust; (1) press bowl of spoon downward and hold onto tongue

-facilitate swallow by lip closure, by placement and downward pressure of the spoon on the middle aspect of the tongue

-facilitate chewing by placement of foods, such as long soft cooked veggie, between the gum and teeth

-integrate preventive measures to work out of abnormal patterns; (1) provide firm downward pressure, using a spoon on the middle aspect of the tongue in presence of a tonic bite reflex; (2) prevent tongue retraction to avoid choking; (3) facilitate lip closure for a tongue thrust that can result in loss of liquid and food, drooling and failure to thrive; (4) decrease tactile sensitivity prior to feeding as well as at other times, by providing firm pressure; encourage sucking/chewing on a cloth; rub gums, palate, and tongue; promote oral exploration of toys; use a NUK toothbrush; and vary texture of food, gradually introducing mashed potatos mixed with other veggie and soft meats

-Consider and utitlize the approp. texture of food as related to the child’s feeding prob. (thick foods are easier to swallow and manage esp. if a tongue thrust is present

-a major role of the therapist is to assist the caregiver in considering and promoting a pleasant social atmosphere for feeding by utilizing positioning and handling tech. to promote eye contact and bonding in relax env.

Question 23

A child who has had a TBI demos tongue thrust. What should the OT do FIRST, prior to feeding?
a] Position the child’s trunk, head, neck, and shoulders in proper alignment.
b] Recline the child’s seat backward and postion neck in slight extension.
c] Place the OT’s digits directly under the child’s chin, facilitating tongue retraction.
d] Provide upward pressure under the child’s lower jaw prior to chewing.

Answer 23

A] Position the child’s trunk, head, neck, and shoulders in proper alignment.

c] and d] are correct, but only after the child is in proper positioning.
b] is a contraindication/choking hazard

Question 24

An OTR® is evaluating a child with a developmental disability for feeding concerns. The OTR notes that the child presents with tongue thrust. Which description BEST describes this child’s presentation?

An exaggerated, uncontrolled pushing of food or liquid out of the mouth
An open mouth posture in which the tongue passively hangs out of the oral cavity
Low tone in the tongue
Tongue movement to the sides of the mouth

Answer 24

Solution: The correct answer is A.

Tongue thrust is characterized as an exaggerated, uncontrolled pushing of food or liquid out of the mouth.

B: An open mouth posture in which the tongue passively hangs out of the oral cavity is tongue protrusion.

C: Low tone in the tongue is tongue hypotonia.

D: Tongue movement to the sides of the mouth is tongue lateralization.