PEDS-Feeding Flashcards
Prior to 33 weeks (8 mo) of gestation
An infant is fed by non-oral means
35 weeks (8-9 mo) of gestation or after
Jaw and tongue movement are strong enough to allow for feeding
40 weeks (10 mo) of gestation
rooting, gag, and cough reflexes are present for up to four months, protecting the airway and decreasing the chances of aspiration
4-5 months
munching occurs, consisting of a phasic bite and release of a soft cookie;
upward and downward jaw movement and rhythmic” MUNCHING”
6 months
strong up and down movement of the tongue
7-8 months
beginning of mastication of soft and mashed foods with diagonal jaw movement
9 months
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
12 months, 1 yr
jaw is firm, there is rotary chewing allowing for a good bite on a hard cookie
24 months, 2 yr
able to chew most meats and raw vegetables
Evaluation of feeding
-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.
____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
- neutral pelvic alignment
- trunk stability
- head extension
5-7 months
takes cereal or poured baby food from spoon
6-8 months
attempts to hold bottle but may not retrieve it if it falls; needs to be monitored for safety reasons
6-9 months
holds a bottle with both hands
uses a cup with help
grabs and bangs spoon
9-13 months
finger feeding soft foods
12-14 months
dips spoon in food, brings spoonful of food to mouth, but spills food by inverting spoon before it goes into mouth
15-18 months
scoops food with spoon and brings it to mouth
24- 30 months
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
How should the caregiver position their hand when working on oral motor control?
intervention of oral motor control
-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
How do you facilitate lip closure?
intervention of oral motor control
by applying slight upward pressure of the index finger under the child’s lip
how do you facilitate jaw closure?
by applying upper pressure of the middle finger under the jaw
Intervention of oral motor control
-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.
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.
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
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
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.
