Quiz 5 Flashcards
What do the lips & cheeks do in a typical infant?
Lips locate nipple, bring to mouth, and stabilize the nipple position while forming the anterior seal.
Cheeks provide the stability to maintain the shape of the mouth (sucking pads) and provide lateral boundaries for food on the tongue (help with bolus formation).
What happens to lips when child is hypotonic? Cheeks?Tongue?
Lips- Looser; poor lip seal, period breaks in suction, liquid loss
Cheeks- Unstable; negative pressure may pull cheeks inward which compromises sucking and reduces efficiency. Stability of sucking pads decreases and baby does not develop cheek stability to maintain lip stability and adequate seal.
Tongue- Little shaping or resistance, may protrude, tongue rests forward on lips of over lower gum ridge- may not be able to shape/stabilize nipple during sucking.
What happens to lips when child is hypertonic? Cheeks?Tongue?
Lips- Tightly pursed; nipple insertion is difficult, can impair latch and active sucking.
Cheeks- Associated with increased cheek retraction and open lip posture- contributes to poor seal on nipple and retracted tongue position.
Tongue- Tongue tip elevations, retracted tongue in effort to maintain stability (also micro/retro gnathias because tongue does not have a place to go).
What is tongue thrust/reverse swallow?
A behavioral pattern where the tongue protrudes through the incisors during swallowing, speech and at rest. Teeth are pushed forward and away from upper ride which causes open/over/cross bites. All infants involve tongue protrusion but lost reflex by 6 months. Neurologically impaired cannot inhibit reflex which leads to chronic problem.
What are some causes of tongue thrust?
Immature oral bx, narrow dental arch, prolonged upper respiratory infections (heavy mouth breathers), thumb sucking/pacifier use, open mouth due to structure, large tonsils/adenoids
What does the jaw do?
Provides stable platform for movement, downward movement creates negative pressure/suction, smooth/rhythmic/small excursions
What are some jaw deviations?
Large excursions indicate jaw instability with poor graded movement (interferes in lip seal and tongue movement/suction. Reduced range of movement, clenching jaw, asymmetry of jaw, jaw dissociation…
How do we assess dentition?
Assess bite, oral hygiene, toothbrushing toleration, excess decay, grinding, discoloration, missing teeth
Is it better to have few or no teeth?
None! Having a few teeth interferes with chewing…
How do we assess how dentition is used?
Are movements rhythmical, able to bite cookie in one graded movement, external supports used to make jaw stable? (cup), note chewing pattern, is chewing initiated and maintained?
What does a normal palate look like? Abnormal? What does hard palate do?
Intact smooth palate is shape of tongue roughly.
Abnormal are narrow, grooved, highly arched, or too shallow.
Assists with positioning and stability of nipple, works with tongue to compress the nipple.
What does the soft palate do? Why would it have an abnormal shape?
Creates posterior seal, prevents PNR (abnormal velar movement of discoordination of movement.
Could be due to oral intubation, tongue thrusting, congenital malformation or family trait!
What is key to SSB?
Rhythmicity!
What is dysfunctional feeding characterized by?
Inefficiency, discoordination, dysrhythmia
Non nutritive suck is 2/second
Nutritive is 1/second
What is discoordination in SSB pattern suggested by?
What are the soft signs?
Poor pacing, gulping/audible swallow, gagging/coughing, congestion when you hear wetness in chest, wet vocal sounds, PNR increased nasal congestion…
Flaring, neck arch, pull away from nipple!
What are some of the problems during the oral phase?
Sucking, drooling bolus formation transit problems poor clearance (holding, pocketing) Prolonged feeding time
What is the number one reason kids drool?
Large tonsils- can’t move food from front to back bc don’t have enough motor control or sensory (not comfortable swallowing)
What are some problems during the pharyngeal phase?
Problems with airway protection Penetration/aspiration Impaired airway clearance after aspiration event (silent asp) Poor pharyngeal clearance Prolonged mealtimes
What are some red flags of swallowing dysfunction?
Recurrent upper resp infections Coughing, choking, gagging Spiking temps Change in phonatory/respiratory quality PNR Fatigue associated with feeding Frequent coughing during tube feeding Difficulty adjusting to nipple size/bolus consistency Decrease in O2, apnea, bradycardia Difficulty gaining weight Asthma/allergies (inf dx by parent) Build up secretions during or after feedings (brain giving info to keep going OR coming up from below Food in mouth after swallowing Weak voluntary cough (body used to it so not protecting anymore) Excessive drooling (not swallowing enough) Food loss (attn or swallow?)
What does a Videofluoroscopic swallow study/MBS do?
VIsualizes bolus flow in real time through oral and pharyngeal phases
Screens esophageal transit and basic motility
ID’s aspiration and if present when did it happen in relation to swallow
Texture specificity
Estimate of risk
Response to aspiration
What is the difference between barium and modified barium swallow?
Barium is laying down x ray, modified is looking at physiology of swallow
What does a Videofluoroscopic swallow study/MBS not do?
Rule out aspiration ( we swallow so much it might not catch it)
1-2 min; observes 1-30 swallows max
Define feeding and swallowing development
Predict progression or resolution of the feeding and swallowing problem.
What are potential criteria for VFSS?
Suspicion of oropharyngeal dysphagia, risk for aspiration by history or observation, prior history of aspiration pneumonia
When/why would you do a VFSS?
Will it help with dx/management? When will it be most helpful and findings will make a difference? Child must be ready/willing to participate- crying/screaming will cause aspiration.
