structurally-based feeding skills in children

Question 1

systems/structures include… (3)

Answer 1

1) respiratory system
2) GI system
3) craniofacial structures

Question 2

The body’s first priority is to..

Answer 2

maintain O2 levels (i.e., to breathe)

Question 3

which part do the respiratory & digestive systems share?

Answer 3

They share a portion of the oropharynx

Question 4

True/False: body will not compromise feeding/swallowing in order to maintain adequate O2 intake

Answer 4

False, it will compromise;

Vocal folds will abduct (open) if O2 is needed even if there is still food in the pharynx –> risk for aspiration

Question 5

Many children who have respiratory compromise also have…

Answer 5

feeding difficulties/disorders

Question 6

T/F: Any compromise to the respiratory system dramatically affects an infant’s ability to successfully bottle/breastfeed

Answer 6

True, since they are obligate nose-breathers

Question 7

What is the best position for feeding w/ respiration in mind?

Answer 7

sidelying - allows chest and belly to fall to gravity

ability to breathe adequately & w/ ease can be greatly affected by body positioning

Question 8

evaluation & tx of respiratory system:

Answer 8

want to look @ respiratory system- breath support, rib cage mobility, and rate/ease of breathing– one of the first skills you assess & continually monitor during feeding

-look for chest retractions, nasal flaring, grunting, <60 bpm…

Question 9

what is the rate of breathing for safe swallows

Answer 9

needs to be <60 bpm

Question 10

common GI abnormalities affecting feeding (12)

**don’t have to memorize these

Answer 10

1) GERD
2) constipation
3) slow gastric emptying
4) intestinal dysmotility
5) cricopharyngeal dysfunction
6) esophageal achalasia
7) gastroenteritis
8) intestinal malrotation
9) gastroschisis
10) TE fistula
11) esophageal atresia
12) necrotizing enterocolitis (NEC)

Question 11

esophageal achalasia

Answer 11

failure of LES to relax during swallowing –> lack of esophageal peristalsis; food backs up into esophagus and interrupts subsequent swallows

Question 12

gastroenteritis

Answer 12

inflammation of stomach and small intestine

Question 13

Intestinal malrotation

Answer 13

defect in fetal development where the intestines are twisted abnormally; can lead to intestinal obstruction

Question 14

Gastroschisis

Answer 14

defect in fetal development of the abdominal wall to fully close resulting in the intestines being expelled outside the body

Question 15

Tracheoesophageal (TE) fistula

Answer 15

opening or hole between trachea and esophagus

Question 16

Esophageal atresia

Answer 16

failure of esophagus to connect to stomach (birth defect) and ends in a “blind pouch”

Question 17

Necrotizing Enterocolitis (NEC)

Answer 17

lining of a portion of the intestines dies secondary to decreased blood flow (leading cause of death in postnatal premature babies)

Question 18

Tx of GI probs

Answer 18

typically out of scope of SLP; refer to GI specialist/physician
GI probs most always cause feeding probs however

Question 19

common craniofacial abnormalities affecting feedings (6)

Answer 19

facial paralysis/paresis
cleft lip
cleft palate
macroglossia
micrognathia (small jaw) or retrognathia (retracted jaw)
glossoptosis (backward displacement of tongue)

Question 20

3 respiratory disorders to know:

Answer 20

1) tracheo/laryngomalacia
2) respiratory distress syndrome
3) choanal atresia

Question 21

tracheo/laryngomalacia

Answer 21

too much supraglottic tissue –> floppy airway –> stridor
infant are born w/ this condition; it can improve by 6 months, and is usually gone by 12 mos

-trach is used if condition is very severe= last resort

Question 22

best position for infant w/ tracheo- or laryngomalacia

Answer 22

sidelying or prone on belly so gravity pulls down; infant has more room to expand

Question 23

how do you know if flow on bottle is too high?

Answer 23

by SSB pattern

if they can’t handle flow, stop feeding sooner to allow infant to take breaths

Question 24

respiratory distress syndrome

Answer 24

trouble breathing in acute situation;

• breathing disorder in newborns caused by immature lungs
• when born before 25 weeks, infants can lack surfactant in lungs, which reduces tension between surfaces –> keeps lungs from collapsing
• can lead to bronchopulmonary dysplasia or chronic lung disease

Question 25

choanal atresia

Answer 25

bone between nasal/pharyngeal cavity–> no opening; if both sides occluded –> trached

signs:
- occlude one side and see stats
- shortened sucking bursts
- mouth breathing (not normal!)

Question 26

don’t feed an infant if..

Answer 26

> 2 Liters Oxygen– this tells us that too much is going on- overwhelmed

Question 27

can’t feed an infant w/

Answer 27

CPAP or BiPAP

Question 28

CPAP

Answer 28

continuous airway pressure; helps to keep soft palate open & tissues apart

Question 29

BiPAP

Answer 29

step down from CPAP- bilevel airway pressure; used when infant is unable to push against the positive pressure; pulses air

Question 30

can feed w/…

Answer 30

nasal cannula; but <2 L Oxygen & <60 bpm

Question 31

facial paralysis/paresis implications on feeding

Answer 31

can affect labial seal/tongue; may not be able to bring lips up/together for sippy cup, straw. etc.

Question 32

Moebius syndrome

Answer 32

bottom half of face paralyzed- lack of innervation

requires: chin/cheek support to prevent pocketing, compensatory strategies
may have to teach abnormal feedings patterns to feed efficiently

Question 33

cleft lip feeding problems

Answer 33

not much loss of suction for bottle/breast feeding, but if air leaks from gap in lip, can use nipple w/ broader base or tape to plug hole

Question 34

cleft palate feeding probs

Answer 34

can’t generate the pressure to suck; need special compression bottles

Question 35

macroglossia feeding probs

Answer 35

problems w/ tongue tip lateralization & swallowing/chewing bc tongue is too big

Question 36

micrognathia (small jaw)/retrognatia (retracted jaw)

Answer 36

the smaller the jaw, the more glossoptosis is likely

can cause abnormal teeth alignment
jaw may have small opening that a standard size of nipple will not fit or pass

Question 37

glossoptosis

Answer 37

posterior/inferior displacement of tongue
-can affect breathing

Pierre Robins syndrome-
prevents baby from getting adequate/effective suction–> can’t take in enough calories from feeding–> could mean that breast feeding may be unsuccessful