structurally-based feeding skills in children Flashcards
systems/structures include… (3)
1) respiratory system
2) GI system
3) craniofacial structures
The body’s first priority is to..
maintain O2 levels (i.e., to breathe)
which part do the respiratory & digestive systems share?
They share a portion of the oropharynx
True/False: body will not compromise feeding/swallowing in order to maintain adequate O2 intake
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
Many children who have respiratory compromise also have…
feeding difficulties/disorders
T/F: Any compromise to the respiratory system dramatically affects an infant’s ability to successfully bottle/breastfeed
True, since they are obligate nose-breathers
What is the best position for feeding w/ respiration in mind?
sidelying - allows chest and belly to fall to gravity
ability to breathe adequately & w/ ease can be greatly affected by body positioning
evaluation & tx of respiratory system:
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…
what is the rate of breathing for safe swallows
needs to be <60 bpm
common GI abnormalities affecting feeding (12)
**don’t have to memorize these
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)
esophageal achalasia
failure of LES to relax during swallowing –> lack of esophageal peristalsis; food backs up into esophagus and interrupts subsequent swallows
gastroenteritis
inflammation of stomach and small intestine
Intestinal malrotation
defect in fetal development where the intestines are twisted abnormally; can lead to intestinal obstruction
Gastroschisis
defect in fetal development of the abdominal wall to fully close resulting in the intestines being expelled outside the body
Tracheoesophageal (TE) fistula
opening or hole between trachea and esophagus
Esophageal atresia
failure of esophagus to connect to stomach (birth defect) and ends in a “blind pouch”
Necrotizing Enterocolitis (NEC)
lining of a portion of the intestines dies secondary to decreased blood flow (leading cause of death in postnatal premature babies)
Tx of GI probs
typically out of scope of SLP; refer to GI specialist/physician
GI probs most always cause feeding probs however
common craniofacial abnormalities affecting feedings (6)
facial paralysis/paresis
cleft lip
cleft palate
macroglossia
micrognathia (small jaw) or retrognathia (retracted jaw)
glossoptosis (backward displacement of tongue)
3 respiratory disorders to know:
1) tracheo/laryngomalacia
2) respiratory distress syndrome
3) choanal atresia
tracheo/laryngomalacia
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
best position for infant w/ tracheo- or laryngomalacia
sidelying or prone on belly so gravity pulls down; infant has more room to expand
how do you know if flow on bottle is too high?
by SSB pattern
if they can’t handle flow, stop feeding sooner to allow infant to take breaths
respiratory distress syndrome
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
choanal atresia
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!)
don’t feed an infant if..
> 2 Liters Oxygen– this tells us that too much is going on- overwhelmed
can’t feed an infant w/
CPAP or BiPAP
CPAP
continuous airway pressure; helps to keep soft palate open & tissues apart
BiPAP
step down from CPAP- bilevel airway pressure; used when infant is unable to push against the positive pressure; pulses air
can feed w/…
nasal cannula; but <2 L Oxygen & <60 bpm
facial paralysis/paresis implications on feeding
can affect labial seal/tongue; may not be able to bring lips up/together for sippy cup, straw. etc.
Moebius syndrome
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
cleft lip feeding problems
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
cleft palate feeding probs
can’t generate the pressure to suck; need special compression bottles
macroglossia feeding probs
problems w/ tongue tip lateralization & swallowing/chewing bc tongue is too big
micrognathia (small jaw)/retrognatia (retracted jaw)
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
glossoptosis
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
