Swallowing Flashcards
What is the body’s number one priority
BREATHING!
Goals for feeding
Needs to be safe
Needs to be positive/pleasant experience
Needs to provide adequate nutrition
Sucking definitions - Non nutritive sucking
Finger, pacifier, or at the breast - no nutrition given
Rate of 2 sucks per second
Series of sucks and pauses should start to be rhythmical at 34 weeks
Sucking definitions - Non nutritive sucking - Suck to swallow ratio is
6 to 8 sucks per 1 swallow
Sucking definitions - Nutritive sucking
Half the rate of NNS or 1 per second
Jaw drops down, tongue drops and moves in an ant/post pattern
Seal btw tongue and palate
Tongue is cupped
Sucking definitions - Nutritive sucking - Suck to swallow ratio
1:1 - typically but can be 2:1 or 3:1 too
Sucking definitions - Mature sucking pattern
1:1:1 ratio
10-30 sucks per burst and then brief pause
Rhythmical
Baby’s “fingerprint”
Sucking definitions - Immature sucking pattern
3 to 5 sucks per burst and then pause of equal duration due to breath coming after all sucks and not in synchrony
Sucking definitions - Transitional suck pattern
6 to 9 sucks per burst and variable pauses
Considered abnormal after 40 wks gestation because the mature pattern has not developed
Suck/Swallow/Breathe
SSB Synchrony - infant stops breathing briefly for every swallow
The avg. length of time infant stops breathing while swallowing is 1 sec
SSB - impact of sucking on swallowing
Compression of nipple and expression of milk
Triggers the swallow
Rate, size, and speed of bolus affect frequency and timing of swallow
SSB - Impact of swallowing on breathing
Respiration is suppressed during swallowing as a protective mechanism
Frequent supressions of nutritive sucking leads to dec RR and depth of breaths
SSB - Impact of breathing on sucking
Abnormal resp. function results in abnormal sucking patterns to minimize compromise
Sucking rhythm may influence the RR and pattern
Oral experiences
Intubation OG/NG tubes Taping Suctioning Washing faces Placing pacifier in mouth Feeding Tracheostomy Breathing tx
Infant feeding stress cues
State and attention will tell you a lot Irritability, crying Frequent gaze aversion Silent crying Inconsolible Staring
Infant feeding stress cues - motoric
Flaccid Hyperext of legs, arms Arching trunk Fisting hands Splaying fingers Grimace
Infant feeding stress cues - autonomic
Hiccuping Sighing Yawning Cyanosis Spitting up Coughing
!!! Questions to ask caregivers about bottling
- Typical duration of feeding at home (should be no more than 20 to 30 m)
- Type of bottle and nipple used
- Preferred position
- Temp of milk
- Frequency of emesis and amount
- Typical feeding - what does it look like
Questions to ask caregivers about bottling - first question
Duration of feeding - do not give them a number to go off - just ask
There is no nutritional gain after 30 min
State regulation with feeding
Positioning Alertness Swaddling Hands to midline and mouth Environment "Shut down" versus sleeping
Reasons why children won’t eat
Physical - pain, discomfort, immature motor, oral motor, and/or swallow skills (sensory processing)
Bx/Emotional - child factors, parent factors, environmental factors
Phases of swallowing
Oral preparatory
Oral phase
Pharyngeal Phase
Esophageal Phase
Phases of swallowing - Oral preparatory
Preparation of the bolus to make it cohesive
Not necessary in infant but key once suck is no longer reflexive (3-4 m)
Suckle for purees
Munching/chewing bolus, collective bolus from cheeks and tongue, forming cohesive bolus
Phases of swallowing - Oral phase
Movement of the cohesive bolus posteriorly to trigger proper timing and coordination of swallow reflex
