Swallowing across the lifespan Flashcards
Early development of swallow in utero (5)
- Pharyngeal swallowing 10-14wks
- True suckling 18-24wks
- Consistent swallowing 22-24wks
- Tongue cupping 28wks
- Suck-swallowing pattern 34-37wks - able to sustain nutrition orally, therefore a baby born before 34 weeks may not be capable of feeding for themselves
Birth to 3-4 months: what does feeding achieve? (2)
- State regulation
- Interaction and bonding with caregiver
Birth to 3-4 months: anatomy of swallowing structures
- Tongue takes up a lot of space in oral cavity
- Velum is almost touching epiglottis
- Hyoid cartilage soft and hyoid bone more retracted/hidden
- Consider possible structural differences to oral cavity, oropharynx and larynx in neonates
Newborn reflexes important for feeding (4)
- Rooting 3-4m - turns to source and opens mouth to seek breast/bottle
- Suck-swallow-breathe 3-4m - sucks when mouth is touched (every 1sec)
- Tongue-thrust 5-6m - when lips touched tongue moves forward out of mouth to protect against choking
- Gag - object expelled from back of mouth by tongue, reflex reduced to post 1/3 of tongue by 6m
What is the difference between suckling and sucking?
Suckling: rhythmic back/forward motion of tongue, jaw moves down to create suction, used in early months of life
Sucking: mature actions developed at 6-8m, less jaw, more up and down movement of tongue, tighter lip seal
Feeding after 3-4m (3)
- Reflexes decline or integrated into voluntary movements
- Improved head and neck control
- Ability to isolate elements of swallow
Feeding by 6m (6)
- Can eat solids (transition phase 4-6m)
- Improved head/neck/shoulder/trunk control
- Can usually sit up to feed
- Can grasp (utensils, food)
- Range and strength of tongue movement develops
- Range and strength of lip movements develops
Signs of readiness for spoon feeding - transition feeding 4-9m (5)
- Minimal support for upright sitting
- Midline head position maintained for several minutes without support
- Hand to mouth motor skills
- Dissociation of lip and tongue motions
- Anatomic changes, more space for tongue in oral cavity to allow for vertical motion
Feeding at 9-12m
Dev/posture
- Pulling to stand
- First steps by 12m
- Assisting with spoon
- Refining pincer grasp
Feeding/oral sensorimotor
- Cup drinking
- Eating lumpy/mashed foods
- Finger feeding for easily dissolvable solids
- Chewing includes rotary jaw action
Feeding at 12-18m
Dev/posture
- Refining gross/fine motor skills
- Walking independently, running
- Grasping and releasing with precision
Feeding/oral sensorimotor
- Self feeding, grasps spoon with whole hand
- Holding cup with 2 hands
- Drinking with 4-5 consecutive swallows
- Holding and tipping bottle
Feeding at 18-24m
Dev/posture
- Refined upper extremity coordination
- Increasing attention and persistence in play
- Parallel or imitative play
- Independence from parents
Feeding/oral sensorimotor
- Swallowing with lip closure
- Self feeding predominates
- Chewing broad range of food
- Up-down tongue movements precise
Feeding at 24-36m
Dev/posture
- Jumping
- Pedalling
- Using scissors
Feeding/oral sensorimotor
- Circulatory jaw rotations
- Chewing with lips closed
- One-handed cup holding
- Open cups
- Using fingers to fill spoon
- Eating wide range of solid foods
- Total self feeding, using fork
Some reasons for presbyphagia (8)
- Loss of dentition
- Increased prevalence of prog neuro
- Sarcopenia - loss of skeletal muscle mass
- Ossification of cartilage
- Reduced bulk/sensitivity of VFs - compromised airway protection
- Reduced bulk/strength of tongue and pharynx - oral and phar residue
- Reduced opening of UES - food can ‘get stuck’
- Pharynx longer and more dilated - takes up to 20% longer, airway needs to be protected for longer
