Team care, Dental and Audiology, Feeding Flashcards
Three professionals needed on a cleft team
SLP, surgeon, team coordinator (usually nurse)
Why team care?
Allows for continuity for long-term treatment and for greater communication between professionals working on the same case.
SLP’s role on a cleft team
Provide input to the team Provide support to the family Re-evaluate yearly Assist in developing and implementing plans for services Initiate further referrals
Professionals involved in dental care
Pediatric dentist
Orthodontist
Prosthodontist
Oral surgeon
Primary teeth labelling
A-J on top (starting with right second molar)
K-T on bottom (starting with left second molar)
Secondary teeth labelling
1-16 on top
17-32 on bottom
Pattern: Central incisor, lateral incisor, cuspid, bicuspid 1, bicuspid 2, molar 1, molar 2, sometimes molar 3/wisdom tooth
Types of occlusion
Class I: Normal
Class II: Overbite–top teeth are 1/2 ahead of bottom teeth
Class III: Underbite–bottom teeth whole tooth ahead of top teeth
Overjet
Significant horizontal space between top and bottom teeth
Crossbite
Upper teeth inside lower jaw
Maxillary expanders
Used to widen the palate, particularly for kids with pierre robin
Palatal lift
Lifts the velum–appropriate when VPI is caused neurologically-based
Palatal obtorator
Closes off a fistula or a cleft for improved resonance, feeding, etc. Less expensive than surgery
Speech bulb
Occludes the velopharyngeal port for speech only
Hearing loss in kids with CP
Tends to be bilateral conductive hearing loss
Outer ear pathologies
Microtia; anotia; atresia
Middle ear pathologies
Ossicular detachment or fixation
Eustachian tube malformations
Guidelines for infant feeding
Bottling is efficient (20-30 minutes) Consistent bubbling in the bottle Coordinated ssb Adequate intake with minimal effort Consistent feeding times Consistent weight gain
Cleft lip and feeding
CL only children rarely have problems feeding–only sometimes with latching on
Problems in feeding cleft palate are mostly due to
nasal reflux and failure to create intraoral pressure
Precautions for feeding CP infant
Selection of appropriate nipple and bottle Positioning of nipple and baby (upright) Follow a feeding schedule More frequent burping Nasal saline post-feed
Clinical signs/symptoms of airway involvement in feeding problems
Nasal flaring Inspiratory stridor Difficulty maintaining O2 saturations Gulping Liquid loss Choking/coughing
Clinical signs/symptoms of neurological impact
Hyper/hypotonicity
Lack of sucking effort
State control and organizational difficulties
Lack of basic oral attempt/interest
Medical red flags for feeding
Excessive vomiting Mucus in stool Constipation Eczema/rashes Chronic nasal congestion Excessive bloating/gas after feeds
Possible recommendations
Increased calorie formula Modifications in positioning Bottle changes Chin/cheek support Compression of nipple Frequent weight checks
Pediatric feeding interventions
Pacing
Boundaries (cheek/jaw support)
Positioning
Modifications
4 parameters of bottles
Pliability of nipple
shape of nipple
size of nipple
size of hole
Haberman special needs feeder
Two chambers separated by a disk to allow one-way flow
Adjustable flow nipple the parent can control
Pigeon
Larger; occludes cleft
Fast flowing nipple with one-way valve
Baby has to suck/extract independently
Mead-johnson nurser
Cheaper than other bottles
Longer, softer, cross-cut nipple
Can be used for thickened liquids
Parent controls flow by squeezing bottle
Feeding changes for surgery
Cup feeding only
Thickened formula after lip repair
Thickened formula, then purees after palate repair
Early artic errors/delays in cleft (0-3)
Deletion of final consonants, backing, syllable reduction
Less vocal play, later babbling with restricted inventory, more glottal productions and delayed/limited lexicon
