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Pediatric Dysphagia > Test 1 > Flashcards

Test 1 Flashcards

1
Q

How many chromosomes are in a zygote?

A

46

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2
Q

What is the progression of an embryo’s development?

A

zygote, embryonic period, fetal period

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3
Q

What happens in the embryonic period?

A

(wk 1-8)
wk 3: ectoderm, mesoderm, endoderm formed
6 branchial arches
all major systems developing

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4
Q

What is the fetal period?

A

wk 9 - birth

rabid body growth, slower head growth

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5
Q

Which system is the first one functioning?

A

cardiovascular - heart circulates blood at 21-22 days

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6
Q

When does the central nervous system begin functioning?

A

wk 3

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7
Q

What do we know about the respiratory system in embryos?

A

tracheo-esophageal septum

lungs non-functional during prenatal life

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8
Q

When does the esophagus reach full length?

A

by wk 7

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9
Q

When are the 6 branchial arches formed?

A

4 visible by wk 4

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10
Q

6 branchial arches give rise to formation of?

A

face, neck, nasal cavities, mouth, larynx, pharynx, head & neck muscles, cranial nerves

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11
Q

What is a major embryologic cause of swallowing/feeding problems?

A

branchial arch anomalies - can result in CNS/structural damage and head/neck malformations

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12
Q

What happens during wks 9-12 of the fetal period?

A

head makes up one half the length of the fetus
facial features, limbs, feet, hands present
palatal and nasal septum fusion
taste buds present (around wk7)
CNS is functioning

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13
Q

What happens during wks 13-16 of the fetal period?

A 
body length doubles
sex organs form
ossification of skeleton
eyes/ears move closer to normal position
pharyngeal swallow begins (as early as 12 wks)
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14
Q

What happens during weeks 17-20 of the fetal period?

A

pharyngeal swallow strengthens
fetus swallows and digests up to 50% amniotic fluid
suckling begins
alpha fetal protein testing

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15
Q

Weeks 21-25 of fetal period?

A

substantial weight gain
upper and lower respiratory development
lungs begins to produce surfactant
chance of survival ~24+ weeks with NICU resources @immediate delivery

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16
Q

What happens during wks 26-29 of the fetal period?

A

primitive reflexes begin in utero
possible that lungs might be functional at 29 weeks
CNS continues to mature: regulates body temp, improves rhythmic breathing

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17
Q

What happens during weeks 30-33 of the fetal period?

A

33+ weeks usually okay to deliver at local hospital
skin thickens, body lengthens
breathing patterns continue
premature infant still developing coordinated suck/swallow/breathe

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18
Q

Weeks 34 - 36 fetal period?

A

cusp of premature, might be able to feed orally, breathing okay
body fat ~8%

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19
Q

weeks 37-40 fetal period?

A

normal gestation, expected delivery
swallowing 450 mL a day
body fat ~16%
7 lbs, 19 in average in weight and length

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20
Q

what are the stages of alertness?

A 
deep sleep
light sleep
dozing/drowsy
quiet alert
active alert
alert agitated
crying
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21
Q

What is “shut down”?

A

rapid transition from awake to asleep

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22
Q

How are newborn tongues from adult?

A

newborn tongue fills oral cavity; makes contact with lateral gum and palate
from 2-4 posterior 1/3 of tongue descends into pharynx; movement posterior/inferior – descent complete by 9 years

23
Q

How does the newborn oral cavity differ from the adult?

A

newborn plate short, broad, slight arch; 5-6 folds for gripping
18-24 months soft palate lengths to 4-5 years, thickens to 14-16 yrs

24
Q

What are fat pads?

A

fatty tissue located in masseter muscle; reduces size of oral cavity; functions to provide sucking stability
tissue proportion reduces over time

25
How do newborn mandibles differ from adult?
newborn mandible is not fused; short, broad rami with 140d angle to body; body is longer than rami mandibular halves fuse at approx 2 years by adulthood rami angle 110-120d; body and rami are equal in length
26
How do newborn larynxes differ from adult?
newborn's is small (1/3 size of adult) epiglottis larger, contact with soft palate pyriform sinuses are elevated and smaller hyoid/thyroid space is small (if any) elevated larynx and hyoid as tongue descends (2-4 years) so does larynx similar to adult by 6 yrs
27
How do newborn pharynxes differ from adult?
nasal potion of pharynx gradual curve down approx 5 years, oblique angle during puberty forms 90 degree angle after posterior 1/3 tongue descends, tongue makes up anterior wall of pharynx
28
How does the newborn trachea differ from adult?
@C6 forever infant trachea tilts diagonally posteriorly toddler trachea has more vertical orientation
29
How does the newborn esophagus differ from adult?
at birth, begins C4-C6, ends at C9 | adults: begins/ends 1-2 vert. higher
30
What is the difference between suckling and sucking?
suckling: thru 6 mos, loose lip seal, backward forward sucking: at 6 mos, stronger lip closure, vertical tongue movements, reduced jaw movements
31
What is the normal respiratory pattern in feeding?
apneic moment swallow on exhalation (most of the time) trigger point for pharyngeal swallow
32
What does resting BPM depend on?
stage of alertness, age
33
belly breathing is abnormal after what age?
6 mos
34
What are some common respiratory issues?
``` incoordination of suck/swallow/breathe (abnormal after 1 month) pulmonary disease obstructive issues allergies asthma history of intubation recurrent respiratory infection ```
35
What are some common pulmonary diseases/causes
cystic fibrosis mother with myasthenia gravis werdnig hoffman premature birth
36
What are the primitive reflexes?
Gag, phasic bite, transverse tongue, tongue protrusion, rooting, suckling, grasp, babkin, palmomental, moro (startle), ATNR
37
Are feeding problems caused by the environment?
NO!
38
Eating is instinctive for how long?
1 month
39
Eating is reflexive at what age?
1-6 months
40
after six months, eating is....
a learned behavior
41
What are some clinical assessment goals
``` presence absence of a feeding problem possible etiologies nature and severity baseline of behaviors introduce therapeutic modifications trial feeding determine need for instrumental assessment ```
42
What are the key components of a clinical assessment?
Pt history feeding and swallowing history physical exam observation of feeding
43
What do we need to assess as part of an observation of feeding/swallowing?
``` oral stage typical performance volume of intake/time outward signs of symptoms and aspiration body behavior ```
44
What do we need to assess as part of a physical examination?
``` behavior, state of alertness before, during, and after feeding airway status general postural control and tone primitive reflexes cognitive level of functioning oral motor/cranial nerve evaluation oral structure and function ```
45
What do we want to try and observe in a clinical feeding?
``` bottle or breast cup drinking straw drinking spoon feeding biting and chewing soft solid biting and chewing hard solid ```
46
The developmental progression in learning to eat various food textures requires advancing WHAT kinds of functioning/processing?
oral-motor functioning and sensory processing
47
How much should children consume at eat age?
birth-1 month: 2-6 oz 3 months: 7-8 oz 5 months: 9-10 oz 7 months: 11 oz+
48
Important clinical questions:
what are they doing? what should they be doing? WHY are they doing what they're doing?
49
What are the textures of the food continuum?
mashed table foods --> hard munchables (practice) --> meltable hard solids --> soft cubes --> soft mechanical
50
What are some reasons why children won't eat?
``` Pain malaise/discomfort, fatigue immature motor, oral-motor, and/or swallow skills sensory processing problems learning/behavior nutritional child/parent/environmental factors ```
51
What are some possible interventions?
individual tx group tx pediatric oral feeding clinic follow up consultation with referral to school or community program referral for additional med specialty, lab, or developmental evaluation MBS (if indicated) nutrition follow-up
52
When does the sensorimotor stage start?
24 months ish
53
When does hand to mouth play start?
4-6 months
54
What might children with low muscle tone do?
``` slouch while sitting prop while sitting join lock/fix slide out from underneath table/trays prefer to stand to eat like to walk around and eat appear stronger than they are because of joint locking ```

Pediatric Dysphagia (1 decks)

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