Week 12 Flashcards
It is report that ___ - ___% of typically developing children demonstrate feeding and swallowing problems
25-45%
Prevalence is est to be __-__% of children with developmental disorders
30-80%
Why is the prevalence of pediatric dysphagia increasing?
Improved survival rates of children born prematurely, with low birth weight, and with complex medical conditions
Who is on the pediatric dysphagia team?
Parents: primary caregiver and descision maker for child
Primary physician: medical leader
SLP: team co-leader (with other medical specialties), conducts feeding and swallowing evaluation, VFSS (with radiologist), FEES (with ENT)
Nurse: reviews medical records and parent info, coordinate follow-up, changes feeding tubes (daily care)
Dietitian: assess past and current diets, determines nutritional needs, monitors nutrition status
Psychologist: identifies and treats psychological and behavioral feeding problems, guides parents for behavioral modifications
OT: evaluates and treats problems related to posture, tone and sensory issues
Social worker: assists with access to community resources, advocates for the child
ENT Pulmonologist Radiologist PT Lactation consultant
What are the anatomical differences in pediatrics?
Infant’s oral cavity is smaller
larynx is elevated (descends over first 4 years of life)
Hyoid is elevated and in a more anterior position
Longer and flatter velum
Child can suck and swallow at the same time
What are children with feeding and swallowing disorders at risk for?
Dehydration or poor nutrition
Aspiration or penetration
Pnemonia or repeated upper respiratory infections that can lead to chronic lung disease
Embarrassment or isolation in social situations involving eating
What are signs/symptoms of feeding and swallowing disorders in children?
Arching or stiffening of the body during feeding
Irritability or lack of alertness during feeding
Refusing food/liquid
Failure to accept different textures of food
Long feeding times (more than 30 min)
Difficulty chewing
Difficulty breastfeeding
Coughing or gagging during meals
Excessive drooling or food/liquid coming out the mouth or nose
Difficulty coordinating breathing with eating/drinking (should have a 1:1: sucking/swallow ratio)
Gurgly, hoarse, or breathy voice quality
Frequently spitting up or vomiting
Recurring pneumonia or resp. infections
Less than normal weight gain or growth
What are potential contraindications for clinical assessment for pediatrics?
No clinical Ax has been performed (need hypothesis first)
Infant has not had oral feeding experience
Infant refuses oral intake
No Hx of chest illness
Child is unlikely to cooperate
Infant/child is unlikely to medically tolerate the procedure
Sensory preference issues
Esophageal or GI symptoms
Performing a repeat exam w/o clinical evidence of chage
Findings won’t change management
What are the advantages and disadvantages of FEES in pediatric?
Adv.
- Direct visualization of the structures
- Use of real foods
- Repetitive use
- Portable
- No radiation
Disadv.
- Minimally invasive
- Poorly tolerated (age-dependent)
- No oral stage view, limited pharyngeal view
What are the steps of CSE for pediatric dysphagia?
- Data collection
- Nutritional screening, feeding Hx, and developmental milestones- parent/caregiver report
- Physical assessment- Bx, Development, physical apperance
- Oral sensory-motor and feeding skills assessment - reflexes
When should the rooting reflex disappear?
3-5 mo
When should the suck reflex disappear?
6 mo
When should the tongue protrusion reflex disappear?
4 mo
When should the bite reflex disappear?
3-5 mo
Gag reflex is
lifelong but not present in all
