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Craniofacial Anomalies > Week 2 > Flashcards

Week 2 Flashcards

Feeding the cleft palate baby - growth in the well baby

1
Q

Newborn at home:

A
  • No set feeding schedule
  • Should feed 2-3 oz every 2-3 hours
  • Produce 5 wet diapers several BM /day
  • Initial weight loss during 1st few days
  • Bottle fed regain BW by 7days
  • Breast fed regain BW by 14days
  • Should gain ~1 oz / day
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2
Q

Feeding w/cleft lip

A

-the breast can fill in the opening in the lip/alveolus and there should be no problem generating adequate suction/compression movements

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3
Q

Feed w/cleft lip AND palate

A
  • Feeding & nutrition becomes an immediate concern - think about a straw with a hole in it
  • decreased/absent intra-oral pressure (suction) required to express milk
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4
Q

How often should a baby with an orofacial cleft have his/her weight checked?

A

Every 2-3 days after discharge - then weekly thereafter until adequate weight gain is achieved (usually ~4-5 weeks)

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5
Q

Cleft palate babies require a nipple/bottle that has what characteristics?

A
  • Provides a controllable flow rate

- Energy efficient

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6
Q

What other problems do cleft palate kids have with feeding besides suction/compression?

A
  • Nasal regurgitation
  • Long feeding times
  • Difficulty coordinating swallowing & breathing
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7
Q

How does a child w/a cleft palate compensate for bottle feeding?

A

Compress the nipple between the tongue and the intact portion of the palate

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8
Q

Cleft palate nursers

A

Have a soft, thin walled nipple that is easily compressible and allows milk to flow at a moderate pace

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9
Q

Mead Johnson Cleft Palate Nurser

A
  • Common in hospitals
  • Has a long, thin-walled nipple to direct milk PAST the cleft
  • Can be squeezed in rhythm with infants’ suck/swallow
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10
Q

Haberman Feeder

A
  • Most common
  • Has a squeezable test-tube shaped nipple w/a slit opening. Allows baby to control the flow rate through sucking OR the nipple itself may be pulse-squeezed along w/the infant’s sucking - has slow, medium, and fast flow settings
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11
Q

Pigeon Cleft Palate Nurser

A
  • Has a large bulbous nipple that is firm on the top and softer on the bottom to allow for tongue compression
  • Has a specially designed nipple that maximized the amount of milk that the infant gets through compressions
  • Bottom of the nipple is softer so they can use their tongue to depress it - top part is harder to stabilize against palate - “Y” shaped slit - has a valve that decreases the amount of air the baby takes in
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12
Q

Positioning for feeding

A

Position an infant in an upright or semi-upright position (80-90 degree angle) - reduces the amount of milk that may flow into the nose through the cleft, allowing for better coordination of swallowing & breathing
*Ensure that the nipple is ON TOP OF the infant’s tongue and not pushing it back

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13
Q

What should you monitor while feeding the baby?

A

monitor the infant’s tolerance of liquid flow, respiratory status, and general comfort

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14
Q

Burping the baby

A
  • Gas/burping is a problem b/c they tend to swallow more air as they feed then normal babies
  • May need burping every 1/2 oz or 5 minutes to avoid discomfort & spit up
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15
Q

Feeding times

A

Limit the infant’s feeding time to 30 minutes every 2-4 hours - decreases risk of tiring the infant and wasting calories on prolonged feeding episodes

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16
Q

When would a VFSS be ordered?

A

If the infant is showing signs of excessive choking, sputtering, or discomfort when eating

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17
Q

What makes for optimal feeding?

A

A quiet, relaxed environment with a minimal amount of stimulation is optimal for effective & positive feeding experiences

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18
Q

Introducing soft foods

A

Infants w/orofacial clefts should be ready for soft foods at the same time as other infants

  • Infant cereals ~4 mos & baby foods ~6 mos
  • Normal for them to sneeze/reflux food out of their nose/cleft
  • Foods get stuck in the cleft so limit sticky foods (limit spicy too)
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19
Q

Spoon feeding

A
  • Offer by shallow spoon while infant is upright
  • Spoon w/a shallow/flat bowl is easier for upper lip to remove food
  • Try to keep the spoon in there long enough for them to remove the food
  • Offer water after to rinse the area and make it easier for breathing
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20
Q

Cup drinking

A
  • Sippy cup ~9 mos w/goal of being off the bottle by ~12-15 mos.
  • Choose NON-spill proof (liquid flows more freely in non-spill proof)
  • Dr. Brown cup
  • Start thick (milkshake/nectar)
21
Q

Side feeding

A

Holding the baby horizontally with their face looking away from you - this helps suck / swallow with a cleft & large tongue (compared to oral cavity)

22
Q

Feeding difficulties w/Pierre Robin Sequence

A

Due to cleft palate & w/coordination of the suck-swallow-breath triad
-PRONE or elevated side lying positions help to minimize tendency for airway obstruction (NO ‘back to bed’ for these babies)

23
Q

Hemifacial Microsomia

A

Unilateral mandibular hypoplasia & facial weakness

24
Q

Feeding concerns w/hemifacial microsomia

A
  • May arise out of limitations to the ROM in the jaw, lips, and tongue on one side
  • Utilization of stronger side during feeding may establish a compensatory feeding pattern
25
Q

Factors influencing growth (5)

A
  • Genetic factors (really big in craniofacial)
  • Physical trauma
  • Nutrition
  • Social / emotional environment
  • Cultural considerations / norms
26
Q

Newborn infant - weight / length

A

Average weight: 7 1/2 lbs
Average length: 20 in
-Weight & length should be measured at every health maintenance visit

27
Q

What is the first sign of poor nutrition?

A

Decreasing weight velocity

28
Q

What is a later sign of malnutrition?

A

Decreasing length/height

29
Q

First year of life feeding

A

-Either formula / breast milk for the first year then at one year old, can change to whole milk but limit to 16-18 oz /day

30
Q

When does the full term infant double their birth weight? When does it triple?

A

The full term infant doubles their birth weight by ~5 months and triples it by ~12 months

31
Q

When does subcutaneous tissue (fat) reach its peak?

A

Subcutaneous tissue reaches its peak by ~9 months

32
Q

When does the anterior fontanel (soft spot) diminish?

A

The anterior fontanel diminishes after ~6 months and may become effectively closed by ~9-18 months

33
Q

When does the posterior fontanel close?

A

The posterior fontanel is closed to palpation by ~4 months

34
Q

When does the first tooth typically come in?

A

First tooth ~5-9 months

35
Q

By age 1 y/o, how many teeth does the baby have?

A

Most have 6-8 teeth

*Overall, just know that they should be getting their teeth in the first year of life

36
Q

How is an infant’s growth evaluated?

A

with a growth chart - any deviation from the norm may represent a variant of normal growth / abnormality

37
Q

Gross motor development: Important milestones - 1-2 months

A

1-2 months: lift head off bed when prone, starts to push up on arms

38
Q

Gross motor development: Important milestones - 3-4 months

A

3-4 months: Head up 90 degrees, pushes up on forearms, good head control, hands together in midline

39
Q

Gross motor development: Important milestones - 4-5 months

A

4-5 months: rolls front to back

40
Q

Gross motor development: Important milestones - 6-7 months

A

6-7 months: sits up unsupported, rolls back to front

41
Q

Gross motor development: Important milestones - 9-10 months

A

9-10 months: pulls to stand, cruises

42
Q

Gross motor development: Important milestones - 10-13 months

A

10-13 months: stands, walks

43
Q

Gross motor development - Red flags

A

-Hypotonia / Hypertonia

44
Q

Hypotonia

A

RED FLAG -inability to hold head up in sitting by 3-4 months -persistent head lag beyond 4-5 months -muscles everywhere are just kind of floppy

45
Q

Hypertonia

A

RED FLAG -rolling over or head control BEFORE 2 months -extension at hips, knees, and ankles when pulled vertical from lying down, esp. if bears weight on tip-toes -muscles are spastic & really rigid

46
Q

Van der Woude Syndrome (VWS)

A

-Autosomal dominant - 1 in 100,000 - 1-2% have cleft -lower lip pits -polythelia (extra nipple)

47
Q

Stickler Syndrome

A

-Autosomal dominant / recessive - 1 in 7,500-9,500 - lack of collagen in fetal development

48
Q

Cornelia de Lange Syndrome (CdLS)

A

Synophyrs (unibrow) - carp mouth - webbed neck - intellectual disabilities

49
Q

Beckwith Wiedmann Syndrome (BWS)

A

-Disorder of growth regulation - .07/1000 births -prone to cancer - Predisposition to embryonal tumors, exomphalos / umbilical hernia

Craniofacial Anomalies (4 decks)

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