Week 2 Flashcards
Feeding the cleft palate baby - growth in the well baby
Newborn at home:
- 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
Feeding w/cleft lip
-the breast can fill in the opening in the lip/alveolus and there should be no problem generating adequate suction/compression movements
Feed w/cleft lip AND palate
- 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
How often should a baby with an orofacial cleft have his/her weight checked?
Every 2-3 days after discharge - then weekly thereafter until adequate weight gain is achieved (usually ~4-5 weeks)
Cleft palate babies require a nipple/bottle that has what characteristics?
- Provides a controllable flow rate
- Energy efficient
What other problems do cleft palate kids have with feeding besides suction/compression?
- Nasal regurgitation
- Long feeding times
- Difficulty coordinating swallowing & breathing
How does a child w/a cleft palate compensate for bottle feeding?
Compress the nipple between the tongue and the intact portion of the palate
Cleft palate nursers
Have a soft, thin walled nipple that is easily compressible and allows milk to flow at a moderate pace
Mead Johnson Cleft Palate Nurser
- Common in hospitals
- Has a long, thin-walled nipple to direct milk PAST the cleft
- Can be squeezed in rhythm with infants’ suck/swallow
Haberman Feeder
- 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
Pigeon Cleft Palate Nurser
- 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
Positioning for feeding
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
What should you monitor while feeding the baby?
monitor the infant’s tolerance of liquid flow, respiratory status, and general comfort
Burping the baby
- 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
Feeding times
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
When would a VFSS be ordered?
If the infant is showing signs of excessive choking, sputtering, or discomfort when eating
What makes for optimal feeding?
A quiet, relaxed environment with a minimal amount of stimulation is optimal for effective & positive feeding experiences
Introducing soft foods
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)
Spoon feeding
- 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
Cup drinking
- 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)
Side feeding
Holding the baby horizontally with their face looking away from you - this helps suck / swallow with a cleft & large tongue (compared to oral cavity)
Feeding difficulties w/Pierre Robin Sequence
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)
Hemifacial Microsomia
Unilateral mandibular hypoplasia & facial weakness
Feeding concerns w/hemifacial microsomia
- 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
Factors influencing growth (5)
- Genetic factors (really big in craniofacial)
- Physical trauma
- Nutrition
- Social / emotional environment
- Cultural considerations / norms
Newborn infant - weight / length
Average weight: 7 1/2 lbs
Average length: 20 in
-Weight & length should be measured at every health maintenance visit
What is the first sign of poor nutrition?
Decreasing weight velocity
What is a later sign of malnutrition?
Decreasing length/height
First year of life feeding
-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
When does the full term infant double their birth weight? When does it triple?
The full term infant doubles their birth weight by ~5 months and triples it by ~12 months
When does subcutaneous tissue (fat) reach its peak?
Subcutaneous tissue reaches its peak by ~9 months
When does the anterior fontanel (soft spot) diminish?
The anterior fontanel diminishes after ~6 months and may become effectively closed by ~9-18 months
When does the posterior fontanel close?
The posterior fontanel is closed to palpation by ~4 months
When does the first tooth typically come in?
First tooth ~5-9 months
By age 1 y/o, how many teeth does the baby have?
Most have 6-8 teeth
*Overall, just know that they should be getting their teeth in the first year of life
How is an infant’s growth evaluated?
with a growth chart - any deviation from the norm may represent a variant of normal growth / abnormality
Gross motor development: Important milestones - 1-2 months
1-2 months: lift head off bed when prone, starts to push up on arms
Gross motor development: Important milestones - 3-4 months
3-4 months: Head up 90 degrees, pushes up on forearms, good head control, hands together in midline
Gross motor development: Important milestones - 4-5 months
4-5 months: rolls front to back
Gross motor development: Important milestones - 6-7 months
6-7 months: sits up unsupported, rolls back to front
Gross motor development: Important milestones - 9-10 months
9-10 months: pulls to stand, cruises
Gross motor development: Important milestones - 10-13 months
10-13 months: stands, walks
Gross motor development - Red flags
-Hypotonia / Hypertonia
Hypotonia
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
Hypertonia
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
Van der Woude Syndrome (VWS)
-Autosomal dominant - 1 in 100,000 - 1-2% have cleft -lower lip pits -polythelia (extra nipple)
Stickler Syndrome
-Autosomal dominant / recessive - 1 in 7,500-9,500 - lack of collagen in fetal development
Cornelia de Lange Syndrome (CdLS)
Synophyrs (unibrow) - carp mouth - webbed neck - intellectual disabilities
Beckwith Wiedmann Syndrome (BWS)
-Disorder of growth regulation - .07/1000 births -prone to cancer - Predisposition to embryonal tumors, exomphalos / umbilical hernia
