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Flashcards in Abnormal Sucking Deck (21)
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1
Q

High Suck/Swallow Ratio

A
  • > 2 sucks/swallow
  • inefficient, feed > 30 min. and get fatigued
  • risk for aspiration because spillage
  • weak suck = less than normal bolus size

Modifications:

  • change to faster flow
  • resistive sucking to make suck stronger (slight pull on bottle while ground self on baby)
  • cheek support (for weak suck)
2
Q

Prolonged Sucking/Feeding-Induced Apnea

A
  • long suck/swallow bursts w/o stopping to breathe
  • “difficulty pacing” sucking and swallowing w/ breathing
  • more @ beg. of feeding
  • primary causes: immaturity (not ready for PO), respiratory

Modifications:

  • pacing (stop after 5 sucks/5 seconds)
  • decrease flow rate of nipple
3
Q

External Pacing

A
  • forcing into immature sucking pattern

1) tip bottle down
2) roll over to gum line (breaks neuro pattern)
3) remove bottle

4
Q

Short Sucking Bursts

A

-

5
Q

Disorganized Sucking

A
  • uneven and disorganized burst/pause pattern and S:S:B pattern
  • coughing and choking frequently
  • *high risk for aspiration b/c of oral discoordination
  • possible causes: general neurologic deficits, mild respiratory problems, incompatible nipple flow rate

Modifications:

  • external pacing
  • decrease flow rate of nipple
  • sidelying position
  • swaddle, provide borders
  • modify external stimulation
  • provide rhythmic rocking
6
Q

Anterior loss of liquid during sucking

A
  • consider a slower flowing nipple

- cheek support

7
Q

Poor State Regulation

A
  • modify external environment
  • swaddle, provide borders
  • positioning
  • NNS
  • rhythmical movement
8
Q

S/S of Aspiration & Referral for MBSS

A
  • coughing/choking (rarely in infants under 1 month)
  • wet breath sounds
  • “crackles” during exhalation
  • throat clearing
  • stressful facial expression
  • pulling back of head & arching into extension, but infant may still stay latched & be sucking
  • pulling off nipple, w/ possible head turning or crying/fussing
  • color changes around lips or face
  • rapid breathing (tachypnea)
  • decreased O2 saturation
  • frequent sneezing
  • constant low grade fevers
  • URI/pneumonia
  • red flag: frequent need for nebulizer or other pulmonary treatments
9
Q

Rooting Reflex

A

elicited: when oral area is touched, turn head in direction of touch and vigorously open mouth
purpose: allows infant to locate source of food
integrated: by 3-4 months

10
Q

Sucking Reflex

A

elicited: light touch to lips or tongue from nipple or finger initiates sucking response
purpose: insures infant will obtain nourishment
integrated: by 3-6 months *an infant younger than 3-4 months w/ strong sucking reflex cannot always cease sucking on nipple when overwhelmed

11
Q

Gag Reflex

A

elicited: infants- mid-tongue area; older baby/adult- posterior tongue or pharyngeal wall area
purpose: to protect the person from ingesting items that are too large for the digestive tract or protect the airway from blockage *if not present in infants, doesn’t necessarily mean shouldn’t suck liquids
integrated: present through adulthood

12
Q

Tongue Thrust Reflex

A

elicited: when contact made to infant’s tongue or intraoral cavity
purpose: protective response that prevents anything other than nipple in infant’s mouth
integrated: by 4-6 months

13
Q

Transverse Tongue Reflex

A

elicited: by touching/stroking the lateral borders of the tongue, causes tongue to lateralize to direction of touch, should be equal bilaterally
purpose: aids in development of lateral tongue movement during eating of solids
integrated: under volitional control by 6-8 months

14
Q

Phasic Bite Reflex

A

elicited: rapid, rhythmical up and down movement of the jaw for a bite-and-release pattern (no lateral movement)
purpose: aids in development of chewing
integrate: by 7-8 months (to a more mature biting pattern)

15
Q

Neurodevelopment Progression of Sucking Response

A
  • 15-18 wks: sucking seen in utero
  • 28 wks: sucking seen in extrauterine environment (disorganized & random w/ no coordination of breathing)
  • 32 wks: beginning to see S:S:B coordination (inconsistent & random)
  • 34-35 wks: established coordinated sucking & breathing pattern
  • intro of oral feedings typically by 32-34 wks.
16
Q

Components of Sucking

A
  • suction (- pressure)= jaw/tongue depresses, creating negative space which draws milk out of nipple
  • compression (+ pressure)= tongue pushes against nipple; increased compression on breast vs. bottle
  • burst= S:S:B (1-2:1:1)
  • pause= still latched, just breathing
17
Q

Mature Sucking Pattern (NS) - Normal

A
  • 10-30 sucking cycles per burst
  • continuous sucking burst
  • S:S:B (1-2:1:1)
  • “catch up” breaths during pause period
18
Q

Immature Sucking Pattern (NS) - Normal

A
  • 3-5 suck:swallows/burst
  • respirations only during pause periods (equal duration as suck/swallow burst)
  • *normal sucking pattern for pre-term infants
19
Q

NNS - Normal

A
  • purpose=state regulation, satisfy sucking desire, exploration
  • rhythm= repetitive pattern of equal bursts & pauses
  • *rate= 2x as fast as NS (2 sucks/second)
  • suck: swallow = 6-8:1
  • NOTE: can use NNS as therapy tool

*sign baby is neurologically intact: sucking rate change from NNS to NS

20
Q

Guidelines for PO Readiness

A

•32-34 weeks GA
•gaining weight w/ tube feeding

21
Q

Differences in Anatomy

A
  • sucking pads (cheeks)
  • larger tongue (relative to oral cavity)
  • smaller jaw (relative to oral cavity)
  • velum & epiglottis touching til ~ 6 mos. (nose breathers, valve for airway protection)
  • epiglottis shorter, narrower, softer, 45’ angle/horizontal (nose breathers, valve for airway protection)
  • larger head (compared to body)
  • weak head & neck muscles
  • larynx & hyoid bone more anterior & higher (airway protection, little laryngeal elevation to swallow)
  • swallow reflex at valleculae (precise timing & speed of swallow-shorter pharynx, swallow triggered @ lower level)