Class #4 Normal Swallowing in Infants

Question 1

Definitions unique to pediatrics

Ankyloglossia:

Apnea:

Atelectasis:

Answer 1

short frenum

stopping of breath

alveoli in lungs don’t expand or collapse

Question 2

Atresia:

Atresia choanae:

Answer 2

absence of normal opening

posterior nasal cavity not open

Question 3

Bradycardia:

Bronchopulmonary dysplasia:

Answer 3

drop in heart rate below 90 bpm

chronic lung disorder seen in neonates- requires ventilator

Question 4

Choelstatic jaundice:

Cyanotic:

Answer 4

caused by bile in liver

bluish color due to lack of oxygen

Question 5

Embryogensis:

Gavage feedings:

Answer 5

development of embryo

feeding through tube

Question 6

Hypoplasia:

Mandibular hypoplasia:

Answer 6

incomplete development of tissue or organ

incomplete development of mandible

Question 7

Microcephaly:

Micrognathia:

Answer 7

small head

small mandible

Question 8

Moebius sequence:

Neonate:

Answer 8

sequence of events in utero, damage to CN and face

newborn

Question 9

Phenyldetonuria (PKU):

Pierre Robin Syndrome:

Answer 9

metabolic disorder at birth

symptom cluster: small mandible, tongue, clefts of hard palate

Question 10

Spina bifida:

Subglottic stenosis:

Answer 10

defect in spinal column

narrowing or trachea

Question 11

Tachycardia:

Tachynpea:

Answer 11

elevated heart rate

elevated level of breathing

Question 12

Toxemia:

Tracheomalacia:

Answer 12

toxic products in blood

softening of tracheal cartilages

Question 13

Transitional feeding:

Answer 13

stage of eating from liquid to solid

Question 14

Embryonic Development

____ stages of development

Embryonic Period: _______

Fetal period-_________

Fetus viable after ___ weeks

After _________can survive with medical support

______week crucial to _____ and ______ development

(cranial nerves formed _________)

Answer 14

23

end of 8th week

9 weeks to birth

23

25-29th week

4th-8th

neural and organ development

5th-6th week

Question 15

Swallowing Development

Early in 4th Week: _________ develops

Non-nutrative sucking- __________, seen in “premies” at ____weeks

12th-13th week- ________

Answer 15

Pharyngeal apparatus

11th-12th weeks; 27-28

swallows amniotic fluid

Question 16

Rooting reflex by ______

Trigeminal nerve, taste buds- ________

Smell by _____

Answer 16

32 weeks

12-13 weeks

28-29 weeks

Question 17

Birth- learns ___________

Stable pattern by _______ weeks (necessary for breast or bottle feeding)

Answer 17

suck-swallow/breathe patterns

34-36

Question 18

Premature Infants

2 major prerequisites:

1.
2.

Arvedson says….

Answer 18

1. Strong, rhythmic non-nutrative suck (2 per second) [Sucking air, thumb, pacifier, etc)
2. Stable airway

most achieve oral feeding at 34-37 weeks, some strong babies at 32 weeks.

Question 19

Normal Anatomy

1.
2.
3.
4.
5.
6.
7.

Answer 19

1. Hyoid is high in the neck
2. Gentle curve in pharynx
3. Larynx more superior and anterior
4. Tongue relatively larger-fills oral cavity
5. Sucking pads stabilize cheeks
6. Small mandible makes tongue seem large
7. Nasal breathers

Question 20

In first years

Breathe through ________

_________ disappear

_____ elongates

_______ increases

Angle changes between ________

Answer 20

mouth and nose

Sucking pads “fat pads/cheeks”- help stabilize the nipple

Neck

Laryngeal vestibule

naso- and oro-pharynx

Question 21

Developmental Milestones

Sucking vs. suckling:
a)
b)
c)

Answer 21

a) Initially suckle-, 2nd-3rd trimester
b) Backward/forward motion
c) Lips are loose

Question 22

Develop sucking pattern -____________

a)
b)

Answer 22

6-9 months old

a) Tongue moves up and down
b) More organized expression of milk

Question 23

Development of functional oral motor, swallowing, & respiration

Answer 23

Milestones:

Textbook Table 3-1;

The Source (pg. 19-24) and

Arvedson, (pg. 378)

Question 24

Nutrative vs. non-nutrative suckling -

a)
b)
c)

Answer 24

sucking air or fist

a) More repetitive
b) 6 per second
c) 6-8 per swallow

Question 25

Nutrative- a) b) c)

Answer 25

bottle or nipple a) Initially a long burst of sucks changing to more intermittent b) One per second c) Young infants: 1:1 suck to swallow; older 2-3 sucks per swallow

Question 26

Infant Swallowing Reflexes ``` 1. 2. 3. 4. 5. 6. ```

Answer 26

1. Gag 2. Phasic bite: 3. Tongue protrusion 4. Rooting: searching for food 5. Suckling 6. swallowing

Question 27

Apgar Scores __ skills Score ____ Interpreted as: Poor= Fair= Good=

Answer 27

4 0,1,2 ``` Poor= 0-3 Fair= 4-7 Good= 7-10 ```

Question 28

Early FeedingTransitional Feeding

Answer 28

See hand-outs from The Source

Question 29

Infant Oral reflexes present at term Gag Stimulus: CNs involved: Age of disappearance:

Answer 29

touch posterior tongue or pharynx IX, X persists

Question 30

Phasic bite Stimulus: CNs involved: Age of disappearance:

Answer 30

pressure on gums V 9-12 months

Question 31

Tongue protrusion Transverse Stimulus: CNs involved: Age of disappearance:

Answer 31

touch tongue or lips XII 4-6 months 6-9 months

Question 32

Rooting Stimulus: CNs involved: Age of disappearance:

Answer 32

touch corner of mouth V, VII, XI, XII 3-6 months

Question 33

Suckling Stimulus: CNs involved: Age of disappearance:

Answer 33

nipple in mouth or stroking top of tongue V, VII, IX, XII 6-12 months

Question 34

Swallowing Stimulus: CNs involved: Age of disappearance:

Answer 34

Bolus of food in pharynx V, VII, IX, X, XII Perisists

Question 35

Apgar score at ___ and ___ minutes following birth ``` Attributes: 1. 2. 3. 4. 5. ```

Answer 35

1 and 5 1. Heart rate 2. Respiratory effort 3. Muscle tone 4. Irritability 5. Color

Question 36

``` States of alertness 1. 2. 3. 4. 5. 6. ```

Answer 36

1. Deep sleep: the baby is asleep and has a regular respiratory pattern. Eyes are closed with no eye movements. Responses to external stimuli are delayed. 2. Light sleep: Eyes are closed, though rapid eye movements may be noted beneath closed eye lids, eyes may open occasionally. Low level motor activity present. Irregular respiration. 3. Drowsy or semi-dozing: Infant may look dazed and unavailable. Activity level is variable. 4. Quiet alert: Infant is strongly focused on a stimulus. There is a bright almost gazed look. Motor activity is minimal. 5. Active alert: Considerable motor activity, including thrusting of extremities. Often responds to a stimuli with more movement. Brief fussy periods. 6. Crying: Crying intensely. Difficult to break through the crying with any stimulus.