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Feeding Flashcards

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1
Q

What can cause dysphagia?

A

Medical Conditions: Cleft palate, GERD, Malformation- Pain
Food Allergies-food avoidance
Oral Motor Function-delay, abnormal, inefficient
Sensory Issues
Behavioral issues

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2
Q

What is dysphagia?

A

Difficulty at any stage of the swallow- oral to esophageal

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3
Q

When is a feeding eval needed?

A

If there is a known dx like cleft palate or prematurity.
If meal times take more than 30 minutes
If meals are stressful
If the child shows signs of respiratory distress
If the child has not gained weight

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4
Q

Eating requires…

A

Motor ability: CNS, pulmonary, gastro
- Posture/muscle tone
- Hand control

Oral motor function
- Lip closure
- Jaw movement
- Tongue controlswallowing

Sensory perception
- Hot/cold
- Full/empty
- Liquid/solid

Social and cognitive
- Not eating with mouth open

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5
Q

What are the prerequisites to feeding?

A

Oral integrity
- teeth
- ulcers
- arthritis
Intact cranial nerves
Reflexes
- swallow
Secondary
- bonding with parent
- desire

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6
Q

What is the oral cavity?

A

Hard and soft palate, tongue, fat pads of cheeks, upper and lower jaws, teeth, lips
Contain food, chewing or mastication, bolus formation

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7
Q

What is the pharynx?

A

Base of tongue, oropharynx, tendons, hyoid bone
Funnels food to esophagus, air and food share this space

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8
Q

What is the larynx?

A

Epiglottis and vocal cords
Valve to trachea that closes during swallow

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9
Q

What is the trachea?

A

Tube below larynx
Cartilage rings (chondromalcia)
Airway to lungs

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10
Q

What is the esophagus?

A

Thin and full of smooth muscles
Carries food from pharynx through the diaphragm and into the stomach

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11
Q

What are the steps of the swallowing process?

A
  1. Pre oral
  2. Oral prep
  3. Oral (oral transit)
  4. Pharyngeal
  5. Esophageal
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12
Q

Describe each step of the swallowing process.

A

Pre Oral: voluntary (OT)
- Smell sight, salivation

Oral Prep: voluntary (OT)
- Chew (rotary in adults)
- Form bolus

Oral (Oral Transit): voluntary (OT)
- Bolus is pushed against hard pallet, moved to back of throat

Pharyngeal: nonvoluntary (OT)
- Soft palate elevates to close the nasopharynx
- Breathing stops

Esophageal: nonvoluntary (not OT)
- Things return to normal
- Food passes to stomach

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13
Q

What must you have to drink from a cup?

A

Jaw stability, which usually presents at 24m

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14
Q

What are possible reasons for disorders with eating (not ED like in general)?

A

Disorders of appetite
- Anorexia
Anatomic disorders
- Oropharynx
- Esophagus
- Trachea
Disorders affecting suck, swallow, breath
- Usually, CNS
Coordination disorders
- CP
Infections/Inflammation
Behavior/Experience

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15
Q

What constitutes dysphagia?

A

neurological issue

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16
Q

What constitutes a feeding issue?

A

strong food/texture preference
hypersensitive olfactory
eating disorder (anorexia, bulimia)
positioning (head control, general strength, fatigue)

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17
Q

What is the toughest liquid to swallow?

A

water

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18
Q

Dysphagia symptoms in adults

A

They tell you!
Drooling
Decreased mastication (chewing)
Clearing throat
Choking
Nasal regurgitation
Residual food in oral cavity
Weight loss, dehydration, respiratory problems

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19
Q

What is aspiration?

A

The entrance of food into the larynx below the vocal cords

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20
Q

What is auditory aspiration?

A

coughing or choking

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21
Q

What is silent aspiration?

A

No swallow response
Pooling or wet sounds on auscultation
Change in voice
Change in patient color, vitals or decrease O2 level

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22
Q

What might you see in children who have oral hypersensitivity ?

A

Medical care:
- cavities
- OA in jaw

Tongue thrust
Bite reflex
Gag reflex
Poor jaw grading
Tongue retraction
Inadequate suck
Inadequate chew
Drooling

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23
Q

Motor impairments commonly seen with eating

A

Spasticity
Hypotonic
May not show up until solid food
Problems
- Head and neck control
- Jaw excursion
- Over or under active tongue
- Postural instability
- Hypotonic cheeks
- Elevation of shoulder (for neck support)
- Hypertonic bite
* Tonic bite
* Tongue thrust
* Lip retraction, pursing

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24
Q

Hypotonic feeding issues

Study These Flashcards
A

Poor head, neck and trunk stability
- Fall over
- Elevation of shoulders
- Hyperext of neck
Open mouth-drooling
Wide excursion
Difficulty grading
- Open or closed
Difficulty in mid ranges
- Not hard enough or wears self out
Loss of food
Tongue may be inactive
- Or extreme in range
Lips may not seal or be active
- Spoon drag
Cheeks
- Packing

25
What is paralytic dysphagia?
Lower motor neuron Weakness or paralysis of oral structures Swallowing reflex may be absent Common in: - CVA, TBI and Developmental disorders (MR)
26
What is pseudobulbar dysphagia?
Upper motor neuron Hyper or hypotonic oral structures More common in pediatric population Common in: - CVA, CP, TBI
27
What is mechanical dysphagia?
Loss of structure or weakness due to trauma or surgery Common in: - Cancer, MVA
28
Types of feeds with PEG or NG tubes
Bolus feeding - pts develop hunger - feed at meal time Drip/continuous There is no better or worse way. ICU and inpatient are typically on the continuous drip. If the family is going to take care of it after, they will typically use bolus feeding. Family/pt preference
29
Feeding assessments used
Electromyography: surface electrodes Barium swallow test Videofluoroscopic: Moving x ray Fiberoptic laryngoscope: Camera is introduced Ultrasound: anterior throat Manometry: catheter is introduced to the esophagus to measure force, timing, and sequence to swallow
30
What should we assess with feeding?
1. Pt hx, dx, sx; nutritional source (NG, PEG, oral); NPO; respiration status 2. Cognitive, perceptual, and physical abilities - level of arousal, desire to feed, ability to position self, ability to follow directions 3. Oral abilities - ROM and strength or tongue, lips, and jaw; head control; vision; reflexes 4. Do a feeding trial - start with easy foods like yogurt
31
How do you feel for a swallow?
Index finger under chin Middle finger at base of tongue Ring finger over thyroid cartilage Small finger above jugular notch
32
Compare remedial vs compensatory approaches.
Remedial - rehabilitation, strengthening - LMN (paralytic) dysphagia - modifying to increase strength Compensatory - relearn, start over, education - UMN (pseudobulbar) dysphagia
33
Put these in the order of which you would introduce them to a patient: protein shake water diet coke coffee with cream black coffee
Protein shake Coffee with cream Diet coke Black coffee Water
34
Texture progression for typical kids
Pureed - baby food Mashed - potatoes, peas Chopped Full
35
Dysphagia diet for adults or kids
1. thick puree - pudding or apple sauce 2. soft chewables - soft fruit (banana), cooked veggie 3. drier chewable - bread, cookie 4. foods that require biting - meat 5. mixed textures - oatmeal with raisins
36
Fluid progression
1. None 2. spoon thick (commercial thicken) 3. texture of honey 4. nectar (pulp orange juice) 5. thin flavored fluids (coffee with cream, coke) 5. water
37
Dysphagia level I diet
Pureed Difficulty protecting airway - Crush injury, trachs Little or no jaw or tongue control Delayed swallow Homogenous food, no bumps or lumps, same consistency Moves slower to allow the swallow reflex to kick in Goal is for oral feeding, stepping stone, may not be enough for caloric intake alone
38
Dysphagia level II diet
Soft food Beginning rotary chew Some tongue control Minimally delayed swallow Mild to moderate problems Stick together Good bolus, not fall apart Provide good proprioceptive feedback
39
Dysphagia level III diet
Advanced diet Able to chew Able to form a bolus from different textures Minimal jaw or tongue issues Swallow can be mildly delayed but intact bilaterally Think things a kid can eat without supervision - rice, cooked veggies - no skins, tough or dry course food
40
Dysphagia level IV diet
regular diet
41
What's a half nelson?
CP feeding position we learned in peds Used to support the jaw, lips, and for head control
42
Handling techniques before feeding
Oral support - Stability - Control Tapping/stretching, vibration - to increase tone Rhythmic/firm/deep touch pressure, NUK -to decrease tone Good alignment Pressure to mid to front=retracted tongue will relax - mid to back = extended tongue will relaxed Rhythmic downward pressure to tongue (palm) may facilitate a suck Lateral movement can be inhibitory
43
Handling techniques during feeding
Oral support –not force - Under and around the lower jaw Downward pressure of spoon or nipple=suck Down and in=up and down tongue movt - Inhibit tongue thrust To increase tongue movt lateral- move spoon to side Food on the teeth promotes chewing Stay away from the posterior aspect of tongue - Gag
44
Head position for feeding
Chin tuck is best Upright to slight flexion is ok - Flexion reduces aspiration * Can effect breathing * Some kids like ext because they can breath better, puts them at risk for aspiration
45
How to initiate a swallow in pt with slow or delayed swallow
Frozen pacifier Popsicle Formula
46
How to improve transit with feeding
Handling of head and jaw Outside support Thickened liquids - Proprioception - Easier control Positioning
47
How to increase strength or tone with feeding
Tongue exercises, jaw exercises-increase ROM and strength Peanut butter, gum, tapping, vibration Chin tuck and turning toward affected side
48
How to work with hypersensitivity with feeding
manual input, introduction of textures
49
How to effect poor tongue control with feeding
exercises quick stretch
50
Compensatory strategies for weakness with feeding
Manipulate food Inspect after meals Place food on strong side Break meals up
51
Compensatory strategies for abnormal reflexes with feeding
Avoid provoking them Positioning Exaggerate opening and closing of mouth
52
Compensatory strategies for hyposensitivity with feeding
Temperature, flavors
53
Compensatory strategy for delayed swallow
chin tuck
54
How to impact feeding with reduced laryngeal elevation
shaker exercise nod head yes repeatedly
55
Ways to increase swallow
Chin tuck Effortful swallow Mendelsohn maneuver - Tongue pushes to roof of mouth-point adams apple up Neck rotation-usually toward affected side Supraglottic swallow-hold breath then swallow Estim to stimulate suprahyoid and thyrohyoid muscles Surgery
56
Types of nonoral feeding
nasogastric oralgastric gastronomy
57
Feeding with a tracheostomy
May need to occlude during feeding - talk to medical Chin tuck method
58
Structural problems that effect feeding
Cleft palate or cleft lip Micrognathia (small lower jaw) Downs Syndrome
59
Adaptive equipment used for feeding
Scoop dishes Adaptive nipples Adaptive spoons Adaptive cups Sporks Straws, sippy cups - one way straw Positioning equipment Electric or weighted feeders Modify the task - Drink soup through a straw - Eat with a spork - Change up the food or texture

Geriatrics (20 decks)

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