Functional feeding for the older child

Question 1

T or F. feeding behaviors of a child are driven by a combination of physical responses (i.e. motor and sensory development) and learned behaviors from family and environmental interaction

Answer 1

True

Question 2

normal muscle tone

Answer 2

normal level of tension or slight contraction of a resting muscle. in every resting muscle, there are always some muscle fibers that are contracting. this is a muscles tone

Question 3

what is the purpose of muscle tone?

Answer 3

stabilizes the position of our bodies (specifically joints and bones)

Question 4

what is the function of muscle tone?

Answer 4

makes voluntary contraction of a muscle (to close the jaw) easier and smoother since some of the muscle fibers are already taught

Question 5

what is muscle tone controlled by?

Answer 5

central nervous system cannot be changed by volitional control or improved by exercise

Question 6

what does muscle tone do for feeding?

Answer 6

orofacial muscle tone affects all aspects of feeding and swallowing.
-adequate muscle tone allows the oral and pharyngeal structures to function properly and generate sufficient strength and control for synchronous muscle contractions.

Question 7

T or F abnormal muscle tone negatively affects feeding and swallowing.

Answer 7

True

Question 8

what are the 2 types of abnormal muscle tone?

Answer 8

hypertonia

hypotonia

Question 9

what does hypo mean?

Answer 9

low or insufficient

Question 10

what does the term hypotonia mean?

Answer 10

low muscle tone

Question 11

explain hypotonia?

Answer 11

muscle is flaccid and appears weak

-muscle fibers are slow to react to stimuli and fatigue or relax before reaching maximal contraction

Question 12

hypotonia does what to a childs appearance?

Answer 12

makes them look droopy

-

Question 13

what are some common disorders that hypotonia is associated with

Answer 13

• down syndrome
• prader wili
• shaken baby syndrome

Question 14

what does the term hypertonia mean?

Answer 14

high or increased muscle tone

Question 15

what does hyper mean?

Answer 15

high or excessive

Question 16

what happens to the muscles when they are hypertonic?

Answer 16

muscles appear excessively contracted held taught, tense

Question 17

what are some common disorders associated with hypertonia?

Answer 17

• cerebral palsy (caused by bleeding on the brain)
• CNS infections (meningitis)
• infantile stroke
• anoxic event

Question 18

what are the extrinsic muscles of the tongue?

Answer 18

styloglossus, genioglossus, hyoglossus, palatoglossus

Question 19

what do the extrinsic tongue muscles do?

Answer 19

they stabilize posterior oral tongue and base of tongue in oropharyngeal cavity
-movers of the tongue
-

Question 20

What can happen to the tongue of children with poor trunk control?

Answer 20

children with poor trunk control or respiratory difficulties will contract these extrinsic tongue muscles to help stabilize the head and neck
-this results in tongue retraction and shortening of tongue musculature–>difficulty using tongue in a functional way

Question 21

what are body support and stability provided by: 4

Answer 21

• core strength
• base of support
• head and neck control
• body positioning

Question 22

what does core strength do?

Answer 22

stabilizes body for good trunk control

Question 23

what does base of support help with?

Answer 23

when hips are in neutral position

• -body structures line up
• -back is straighter
• -shoulders are up and aligned
• -rib cage and respiratory system are open

Question 24

what are problems associated with bad base of support?

Answer 24

poor base of support may result in jaw and tongue tensing to help stabilize head and neck
–tongue and jaw do not have free movement in oral motor function

Question 25

what does good head and neck control help with?

Answer 25

- when neck is aligned and head is in midline - -jaw is freer to function independently - -airway is better protected - ----posture for head, function for breathing, function for swallowing

Question 26

what are the neck muscles responsible for?

Answer 26

- -posture for head - -function for breathing - -function for swallowing

Question 27

what is the best positioning for body?

Answer 27

90 degrees for all | ankles knees and hip flexion

Question 28

T or F. the body should have contact with surface (either chair or held by adult)

Answer 28

True

Question 29

sensory processing of stimuli is a huge factor in what?

Answer 29

a child's acceptance, enjoyment, success and safety dyring feeding

Question 30

the brain must do what things with sensory input?

Answer 30

receive control interpret

Question 31

The brain must: receive sensory input from the body

Answer 31

yes

Question 32

the brain must control sensory input by doing what?

Answer 32

limiting the amount of info that is being processed (tune out extraneous stimuli)

Question 33

during feeding the brain controls sensory info:

Answer 33

the brain processes and filters out background or extra stimuli in order to prevent sensory overload

Question 34

T or F. the brain must interpret sensory input=pain, pleasure, noxious touch soothing, alerting

Answer 34

True

Question 35

During feeding the brain interprets sensory info:

Answer 35

interprets taste and other stimuli as good or bad - -based on that the brain decides whether or not to allow that stimuli again or to respond negatively to it.. - -it also contributes to normal oral-motor manipulation of that stimuli or bolus

Question 36

explain sensory development in infants

Answer 36

- mouth is a very sophisticated tactile system - ability to accept and reflexively respond to tactile stim to the cheeks, lips, gums, and tongue is critical for their survival (nutrition and airway protection) - negative stimulation early in life significantly affects development of a normal oral sensorium (i.e intubation, feeding tubes, surgeries, force feedings)

Question 37

sensory development with older children=

Answer 37

initially uses mouths more than any other system to explore the world - pleasure received helps child to progress through the food hierarchy - exploration of a variety or oral movements also contributes to speech abilities

Question 38

if you cannot breathe can you eat/

Answer 38

no

Question 39

what is the body's firs priority?

Answer 39

breathing maintaining 02 levels

Question 40

the respiratory system and what other system share a portion of the same tract?

Answer 40

digestive system oropharynx | --resp system will always win!

Question 41

T or F many children who have respiratory problems will also have feeding difficulties...

Answer 41

true

Question 42

why are infants obligate nose breathers?

Answer 42

bc the velum rests up against the epiglottis for extra protection of the airway

Question 43

T or F. ability to breathe adequately and with ease can be greatly affected by body position

Answer 43

True

Question 44

what position is the best for breathing?

Answer 44

sidelying---allows chest and belly to fall to gravity

Question 45

what is one of the first things you assess when assessing feeding?

Answer 45

respiratory system | --breath support, rib cage mobility, and rate/ease of breathing is always one of the first skilld you assess

Question 46

how many breaths need to happen for a safe swallow?

Answer 46

<60 breaths per minute

Question 47

Always remember that GI problems can cause the infant to have disordered feeding

Answer 47

yeppp

Question 48

what are the common abnormalities (craniofacial) that affect feeding?

Answer 48

- facial paralysis/paresis - cleft lip - cleft palate - macroglossia - micrognathia - glossoptosis

Question 49

what problems can arise from facial paralysis/paresis?

Answer 49

oral seal--anterior loss of bolus - -can help with pushing cheeks extra support - -will affect chewing sublingual residue not a great rotary pattern due to lack of structure

Question 50

what is macroglossia?

Answer 50

big tongue - -down syndrome - -can cause breathing problems - -problems with bot retraction - ---does the tongue block airway - --can they use their tongue functionally how does it affect tongue elevation/retraction etc..

Question 51

what is micrognathia? rectrognathia

Answer 51

small jaw/retracted jaw - -pierre robin - -bc jaw is so far back the tongue can block airway - -tongue is normal - --most important question can they maintain a Peyton airway

Question 52

feeding experiences can be conditioned or learned?

Answer 52

- -pleasure sensory--child will want to accept bolus again negative they will not - -if child aspirates often they will not want to eat --praise is given when a child tries something new --this will become a learned behavior -can learn bad behaviors too

Question 53

food allergies and intolerance can lead to what 6 things?

Answer 53

1. potentially negative experiences if food causes gi pain/discomfort 2. diet may be severely limited with multiple food allergies 3. often leads to food refusal and food aversion 4. always ask about current / former food allergies 5. infants under 18 mos: ask probe questions about how they tolerate different foods - allergy weight rule ????