Guest: Pediatric Feeding and Swallowing Flashcards
Medical and physiological factors of PFD
- Neurological impairment
- Neurodevelopmental impairment
- Oropharyngeal and/or laryngeal impairment
- GI Tract dysfunction
- Pulmonary System
- Cardiac System
- Musculoskeletal System
Nutritional factors of PFD
- Restricted quality, quantity and/or variety (dysphagia, selective)
- Increased risk for malnutrition, overnutrition, micronutrient deficiency
- Risk of dehydration
- Adversely impacting growth, development and health
Development and skill factors with PFD
Altered feeding experiences due to illness, injury, developmental delay, specific sensory or oral motor impairments may lead to impaired feeding skills
* sensory (narrow take on foods, like consistency and know what to expect)
* oral-motor skill & pharyngeal function
* delayed feeding skills (typically matches what is going on with the rest of the body)
Behavioural & psychosocial factors of PFD
Child
* Anxiety, disordered thinking, dysregulated temperament
* Learned feeding aversion
* Disruptive mealtime behavior
* Picky Eating
* Grazing
Caregiver
* Force feeding
* Misinterpreting hunger/fullness cues
* Only offering preferred foods
* Mismatch of child’s skill with foods caregiver provides
* Stress & Distress
Environment
* Using distractions
* Feeding when asleep
* Inconsistent mealtime schedule
Interdisciplinary Approach to Feeding
Interdisciplinary team provides a comprehensive assessment
* Registered Dietitian (RD)
* Occupational Therapist (OT)
* Speech Language Pathologist (SLP)
* Psychologist (Psych)
* Social Work (SW)
Clinical Interview: How to talk to
caregivers about their concerns
- Does your child cough or choke with food or drinks? If yes, then how often? with certain foods or textures? only fluids)
- Does your child eat a good variety of foods? Do you feel like they eat enough food?
- Does your child ever refuse to eat? How often? What foods?
- Does your child need distractions to help them eat?
- Does your child have a way to communicate that they are hungry, thirsty or full?
- What do mealtimes look like for your family?
Red flags that might indicate a PFD (dysphagia)
- Coughing with intake
- Choking episodes
- History of pneumonia or chest infection
- Difficulty with texture progression
Assessment considerations for dysphagia
- VFSS
- Positioning (ideally sitting, well supported, midline position, feet on the ground)
- Pacing (how fast fluid going into mouth; different bottles, nipple flow rate, thickening agent)
- Sustainability of feeding schedule
- Safe texture and fluid consistency
- Are they able to meet growth and nutrition/hydration
- Consider alternative to oral feeds
- Oral hygiene practices
How can bottle feeding be adjusted?
- flow rate
- positioning
- thickening
T.S. case study
Notes
Red flags that might indicate picky/selective eating
- dropping foods
- Limited food repertoire (<20 foods, may be missing a food group)
- Growth concerns (overweight/under weight)
- Hydration concern
- Micronutrient deficiencies or anemia
- Sensory concerns
- Behaviour & mealtime dynamics
- Need to use distractions
considerations for picky/selective eating
- Rule out any oral motor/functional reasons for food avoidance
- Are they avoiding certain food groups/food textures?
- Assess growth and nutrition
- Do they need supplements and what form might they best tolerate?
- Target foods/food groups to work towards
- Assess family’s capacity/motivation to change
- Setting realistic goals/strategies
Picky eating strategies
- Food exposure
- Mealtime routines
- Sitting at the table
- Reducing mealtime distractions
- Parent & child roles
Picky eating case study
Notes
