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663 Pediatric Swallowing > Lecture Slides: Pediatric Swallowing > Flashcards

Lecture Slides: Pediatric Swallowing Flashcards

(58 cards)

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1
Q

newborn-infant tongue

A

smaller mandible so takes up more space in oral cavity; solely in oral cavity; posterior third of tongue descends at 2-4 years and completes by 9 years

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2
Q

newborn-infant pharynx AND larynx

A

pharynx-larynx elevated in the neck (aspiration is more difficult); with age, pharynx elongates and larynx descends in the neck

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3
Q

newborn-infant hard and soft palate

A

hard palate : short, no arch, and has folds of mucosa (facilitates latching) :: soft palate : grows in length (by age 4-5) and thickness (by age 14-16)

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4
Q

newborn-infant mandible

A

mandible is not fused, begins to fuse at age 1; mandible is small (reduces size of oral cavity); rami of jaw angles more with age

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5
Q

newborn-infant larynx

A

at birth larynx is 1/3 length of adult; pyriform sinuses more shallow; larynx and hyoid more elevated at birth; larynx descends at 2-4 years (C7 by adulthood)

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6
Q

newborn-infant epiglottis

A

proportionately larger in an infant; makes direct contact with the soft palate

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7
Q

newborn-infant pharynx

A

angle of the relationship between the nasal and oral cavities moves from oblique to 90 degrees by age 5; as the tongue descends, the posterior aspect becomes the anterior wall of the pharynx

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8
Q

swallowing differences in infants: mouth

A

tongue fills mouth; cheeks with sucking pads; small mandible proportionate to cranium

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9
Q

swallowing differences in infants: pharynx

A

nasopharynx gently curves to hypopharynx (oropharynx is not definite or distinguished); pharynx sits at C3

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10
Q

swallowing differences in infants: larynx

A

located at C3-C4; arytenoids nearly mature in size compared to laryngeal structures (which are a third of adult size)

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11
Q

infant volume per swallow

A

0.2 ml (+/- 0.11 ml)

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12
Q

infant swallows per day

A

600 to 1000

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13
Q

___ is “head to toe”

A

motor development

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14
Q

postural control is important because it affects ___

A

feeding success and airway protection

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15
Q

problems with ___ may interfere with the normal patterns of breathing and swallowing

A

muscle tone or coordination

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16
Q

which respiratory tract issues may disrupt feeding

A

reduced patency; hypo pharyngeal compression due to position of structures; normal neck flexion; mandibular retraction that reduces pharyngeal space; small laryngeal vestibule

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17
Q

breast feeding requires nipple contact ___

A

between the tongue and hard palate; lip seal creates negative pressure in the oral cavity

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18
Q

suckling

A

0-6 months; loose lips, reduced lip seal; wide mandibular excursions; tongue moving in and out

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19
Q

sucking

A

6-9+ months; tight lip seal, reduced tongue seal; reduced mandibular excursions; tongue moving up and down

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20
Q

non-nutritive suck(l)ing

A

advantages: calming; valuable to medically fragile kiddos; NNS along with tube feeds is good for the kiddo

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21
Q

for non-nutritive suck(l)ing, breathing is ___

A

continuous

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22
Q

whether or not a child can produce a normal non-nutritive suck(l)ing reveals their ___

A

readiness to feed

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23
Q

assessment procedures

A

bedside swallow eval; FEES; MBSS

**same strengths and weaknesses as adult versions of these assessments

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24
Q

pediatric dysphagia symptoms

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A

failure to thrive; sudden change in feeding; bx changes before / after feeding; weak / dysfunctional suck; coughing / choking during feeding; unexpected physiological changes after meals

25
components of clinical exam
hx; bx / state / sensory integration; general posture control / tone; respiratory function / endurance; oral-motor / CN evaluation; feeding / swallowing evaluation
26
clinical exam: hx
current status / dx; social hx; medical hx; feeding and swallowing hx
27
clinical exam: bx / state / sensory integration
stage of alertness before, during, or after feeding to help determine optimum degree for feeding; note stress cues (indicates difficulty during feeding)
28
clinical exam: general posture control / tone
assess muscle tone / posture / movement abnormalities; evaluate head / neck / trunk alignment; evaluate head support; note abnormal compensatory bxs
29
clinical exam: respiratory function / endurance
observe respiratory patterns at rest and during activity; observe for: belly breathing, gulp breathing, reverse breathing, irregular / shallow breathing
30
clinical exam: oral-motor / CN evaluation
oral primitive reflexes that may interfere with feeding; oral structures and function; CN screening
31
clinical exam: feeding / swallowing evaluation
bottle feeding: NS vs NNS position on the nipple; initiation of suckle / suck; mandibular excursion; feeding endurance; cup / straw / spoon feeding; biting / chewing solids (soft and hard)
32
when to recommend MBSS
similar reasons to adults (signs / symptoms of aspiration, reduced oral intake, prolonged period of time to complete meal); signs of distress (for severely cognitively impaired); DO NOT recommend MBSS until sucking bx has developed around 38th week
33
who is on the disciplinary team
SLP; RN; lactation consultant; dietician; pediatrician; PT; gastroenterologist; social worker
34
adult dysphagia vs pediatric dysphagia
anatomy and physiology are different; infant has primitive reflexes and different promoter and feeding abilities; because of fast development, more follow-up required
35
what do we train the parent / caregiver on?
positioning; setting the environment; selecting feeding choices and methods; understanding the feeding problem
36
management options
nutritional considerations; how to modify environment and impact on feeding; position of child and parent; appropriate feeding methods based on child's skills, age, and needs; appropriate timing and amount of food; meal scheduling; supporting parents' needs and skills; oral exercises and oral / facial support
37
nutritional considerations
coordinate time to feed and nutritional needs with the child's swallowing ability; full oral feed for infants is ~ 30-45 minutes; look for fatigue during feeding; determine whether supplementation is needed (small, frequent meals; adding calories, vitamins, minerals; NGT or PEG)
38
feeding environment
calm setting without distractions; rhythmical elements (music, rocking)
39
positioning and seating
relaxed, comfortable seating arrangement; sustainable posture / position; balance, stability, mobility; efficient and safe swallow; promoter control; inhibition of abnormal reflexes; independent feeding
40
for ___, proper posture / seating is essential in order to promote safe feeding
kiddos with neurological impairments
41
a posture should decrease ___, not increase it
fatigue
42
greater stability = greater ___
mobility / control
43
when considering positioning and seating, take a ___ approach
whole body
44
positioning and seating: what affects what
feet and leg instability : affects trunk stability :: trunk instability : affects shoulder girdle stability :: shoulder girdle instability : affects head and neck stability :: head and neck instability : affects jaw, lip, tongue control
45
positioning principles: pelvis and hips
newborns may need to be flexed into a curled position with hips bent and knees flexed; hips should be flexed in a good sitting position
46
positioning principles: trunk
symmetrical and not rotated; upright unless a slight recline helps stability
47
positioning principles: legs
should be still; bent in order to inhibit extension in hips
48
positioning principles: shoulder girdle
slightly forward to assist forward arm position and general flexion; may be assisted by swaddling
49
positioning principles: head and neck
head in slightly forward posture with chin tucked, assist swallow efficiency and safety, inhibit abnormal extensor patterns (be careful not to collapse airway)
50
to breastfeed or not?
ask: will it provide adequate nutrition? is it physically possible for the child? what are the child's positioning needs? will it be safe? does the mother want to breastfeed?
51
mother promotes breastfeeding by ___
supporting infant's head, neck, and trunk; shaping breast to form a teat; eliciting rooting reflex at the breast; bring baby to the breast (rather than breast to baby)
52
breastfeeding
can be facilitated by careful positioning and stimulating early primitive oral reflexes; children with macroglossia or related conditions (micrognathia) will do better i na prone feeding position where the tongue is brought forward and doesn't risk blocking the airway
53
preparing for feeding
modifications to the feeding environment; ensuring appropriate positioning; oral desensitization before feeds for hypersensitive kids; oral stimulation before feeds for hypotonic kids; kids with delayed feeding skills may benefit from mouthing / chewing activities before meals
54
characteristics of oral hypersensitivity
avoidance of mealtimes; refuses the breast; refuses or gags on teats; refuses the dummy; rejects mouthing toys; refuses range of textures; avoids tastes / textures; no preference for self-feeding
55
characteristics of oral hyposensitivity
poor sucking and chewing; diminished response to sensory input; drooling; inclined to overfill mouth; enjoy foods of strong flavors and increased textures
56
benefits of oral stimulation in infants / newborns
improved head position; improved mouth opening to accept breast / bottle; forward tongue posture over the gum line; reduction of gag; sucking initiation; lip closure
57
facilitative approaches
establishing a nutritive suck; external pacing (establish an internal rhythm); oral stimulation programs; reducing oral aversions; develop chewing skills; address behavioral feeding disorders; oral-motor tx (same concerns as adults)
58
compensatory strategies
establishing optimal infant state / feeding readiness; altering environment to support feeding; establish optimal position; alter consistency, temperature, volume, and taste of food; change feeding utensils

663 Pediatric Swallowing (1 decks)

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