Ped Feeding & Swallowing

Question 1

Difficulties in the Oral Stage of eating include

Answer 1

1) Chewing
2) Bolus Manipulation

Question 2

Difficulties in the Pharyngeal Stage include

Answer 2

Related to timing of swallowing.

1) Laryngeal Penetration (food enters laryngeal vestibule)

2) Aspiration (food passes vocal cords)

Question 3

Silent aspiration =

Answer 3

aspiration without clinical signs

May present as recurrent airway infections, or oral aversions

Question 4

Feeding disorders definition

Answer 4

Trouble eating due to taste, texture etc.

+/- Dysphagia (swallow)

Found in 80-90% of children with developmental disabilities

Question 5

Reasons kids refuse food

Answer 5

Trauma response/Safety

Grazing (lack of hunger cues)/Distractions

Sensory aversion

Medical Reasons (GI, Resp, Neuro)

Question 6

Clinical Feeding Evaluation assesses

Answer 6

Oral Motor skills
Sensory response

Question 7

Instrumental Assessment includes

Answer 7

Assess Pharyngeal swallow via:

Video Fluoroscopic Swallow Study (VFSS)
Modified Barium Swallow (MBS)
Flexible Endoscopic Exam of Swallowing (FEES)

Question 8

Video Fluoroscopic Swallow Study (VFSS) or Modified Barium Swallow (MBS)

Answer 8

Gold standard

Uses radiation

can’t assess breastfeeding

Question 9

Flexible Endoscopic Exam of Swallowing (FEES)

Answer 9

Can assess before/after breastfeeding

cannot assess oral or pharyngeal phase

Question 10

When does the rooting reflex appear?

Answer 10

28th fetal week

Question 11

When does the Suck Swallow Breath (SSB) pattern mature?

Answer 11

37-40 fetal week

Question 12

Pacifier Pros & Cons

Answer 12

Pros: Protect against SIDS, learn oral motor patterns

Cons:
Altered Canine relationship
Changes myofunctional characteristics (hard palate, tongue, lip, swallow)

Question 13

Ideal Suck Swallow Breath (SSB)

Answer 13

1:1:1

alterations can lead to altered bolus, pharyngeal pooling, delayed swallow

Question 14

Disorganized vs Dysfunctional Sucking

Answer 14

Disorganized: poor rhythm, latch, or organization

May improve with compensatory strategies

Dysfunctional: tongue problems, persistent or learned non-nutritive problem

Will NOT improve with compensatory strategies

Question 15

Goals of Oral Feedings

Answer 15

Safety - pulmonary

Efficiency - 20-30, more energy gained

Sufficiency - 25-30g/day gain in 4mo

Question 16

Benefits of elevated side lying feeding

Answer 16

Reduces gravity
Supports breathing mechanism
Slow flow of bolus

Question 17

How should infant diet be selected?

Answer 17

Based on skill to avoid the formation of maladaptive responses

Question 18

Transitioning to a cup

Answer 18

Can start as early as 6-8mo

May improve swallow

=/= to drinking from bottle

Question 19

TABBY tongue assessment scale

Answer 19

8 = normal tongue

6-7 = wait and see

<5 = impaired tongue, need to assess effects on breastfeeding

Question 20

What are Orofacial Myofunctional Disorders

Answer 20

atypical, adaptive patterns that emerge in the absence of normalized patterns within the orofacial complex

Thumbsucking
Tongue thrust

Question 21

Premature children tend to have

Answer 21

narrow palate, poor SSB that improves

Question 22

Bronchopulmonary dysplastic patients tend to have

Answer 22

poor SSB that does not improve, reflux

Question 23

Cleft Palate tend to have what kind of feeding problems?

Answer 23

no suction, require special bottles

Question 24

Pierre Robin Sequence tend to have

Answer 24

cleft palate, fallen back tongue, small jaw

Question 25

Down Syndrome tend to have what feeding considerations?

Answer 25

poor SSB, hypotonia (poor positioning), dysphagia infection risk, heart problems

Question 26

Diabetic infants tend to have

Answer 26

poor feeding cues

Question 27

GERD infants tend to have

Answer 27

feeding refusal, GI upset

Question 28

Recommendations for Cleft kids

Answer 28

inability to suck --> start cup usage earlier Obturators can help with feeding efficiency, but DO NOT provide suction

Question 29

CPalsy kids tend to have what sort of feeding problems?

Answer 29

dysphagia, reflux, speech delay

Question 30

Dental concerns Down Syndrome and Cerebral palsy

Answer 30

Delayed tooth eruption Malocclusion Gum disease High palate Cariogenic nutrition Aspiration risk

Question 31

Dental Concerns ASD

Answer 31

~70% do not want to try new foods Prolonged bottle use self-injurious behaviours --> try food chaining?