pediatric swallowing

Question 1

what are some causes of pediatric swallowing disorders?

Answer 1

neurologic (like bubby; TBI or cerebral palsy)

anatomic and structural (cleft)

genetic (DS)

or systematic illness (chronic lung disease)

Question 2

what are management strategies for children with a weak suck or sucking?

Answer 2

pressure to assit lip closure
jaw stabilization

Question 3

what are management strategies for children with suck and swallow coordination?

Answer 3

stroke hyoid muscle towards sternum

nipple changes on bottle to get optimal flow

Question 4

what is a management strategy we could use for children with inconsistent sucking?

Answer 4

stroke tongue

Question 5

what is a management strategy we could use for children with mild sucking incoordination or limited sucking?

Answer 5

offer pacifier

Question 6

what is a management strategy we could use for children with uncoordinated suck/swallow/breathe sequencing?

Answer 6

use cotton swab dipped in water, formula, or breast milk

Question 7

what are some management strategies we could use for children with cleft lip prior to repair?

Answer 7

haberman feeder
slightly longer nipples
frequent burping during feedings

Question 8

what are some management strategies we could use for children with cleft lip post-repair?

Answer 8

give all food and liquid by cup
give smooth and lumpy purees
hold off on crunchy foods

Question 9

what are some management strategies we could use for a child who has CP with increased tone?

Answer 9

finger tapping or vibration to cheeks and lips

prone positioning

mouth play with fingers and toys

Question 10

what are some management strategies we could use for a child who has CP with decreased tone?

Answer 10

pleasurable stimulation on face

mouth play to get a gradual opening

straw drinking

Question 11

how can we treat pediatric swallowing/eating disorders due to sensory issues?

Answer 11

using the desensitization hierarchy

Question 12

what is the desensitization hierarchy?

Answer 12

tolerating
interacting
smelling
touch
taste
eating

Question 13

define the tolerating and interacting stages of desensitization

Answer 13

T: child moves from being in the same room with food to looking at it when food is strictly in front of the child

I: child uses utensils, may stir food but not put into mouth

Question 14

define the smelling and touching stages of desensitization

Answer 14

S: child tolerates the odor of food in the room to picking up food to smell it

T: child tolerates food on fingers, hand, upper body, chin, cheek, nose, lips, teeth, and tongue

Question 15

define the tasting stage of desensitization

Answer 15

T: child licks lips or tongue, bites, then spits out; bites and hold in mouth before spitting out; chews and partially swallows; chews and swallows with drink; chews and swallows independently

Question 16

define the eating stage of desensitization

Answer 16

gradual changes throughout the steps lead the child to functional eating without any specific focuses by caregivers

Question 17

what are the common illnesses or diagnoses a preterm infant is likely to develop?

Answer 17

neurological
gastrointestinal
cardiac
respiratory

Question 18

a neurological diagnosis or illness could look like..

Answer 18

only show basic electrical activity in primary motor and primary sensory regions

deficits in esophageal motility, function of LES, gastric emptying, intestinal mobility, gut issues

Question 19

cardiac illness could look like..

Answer 19

ductus arteriosus does not close so baby needs surgery

Question 20

respiratory illness could look like..

Answer 20

stridor or apnea

stridor: high pitch whistling sound when breathing (usually during inhalation)

Question 21

what can we do to treat/manage hyposensitivity?

Answer 21

firm but gentle stroking around mouth and on tongue

Question 22

what can we do to treat/manage hypersensitivity?

Answer 22

deep, sustained pressure in and around mouth by caregiver’s or infant’s hand; stroke face

Question 23

what can we do to treat/manage reduced sensory awareness?

Answer 23

varied food textures and temperatures

drop of liquid in the corner of the lips

Question 24

what are signs and symptoms of malnutrition in an infant?

Answer 24

dry eyes, mouth, or skin
infrequent urination or wet diapers
strong color or smell of urine
constipation
lethargy
irritability

Question 25

what are the components of an infant feeding assessment?

Answer 25

case history feeding readiness direct feeding assessment parental competence and confidence with feeding the infant

Question 26

what information do we obtain during case history?

Answer 26

gestational age at birth current gestational age birth weight and percentile Apgar scores medical conditions medical interventions required mother's intention to breastfeed multiple birth status (e.g., twins)

Question 27

what do we do to assess feeding readiness?

Answer 27

Observation of physiological stability, motor organization, state control and attention, and self-regulation both at rest and during handling Assess infant's oral structures and functioning including nonnutritive sucking (lip seal, tongue cupping, sucking strength and rhythm)

Question 28

what information do we collect during a direct feeding assessment?

Answer 28

A description of how the infant was fed sucking SSB coordination Physiological status: any changes in heart rate, respiration, etc. Stress cues

Question 29

what are the physiological indications of stress in a preterm infant?

Answer 29

changes in heart rate, coughing, color change

Question 30

what are the motor organization indications of stress in a preterm infant?

Answer 30

extension patterns, increase or decrease in tone

Question 31

what are the state of control indications of stress in a preterm infant?

Answer 31

extremes of states such as hypervigilance, irritability, rapid change in state

Question 32

what are the self-regulation indications of stress in a preterm infant?

Answer 32

inability to calm, require high levels of coregulation

Question 33

what are feeding interventions for preparation of oral feeds

Answer 33

kangaroo care (skin to skin) nonnutritive sucking during tube feeding nonnutritive sucking for 5 to 10 mingues before oral feeding

Question 34

what are feeding interventions for improving sucking?

Answer 34

suck training (finger in mouth from front to back) oral tactile stimulation (massage structures) oral support during oral feeds (support of lower lip)

Question 35

what are feeding interventions for improving SSB coordination (suck swallow breathe)

Answer 35

slower-flowing nipples side lying position externally paced feeding combining the side-lying position and externally paced feeding

Question 36

what are some feeding techniques for a low risk infant?

Answer 36

standard newborn nipple and holding the infant in the standard position; no alterations If the infant shows any decline in physiological stability or engagement use slower flowing bottle nipple, horizontal milk flow, external pacing

Question 37

what are feeding techniques for a high risk infant?

Answer 37

start with the maximum adaptation: slow milk flow, side lying position, horizontal milk flow, external pacing

Question 38

what are some strategies for the progression of oral feeding?

Answer 38

cue based feeding semi-demand feeding demand feeding

Question 39

define cue based feeding

Answer 39

offering oral feeds when the infant displays engagement/readiness cues and discontinuing oral feeds when the infant displays disengagement cues

Question 40

cue based feeding is used for xx and demand feeding is used for xx

Answer 40

high risk infants; low risk infants

Question 41

define semi-demand feeding

Answer 41

offering the infant the opportunity to oral feed on a schedule an oral feed progresses only when the infant shows feeding readiness cues before the feed and engagement cues during the feed discontinued based on disengagement cues

Question 42

define demand feeding

Answer 42

offering oral feeds based entirely on the infants' demand cues infants are fed orally as much as they want and as often as they demand infants showing signs of hunger