Common feeding problems in peds
Refusal Aversion & selectivity Oral motor Dysphagia
Feeding problems can lead to
Nutrition & growth deficiencies (FTT), Developmental feeding delays, Social “differences” [(food centered society) They’re annoying at dinner], Increased family pressures/difficulties
At THREE months
The child is able to refuse food because it is no longer a reflex. This is when we begin to see feeing problems.
Are feeding problems typically psycho-social?
It is rare for feeding problems to solely be related to parenting, but parenting may contribute to an already difficult feeding relationship.
Review physiological refusal: - What issues may result in refusal? - Symptoms?
Refusal may be a response to GI issues, food allergies, inability to manage the flow of milk secondary to breathing problems, etc.However, typical symptoms are not always present (skin breaking out or blood in stool). In other words, this isn’t always obvious.
It is extremely important for a child to establish a ____ ____ with food during the first few months of life because why?
positive relationship BC: First few months are vital, like many other developmental areas. Difficult to change that relationship later in life.
Discuss balance in tx of oral aversions
Must be sensitive to aversion in tx. If you push too much, you might make the aversion worse.
A study of oral aversions and selectivity found that one of the biggest issues in feeding development is
Transitioning to solid foods and enjoying mealtimes.
What causes oral hypersensitivity? What was said in lecture about children in the NICU?
may be caused by general sensory overload, traumatic oral & facial experiences, oral sensory-motor deprivation, and/or GI issues. Most children that spend a lot of time in the NICU have difficulty with the mouth because they have negative association to the mouth (tube feeding, tape, etc). Just being in the NICU is enough to overstimulate the infant because they have premature senses and may impact feeding.
What are some S/S of aversion and/or selectivity?
weight loss or failure to thrive, decreased interest in eating, obvious preference for one consistency over another
Common red flags that may warrant referral
feeding is consistently 30-45 minutes, unexplained refusal and under nutrition, weight loss or lack of weight gain, excessive cough or recurrent coughs with feeding
What to watch for in a clinical/bedside evaluation
pharyngeal red flags, any signs of GERD, signs of stress, aversion or oral-motor problems, state of alertness
When do babies begin to drink from a cup?
between 6--12 mos
When do babies begin eating lumpy food?
Treatment Techniques/Therapy Interventions to Consider for Oral Aversion
Work from developmental age of current oral skills, establish food patterns and branch out one attribute at a time (flavor texture, temp, color, etc.) Try facial/oral food play, have fun with food, educate family on how to make meals a social time.
Treatment Techniques/Therapy Interventions to Consider for Swallowing Safety
Implement diet changes and establish compensatory measures to assist with safety and function (texture, position, behavioral education related to risk factors) NMES consideration
Treatment Techniques/Therapy Interventions to Consider for Oral Motor/Sensory
Establish functional oral motor tasks to improve strength and function Tooth brushing using a vibrating head to desensitize the oral cavity
What is the first goal of successful infant feeding?
What is the second goal of infant feeding?
Feeding should be NURTURING & ENJOYABLE
What are moderate stress cues?
Sighing Yawning Sneezing Sweating Tremoring Startling Gasping Straining
What are major stress cues?
Coughing Spitting up Gagging/choking Color change Respiratory pauses Irregular respirations
How to perform external pacing
Tilt the bottle back so the infant cannot continue to drink and has to take a breath
What is modified side lying
•Infant is held swaddled with a slight upright tilt whereby his/her head is held slightly higher than feet, and overall head/neck/spine are aligned.