Quiz 4

Question 1

Describe oral motor development at 18 months.

Answer 1

Jaw is stable under cup with upper lip seal and no tongue protrusion. Tongue tip elevates more consistently when swallowing semi solids. No drooling while walking, running, fine motor…

Question 2

Describe liquid consumption at 18 months.

Answer 2

One ounce or more without pausing.

Question 3

Describe solid consumption at 18 months.

Answer 3

Coordinated and emerging rotary chewing is becoming more consistent. Chew with lips closed with more food and saliva loss with new foods. Teething begins. Prefers self feeding and can sustain a controlled bite on hard cookie (bite and pull away).

Question 4

Describe oral motor development at 24 months.

Answer 4

No drooling while drawing, manipulating toys, or speaking. Internal jaw stability with cup drinking, and up down sucking with cup held between the lips.

Question 5

Describe solid consumption at 24 months.

Answer 5

No extraneous movement (asking caregiver to hold, pulling head back) with biting, chews with mouth closed, and food is transferred from one side to the other. Mature rotary chewing is seen but may still be inconsistent depending on exposure and practice.

Question 6

What are the three questions caregivers ask?

Answer 6

Where did this problem come from? How do we fix it? When will it be fixed?

Question 7

What are the three goals of assessment?

Answer 7

Determine the safest and most efficient consistencies to maintain nutrition, hydration and protection of airway.
Determine what they “can’t” versus “won’t” do.
Determine most effective method of management.

Question 8

What are some primary criteria for referral?

Answer 8

Poor SSB, weak suck, apnea during feeding, gagging, coughing, new feeding difficulty or food refusal, FTT, recurrent pneumonia, lethargy, feeding >30 min,

Question 9

What are some secondary criteria for referral?

Answer 9

Vomiting, nasal regurgitation, increased drooling, regression or change in medical status.

Question 10

What is the ICF-CY?

Answer 10

The International Classification of Functioning- Children & Youth is a conceptual framework/language for problems in infancy, childhood, and adolescence involving functions and structures of the body, activity limitations and participation restrictions, and other environmental factors. Emphasizes function and can be used across disciplines!

Question 11

What does WHO say about assessment approach?

Answer 11

Should be holistic, work from big to small, facilitate function rather than focus on impairment. How can we make the greatest impact/what can we change to make the greatest impact?

Question 12

Where does the assessment start?

Answer 12

Start assessment as soon as you see the child. Look at posture, breathing, interactions between caregiver and child.

Question 13

What is important to let family know in introduction?

Answer 13

Build rapport and make sure parents know that earliest communication occurs through feeding (holding in feeding position, calm baby, talk to baby).

Question 14

What is long term prognosis related to?

Answer 14

Underlying medical and neurologic problems.

Question 15

What are some of the first steps in assessment?

Answer 15

Assess state of alertness, global tone/positioning, respiratory status (rate/monitors), intraoral exam, therapeutic trial

Question 16

What type of information should be on a questionnaire?

Answer 16

Identifying info, reason for assessment, family history, prenatal history/milestones, medical status, feeding history, current feeding, where child is fed…

Question 17

What info is a part of prenatal/birth history?

Answer 17

Feeling during pregnancy, drug use, illness, length/delivery/complications, birth weight, Apgar score

Question 18

What info is part of medical status?

Answer 18

Dx, medications, food restrictions, respiratory support

Question 19

What info is part of feeding history?/

Answer 19

When problem was noticed, breast or bottle fed (was it preference?), problems with sucking, when were cups/spoons/textures introduced and how did it go… May want a 24 hour food log, and description of typical feeding (thickened? bottle type?)

Question 20

What are some things to do before starting your assessment?

Answer 20

Gather info, plan observation, select/gather equipment, consider safety of patient/examiner (universal precautions, oxygen, suction, heart monitor)

Question 21

What are some of the recommended tools for assessment?

Answer 21

Variety of nipples, padded infant spoon, sippy cup, open cup, cut out cup, straws, toothette sponge stick, tongue depressor, nuk texture brush, towels, rice cereal, grahams…

Question 22

What are two types of assessment?

Answer 22

Naturalistic: normal bottle/nipple/breast, typical time, primary caregiver feeding

Elicited: modified to elicit bx or observe that which did not occur spontaneously, may need baby in different state (awake v sleepy)

Question 23

What can we observe in an infant’s bx or state?

Answer 23

Can look at autonomic nervous system (bp, hr, rr), physiologic system (organ systems), motoric system, state system (sleepy/drowsy/crying-if not steady, not right)

Question 24

What is tachycardia? Bradycardia? When does bradycardia occur?

Answer 24

Heart rate higher than expected for age/disease. Abnormal drop in heart rate that may occur during prolonged sucking, induced apnea, aspiration, prolonged feeding…

Question 25

When is respiratory rate highest? Lowest?

Answer 25

Highest when awake, lowest when asleep. Increase of 10 okay, stop if over 80.

Question 26

What should be looked at during feeding in terms of respiration?

Answer 26

Effort or distress, apnea, color change, retractions (concave neck), breath holding

Question 27

What can be looked at in terms of O2 saturation?

Answer 27

Amount of O2 in blood and available for exchange is lower than 90 to suggest hypoxia (some babies with heart conditions ok)

Question 28

What observations should be made during feeding?

Answer 28

Voice (weak, wet?), breathing over feeding?, bolus formation, initiation of propulsion

Question 29

What is a therapeutic trial?

Answer 29

Based off of info and observations made hypotheses are developed and aspects (tools, position, techniques, texture) of feeding are altered to see changes in performance

Question 30

What are responses to tactile input?

Answer 30

Oral reflexes are adaptive and protective, can also be behavioral responses! Could start by touching hands or feet before moving to mouth...

Question 31

How can we see the difference between primarily oral sensory and primarily motor children?

Answer 31

Primarily oral sensory will manage liquids better than solids, vomit with certain textures, gag with smell or taste, want to be independent with feeding and refuses toothbrushing Primarily motor has difficulty coordinating all textures (not specific), gags when food moves through cavity, tolerates others helping to feed, and is okay with toothbrushing.

Question 32

What is hyposensitivity?

Answer 32

Reduced awareness to stimuli in mouth--> poor suck, liquid pooling and loss, gag, overstuffing/pocketing Basically, don't know when mouth is full, when nipple in mouth, when drooling...

Question 33

What is hypersensitivity?

Answer 33

Heightened awareness to stimuli in mouth--> heightened gag reflex, refusal of foods, refusal to progress in textures

Question 34

What is oral aversion?

Answer 34

COMPLETE refusal of all oral experiences- could be sick, struggling to breathe, can't accept another variable. Always has a learned component.

Question 35

What are factors that contribute to abnormal tactile responses?

Answer 35

Immaturity, chronic illness, bad oral-tactile experiences, delayed intro of oral feedings, neurologic impairment