Dysphagia Test 4F

Front 1

What are the anatomical differences in infant vs. adult?

Back 1

-oral cavity is smaller than in the adult
-tongue fills the mouth and rests more anteriorly
-the soft palate, tongue and epiglottis are very close together
-lower jaw is small and pulled back
-anterior movement of the pharyngeal wall is much greater
-larynx is higher and pharynx shorter causing less laryngeal excursion in infants
-sucking (fat) pads exist
-epiglottis is omega-shaped in infants (fan shaped in adults)

Front 2

What are the physiological differences in infants vs. adult swallowing?

Back 2

1. Babies use a suck-hold-breathe-swallow cycle
2. Decreased elevation of the larynx in babies
3. More posterior pharyngeal wall movement for babies
4. babies can load as much as 6 tongue pumps of milk into the valleculae before swallowing

Front 3

Liquid Level Advances
-Birth through 2

Back 3

Milk Feeding amounts:
0-1 mo. 2-6oz./feed
2-3 mo. 7-8 oz./feed
7 mo. 11 oz./feed

Front 4

Food Level Advances
-Birth through 2

Back 4

6 mos. Strained food, sippee cup
7 mos. Bite is acheived
8 mos. Better lip closure
9 mos. Bite is under volitional control
10-12 mos. Chewing begins
by 2 yrs can mash most foods
by 3-4 yrs chewing is mature; adult pattern is acheived

Front 5

Vital signs for Premies/full term Infants

Back 5

Heart rate:
-full term baby: 120-140 BPM
-preemie baby: 160-180 BPM
-low heart rate: <90 or 100 BPM

Respiratory Rate:
For full term baby: 30-60 breaths per min
During feeding: 40-50 BPM
High: 70 BPM

02 (Oxygen) saturation level: 92-100%

Front 6

Goals for Feeding outcomes (Peds)

(Red flags for feeding delays)

Back 6

-Not spoon feeding by 9 months
-Not chewing or self-feeding by 18 mos
-Not cup drinking by 24 months

Front 7

What is the PURPOSE of a feeding/swallowing evaluation:

Back 7

-Support appropriate growth/nutrition and development
-Assess for any changes in feeding/swallowing skills as the child grows

Front 8

Pediatric Medical History
-What questions do you want to ask concerning the child's PRENATAL (during pregnancy) history?

Back 8

-Was there any exposure to drugs/alcohol?
-Was there any maternal infection?
-Was the mother exposed to radiation?
-Was there an excessive amount of amniotic fluid?
-Was the baby full term/premature?

Front 9

Pediatric Medical History
-What questions do you want to ask concerning the child's PERINATAL (during delivery) history?

Back 9

-Was there any meconium aspiration? Ventilation? Intubation?
-what were the APGAR scores (8,9 typical)

Front 10

Pediatric Medical History
-What questions do you want to ask concerning the child's POSTNATAL history?

Back 10

-Note any formal diagnosis/conditions
-review any previous evaluations (NICU evals), special medical testing (GI, endoscopy, MBSS) related to feeding/swallowing
-Genetics testing/diagnosis?
-Structural deformities?
-Surgical procedures pertinent to feeding/swallowing? Nissen? Cleft repair? Complications?
-Dental problems? Enamel issues make kids sensitive to temperature.
-Respiratory problems? Look for tongue touching the roof of mouth when sitting
-Gastrointestinal problems GERD
-Medications
Allergies

Front 11

What questions would you want to ask concerning the child's DEVELOPMENTAL HISTORY?

Back 11

-When did the child meet developmental milestones such as sitting independently, crawling, walking? (The development of the milestones contributes to the development of oral sensorimotor skills)
-In general, a child sits independently at 4-7 mos, crawls, pulls to stand by 7-10 mos, walks by 13-18 mos

Front 12

What questions would you want to ask concerning the child's FEEDING HISTORY?

Back 12

-When did the child meet feeding milestones? (Children begin to be spoon fed at 6 mos)
-Get current height and weight info
-How long do feedings last?
-If bottle feeding, find out what formula the child is using; has the child had to try more than one formula?
-Ask about the feeding schedule? Infants typically eat every 3 hours
-For children who eat solids, ask about what foods are easy/difficult for the child to eat; ask about what foods the child likes/dislikes
-It can help for the family to provide a 3 day journal of meals
-Does the child drink juice? This can reduce appetite!
-Does the child need supplemental nutrition? Tube feedings? Continuous/bolus feedings? Night feedings only?

Front 13

Signs/symptoms of infant stress

Back 13

-hiccups
-yawning
-spitting up
-flailing movements
-finger splaying
-gaze aversion
-staring
-panicked look

Front 14

Benefits for nonnutritive sucking

Back 14

It is a way to facilitate a calm state to get the infant ready for feeding

Front 15

Burping

Back 15

?

Front 16

Bottle flow rates:
-What nipples do you want to avoid?

Back 16

-Nipples with high-flow rates becaue they may flood the pharynx, triggering multiple swallows, leading to interruption of breathing

Front 17

Bottle Flow Rates:
-What flow rate nipple should you consider?

Back 17

-Standard flow rate nipple

Front 18

Speech Considerations

Back 18

-cheek and lip musculature are the reasons for so many feeding and expressive language delays
- decreased cheek and lip movement can cause decreased facial expressions=breakdowns in communication
-What can we do? Provide massage and sensory input to improve/increase movement; facilitate sound production, i.e. Mmm sound (4-6 mos) for lip closure

Front 19

How do you treat a child with hypertonia?

Back 19

-Inhibition (calming, desensitizing, organizing)
-slow, rock/roll movement
-warmth
-weight bearing; joint compression
-rhythmic input (less than heart rate)
-DEEP TOUCH, MASSAGE
-linear movement
-vibration
-stroking along sides of spine
-upside down

Front 20

How do you treat a child with hypotonia?

Back 20

-Facilitation (alerting, intense, can be organizing)
-fast movement
-TAPPING AND QUICK STRETCH TO MUSCLES, QUICK BRUSHING
-icing
-bright colors, lights, noise
-arrhythmic input
-rotary movement
-light touch, tickling
-vibration up to 3 mins