Pathophysiology Of Swallowing In Infants

Front 1

Risk factors for infants with swallowing disorders

Back 1

malnutrition, dehydration, and respiratory problems

Front 2

Etiology of feeding and swallowing problems

Back 2

Prematurity
Cerebral palsy
Autism
Head and neck abnormalities
Muscle weakness in the face and neck
Gastroesophageal reflux
Multiple medical problems
Respiratory difficulties
Medications that may cause lethargy or decreased appetite
Problems with parent-child interactions at mealtime

Front 3

Symptoms related to infant swallowing disorders

Back 3

Poor feeding
Difficulty chewing
Difficulty drinking from a bottle or cup
Difficulty breast feeding
Refusing food or liquid
Coughing or choking while eating or drinking
Excessive drooling and food spilling from the mouth
Liquid leaking out the nose
Gagging
Vomiting during meals

Front 4

Treatments for infants with swallowing disorders

Back 4

Medical intervention, as needed
Direct feeding therapy designed to meet your child's individual needs
Nutritional changes
Postural or positioning changes (different seating, etc.)
Behavior management techniques
Desensitization to new foods or textures
Food temperature and texture changes
Referral to other disciplines, such as psychology or a dentist

Front 5

SLP intervention for feeding therapy with infants

Back 5

Strengthening the muscles of the mouth
Increasing tongue movement
Improving chewing patterns
Increasing tolerance of different foods or liquids
Improving sucking /drinking ability
Coordinating the suck-swallow-breathe pattern (for infants)
Altering food textures and liquid viscosity to ensure safe swallowing
Other interventions depending on your child's specific needs

Front 6

What is a Modified Barium Swallow Procedure?

Back 6

An x-ray procedure that obtains views of swallowing function that are then recorded on videotape.

Front 7

What is a Modified Barium Swallow procedure useful for?

Back 7

Its useful in determining the presence or absence of aspiration of material into the airway and assessing the movement of material into and through the upper portion of the esophagus.

Front 8

How is a modified barium swallow procedure performed?

Back 8

Small amounts of different textured, flavored barium are swallowed. The barium may be mixed with different textures and food to assess swallowing function. Only a limited number of teaspoon size swallows and sips are presented.

Front 9

What information is provided with a MBS procedure?

Back 9

The MBS provides information about how material is managed orally just prior to the swallow and evaluates the mechanical aspects of the swallowing mechanism including airway protection and how well the material moves through the different phrases of swallowing.

Front 10

Is the patient sedated during a MBS procedure?

Back 10

The patient fully alert.

Front 11

Is the MBS procedure painful?

Back 11

No,its painless.

Front 12

How long does it take to complete a MBS?

Back 12

Usually about 10 minutes.

Front 13

What are the three stages of swallowing where a disorder may occur?

Back 13

Esophageal phase (as food moves down the esophagus to the stomach)
Oral phase (as food is chewed and prepared to swallow)
Pharyngeal phase (as food moves from the mouth into the upper part of the throat)

Front 14

What is choking?

Back 14

A complete blockage of the upper airway by food or other objects, preventing a person from breathing effectively

Front 15

What is aspiration?

Back 15

Entry of material (usually liquids) into the airway below the true vocal cords

Front 16

What is Videofluoroscopic Swallowing Study (VFSS)?

Back 16

VFSS is used to document occurrence of aspiration, reasons for aspiration, and possible therapies for aspiration. In this study the infant is given breastmilk or formula mixed with liquid barium. The infant is placed in a feeding seat and the fluoroscope table is tilted so that the response of the pharyngeal area during feeding can be captured as a permanent video image.

Front 17

How can family or caregivers help?

Back 17

ask questions to understand problems in feeding and swallowing
make sure they understand the treatment plan
attend treatment sessions and follow recommended techniques at home and school
communicate with everyone who works with the child about the feeding and swallowing issues and treatment plan.

Front 18

What is pediatric dysphagia?

Back 18

Swallowing problems in infants and children is often diagnosed as this.

Front 19

Who may be diagnosed with Pediatric dysphagia?

Back 19

Premature babies may be diagnosed with pediatric dysphagia if they develop irregular suck patterns during nursing. Toddlers and infants with cerebral palsy or a correctable cleft plate may also be diagnosed with pediatric dysphagia.

Front 20

What occurs in the oral preparation stage?

Back 20

Food is chewed and moistened by saliva. The tongue pushes food and liquids to the back of the mouth towards the throat. (This phase is voluntary: we have control over chewing and beginning to swallow.)

Front 21

What occurs in the pharyngeal phase?

Back 21

Food enters the pharynx (throat). A flap called the epiglottis closes off the passage to the windpipe so food cannot get into the lungs. The muscles in the throat relax. Food and liquid are quickly passed down the pharynx (throat) into the esophagus. The epiglottis opens again so we can breathe. (This phase starts under voluntary control, but then becomes an involuntary phase that we cannot consciously control.)

Front 22

What occurs in the esophageal phase?

Back 22

Liquids fall through the esophagus into the stomach by gravity. Muscles in the esophagus push food toward the stomach in wave-like movements known as peristalsis. A muscular band between the end of the esophagus and the upper portion of the esophagus (known as the lower esophageal sphincter) relaxes in response to swallowing, allowing food and liquids to enter the stomach. (The events in this phase are involuntary.)

Front 23

When do swallowing disorders take place?

Back 23

Swallowing disorders occur when one or more of these stages fails to take place properly.

Front 24

How is dysphagia diagnosed?

Back 24

oral-pharyngeal video swallow
Your child is given small amounts of a liquid containing barium to drink with a bottle, spoon, or cup, or spoon fed a solid food containing barium. Barium shows up well on x-ray. A series of x-rays are taken to evaluate what happens as your child swallows the liquid.
barium swallow/upper GI series
Your child is given a liquid containing barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) to drink, and a series of x-rays are taken. The physician can watch what happens as your child swallows the fluid, and note any problems that may occur in the throat, the esophagus, or the stomach.
endoscopy
A test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of the digestive tract. Under anesthesia, an endoscopy is performed. Pictures are taken of the inside of the throat, the esophagus, and the stomach to look for abnormalities. Small tissue samples, called biopsies, can also be taken to look for problems

Front 25

What are some other tests that may be performed to evaluate dysphagia?

Back 25

esophageal manometry
Under sedation, a small tube containing a pressure gauge is guided through your child's mouth and into the esophagus. The pressure inside the esophagus is then measured to evaluate the esophageal motility.

Under anesthesia, a physician places a tube into your child's throat and looks through it for narrowed areas and other problems.

Front 26

Intervention for infants with swallowing disorders.

Back 26

Adding a small amount of rice cereal to infant formula or pumped breast milk may help dysphagia. Blending the formula/cereal mixture before adding it to a baby bottle can remove the lumps and make the mixture easier to suck through a nipple, as well as easier to swallow.
Do not cut holes in nipples, since this can increase the risk for choking and aspiration, as well as interfere with the baby's oral development. Future feeding and speech skills may be affected.
Baby foods should not be offered to infants from a spoon until they are at least 4 months old, since they do not have the proper coordination to swallow foods from a spoon until this age.
Your child's speech or occupational therapist may be able to recommend other commercial products that help thicken liquids and make them easier to swallow.

Front 27

What is the long-term outlook for a child with dysphagia?

Back 27

Some children with dysphagia will have long-term problems. Children who have other health problems, especially those that affect the nerves and muscles (such as muscular dystrophy and brain injury), may not be able to experience much improvement with their swallowing difficulties. Other children may learn to eat and drink successfully.