Pathophysiology Of Swallowing In Infants

Front 1

How are disorders of swallowing categorized?

Back 1

Disorders of swallowing may be categorized according to the swallowing phase affected.

Front 2

What does impaired control of the tounge usually cause?

Back 2

Oral-phase disorders affecting the oral preparatory and oral propulsive phases.

Front 3

Name symptoms and or disorders associated with oral phase swallowing.

Back 3

Cannot form a bolus or residue on the floor of the mouth due to reduced range of tongue motion or coordination
Cannot hold a bolus due to reduced tongue shaping and coordination
Unable to align teeth due to reduced mandibular movement
Food material falls into anterior sulcus or residue in the anterior sulcus due to reduced labial tension or tone.
Food material falls into lateral sulcus or residue in the lateral sulcus due to reduced buccal tension or tone.
Abnormal hold position or material falls to the floor of the mouth due to tongue thrust or reduced tongue control
Delayed oral onset of swallow due to apraxia of swallow or reduced oral sensation
Searching motion or inability to organize tongue movements due to apraxia of swallow
Tongue moves forward to start the swallow due to tongue thrust.
Residue of food on the tongue due to reduced tongue range of movement or strength
Disturbed lingual contraction (peristalsis) due to lingual dyscoordination
Incomplete tongue-to-palate contact due to reduced tongue elevation
Unable to mash material due to reduced tongue elevation

Front 4

In the event that pharyngeal clearance is severely impaired, what happens?

Back 4

a patient may be unable to ingest sufficient amounts of food and drink to sustain life.

Front 5

Name 6 pharyngeal-phase swallowing symptoms and disorders.

Back 5

Cervical osteophytes
Coating of pharyngeal walls after the swallow due to reduced pharyngeal contraction bilaterally
Vallecular residue due to reduced posterior movement of the tongue base
Coating in a depression on the pharyngeal wall due to scar tissue or pharyngeal pouch
Residue at top of airway due to reduced laryngeal elevation
Laryngeal penetration and aspiration due to reduced closure of the airway entrance (arytenoid to base of epiglottis)
Aspiration during swallow due to reduced laryngeal closure

Front 6

retention of food and liquid in the esophagus after swallowing is the result of _______________.

Back 6

Impaired esophageal function

Front 7

What is the definiton of aspiration?

Back 7

Aspiration is the passage of food or liquid through the vocal folds.

Front 8

People who aspirate are usually at risk for ________________.

Back 8

pneumonia

Front 9

What factors usually influence the effects of aspiration?

Back 9

quantity, depth, physical properties of the aspirate, and pulmonary clearance mechanisms.

Front 10

How can the severity of aspiration be described?

Back 10

(1) Estimate the percentage of the total bolus aspirated or (2) estimate the depth of bolus invasion into the airway. The Eight-Point Penetration-Aspiration Scale is an example of an estimation tool.

Front 11

What are children with dysphagia at risk for?

Back 11

malnutrition, dehydration, and respiratory problems

Front 12

What are the causes of feeding and swallowing problems?

Back 12

Prematurity, Cerebal palsey, autism, head and neck abnormalities,gastroesphogeal reflux,multiple medical problems,respiratory difficulties

Front 13

What typical symptoms do children with feeding and swallowing problems usually exhibt?

Back 13

Poor feeding, difficulty chewing, difficulty drinking from a bottle or cup,difficulty breast feeding,refusing food and liquid,coughing or choking while eating/drinking,vomiting during meals, gaging, leaking liquid from the nose,excessive drooling or food spilling from the mouth,poor weight gain

Front 14

If a problem is noticed with feeding and swallowing, who should be contacted?

Back 14

The child's pediatritian

Front 15

If further assessment is believed to be warranted by the pediatritian, who will the child be referred to?

Back 15

An SLP and or feeding team.

Front 16

Who is the feeding team comprised of?

Back 16

SLP, physical therapist, occupational therapist, a physican or nurse and a dietician

Front 17

What may a feeding team and or a SLP reccomend after a feeding evaluation?

Back 17

Medical intervention,direct feeding therapy,nutritional changes,postural or position changes,behavior management techniques,food temperature and texture changes, referal to other disciplines,Desensitization to new foods or textures

Front 18

What will the focus of intervention include if feeding therapy with an SLP is reccommended?

Back 18

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, and other interventions depending on the child's needs.

Front 19

Infant dysphagia rates increased as a result of what?

Back 19

improved survival rates for infants born prematurely or with life-threatening medical disorders.

Front 20

What has nasopharyngeal reflux been associated with?

Back 20

Apnea, choking, and pnuemonia in infants.

Front 21

What key symptoms are present in infants/young children?

Back 21

subtle prolongation of feeds, delay in milestones of feeding abilities, impairment of normal weight gain, excessive drooling of saliva, increases of regurgitation beyond that expected physiologically, unexplained fussiness, or chronic/recurrent respiratory symptoms.

Front 22

What diagnostic methods are used with children?

Back 22

radiography (particularly esophagram or videofluoroscopic swallowing study), manometry, endoscopy of the esophagus or airway (including fiberoptic endoscopic evaluation of swallowing with sensory testing), scintigraphy, esophageal pH-metry or impedance, or central nervous system imaging.

Front 23

What does a complete feeding history include?

Back 23

A complete feeding history includes information on the duration and progression of the symptoms and many other aspects of the feeding experience for the young child .

Front 24

What is sialorrhea?

Back 24

the unintentional loss of saliva and other oral contents from the mouth

Front 25

How can dysphagia be displayed in the less verbal child?

Back 25

it may be represented by refusal by a hungry child of offered nutrients, by regurgitation of undigested ingested food, or even by drooling in a child unable to handle oral secretions appropriately. In young or developmentally delayed nonverbal children, slow eating or repeated swallowing may be the only visible signs of dysphagia.