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33 Cards in this Set
- Front
- Back
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What percent of typically developing children have feeding disorders?
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25%
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What percent of children with developmental disabilities have feeding disorders?
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80%
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What percent of children terminate meals after a brief period? "Picky" eaters? Evidence of food selectivity?
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-terminate early: 52%
-"picky" eaters: 35% -food selectivity: 33% |
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What motor-based feeding problems are there?
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-trouble with coordination and timing
-trouble with sensory system (limited environmental interaction) -emotional/behavioral response to lack of control |
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What sensory-based feeding problems are there?
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-impaired sensory systems that don't support info for eating/drinking
-cranial nerve damage? -poor muscle tone and coordination |
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What structurally-based feeding problems are there?
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-structural problems of mouth/face (e.g., cleft lip/palate)
-those without typical experiences with oral exploration for development -those with physiologically based GI problems (e.g., GERD) |
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What experientially-based feeding problems are there?
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-behavioral feeding issues or food selectivity/refusal
-generally have underlying impairments in physical, sensory, or structural skills |
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True or false: GI issues are common causes of dysphagia in children with feeding issues.
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True: very common
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What is GERD?
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Gastroesophageal Reflux Disease
-chronic condition -lower esophageal sphincter allows gastric acids to reflux into esophagus -causes heartburn, acid ingestion, and injury to esophageal lining |
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What is EERD?
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Extraesophageal Reflux Disease
-chronic condition -acid/stomach contents emerge from upper esophageal sphincter into pharynx, larynx, mouth, and nasal cavities |
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What GI issues may cause dysphagia?
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-GERD/EERD
-motility issues -stricture -pyloric stenosis -post surgical repair -constipation (big problem for CP kids) -esophagitis (like reflux but no response to meds) -food allergies -drug side effects -low muscle tone |
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What are signs/symptoms of GERD/EERD?
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-chronic bad breath
-emesis/frequent spitting up -loss of taste -food refusal *drooling -coughing/choking with feeding/eating *arching (#1 sign) -heightened sensitivity to oral-sensory input -irritable/cranky -sleep problems -self-limit what they eat -picky eater *chronic hoarseness or cough -aspiration -aspiration pneumonia *snoring (not normal for kids) *NG tubes (contribute to GERD) |
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What is the therapists role for GI issues?
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-recognize GERD/EERD (aspiration from backflow?)
-train parents, etc. -communicate with MD/RN -sensory-behavioral tx (optimal success w/ good medical management) |
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What are some GI disorders?
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-GER
-Motility -constipation -short bowel (short gut) -pyloric stenosis -dumping syndrome |
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What is GER?
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GI disorder
-negative association w/ feeding -painful -positioning and meds most effective txs |
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What is motility?
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-problems moving food thru esophagus
-delaying stomach emptying |
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What is pyloric syndrome?
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-muscles of pylorus are thickened
-prevents stomach from emptying into small intestine -projectile vomiting -wavelike motion of abdomen after eating (before vomiting) -starts at 3 weeks old and usually diagnosed by 6 mts -tx requires surgery |
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What is dumping syndrome?
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-stomach contents are dumped into small intestine
-causes nausea/cramping -associated w/ stomach surgeries -symptoms occur w/in 1-3 hrs of eating (change in diet, time, exposure) |
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What are txs for GI issues?
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*positioning (during and after meals)
-decrease intra-abdominal pressure -diet (infants: smaller, more frequent feedings, thicker lower fat formulas; children: take cues from them related to textures and flavors) -activity (avoid hurried meals and excessive activity during meals) -meds (side effects, limited evidence of effectiveness) -surgical (fundoplication) |
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What is fundoplication?
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-tx for GI issues
-reduces reflux -negative side effects (wretching, bloating, nausea, gagging, constant sense of fullness, dysphagia, dumping or rapid emptying stomach) |
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What positions are there for infant reflux?
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-prone (face down)
-sidelying (on side) -supine (on back) -upright/semi-reclined |
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What is the best way to reduce reflux in infants? and why?
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prone positioning
-30-60 degree incline -improved oxygenation/ventilation -promotes hands to mouth -best for after feeding |
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What does the side-lying feeding position help with?
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-left: decreases GER
-right: promotes gastric emptying -promotes hand to mouth -increases timing and coordination (creates neutral oral cavity) -decreases breathing work -increases organization and self-calming |
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What does upright/semi-reclined feeding position do?
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-easiest access for medical equipment
-focus and bonding w/ caregiver -pressure may lead to lower esophageal sphincter to fail and increase reflux symptoms |
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What is MSPI?
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Milk Soy Protein Intolerance
-develops around 2-3 weeks and usually outgrows by 12 mts -no meds, just eliminate substances from diet -symptoms: inconsolable crying, insatiable hunger or food refusal, reflux and vomiting, rash, blood/mucus in stool |
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What foods should be avoided before 1 year of age?
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-tree nuts
-peanuts -shellfish -egg whites -whole wheat -raw honey -cow's milk -soy |
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What cardiopulmonary problems are there related to swallowing?
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-delayed initiation of swallow due to incoordinated breathing
-fatigue -use weaker suck to maintain breathing |
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What techniques can be used for cardiac problems in swallowing?
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-energy conservation techniques (positioning)
-use chin support to decrease respiratory strain from suck -faster flow rate -if no reflux (rare) increase formula's caloric density -max 30 min feeding |
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What pulmonary problems are there for feeding?
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-activity tolerance
-increase breathing work -coordination of breathing and eating |
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What technique helps pulmonary problems for feeding?
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-positioning is key: facilitate chest accessory muscles
-anterior pelvic tilt -scapular retraction -thoracic extension |
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What pulmonary sensory deficits are there?
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-limited saliva, breath, and secretions in mouth
-prolonged oral intubation -negative experiences (pain) w/out positive oral experiences early due to medically fragile -limited exposure to smell/taste -no messy play due to medically fragile |
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What can be used to diagnose dysphagia in peds?
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-clinical bedside eval
-VFSS/MBS study -FEES |
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What are the primary areas influencing pediatric feeding and swallowing function?
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-oral sensory problems
-oral motor problems -oral structural/alignment problems -pharyngeal sensory problems -pharyngeal motility problems -pharyngeal structural/alignment issues -GI issues -respiratory/airway issues |
