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Typical feeding dev (2) - Coggle Diagram
Typical feeding dev (2)
Dysphagic phases
Oral
Absent oral reflexes
Uncoordinated suck
Immature biting, chewing
Poor oral prep skills
Oral apraxia
Pharyngeal
Poor SSB coordination
Delayed swallow trigger
Poor pharyngeal clearance
Oesophageal
Impaired opening of UES
Impaired opening of LES
LES relaxation causing reflux
Poor motility- contractions occurring in the esophagus, which impact propelling the food bolus forward toward the stomach.
Penetration, aspiration
Primary aspiration: aspiration on bolus that orignates above airway
Secondary aspiration: esp chn w low muscle tone, cerebral palsy, after the swallow then leftover from food. Aspiration of material that originates below airway eg. refluxed material
Risks of dysphagia
Aspiration (where material enters airway below lvl of VF)
At risk of dev respiratory disease including pneumonia
In some cases, may need to alter, cease oral feeding
During a feed may observe:
wet voice during feeds, wet breath, cough
, colour changes, oxygen desat, gagging, watery eyes, nasal flaring, sudden state or tone change. BUT this is only suggestive. Can only confirm after doing instrumental Ax
Apnoea
Occurs when airway closes and fails to reopen-there is a period where no breathing occurs
May occur in response to material entering airway in young infants
In young infants, this response aka laryngeal chemoreflex-may be more prevalent cf. coughing, choking in prem infants
Different to choking (solid bolus blocks airway)
Common presentations feeding difficulties in chn
Limited range of textures: Often reliance on easy to eat foods, puree, dissolvable vs. lumpy, mechanical
Limited range of foods: <30 foods, <10 proteins/dairy, <10 fruits/veg, <10 carbs
Prolonged mealtime duration, >30 min at mealtimes, >2h a day spent trying to feed child
High freq problematic behaviour at mealtimes
Parental stress related to child's eating problems
Impact of feeding difficulties
Feeding difficulties
Limited diet variety
Reliance on energy-scarce foods
Poor growth, underweight, poor nutrition
Reliance on energy-dense foods eg. drinking a lot of milk, junk foods
Adequate weight gain/ excess weight gain
Tube placement
Benefits
Impv nutrition
Impv dev
Impv parent-child interactions
Impv sleep
Indications for tube-feeding
Inability to suck or swallow (unsafe swallow, prem)
Increased nutrition requirements/inadequate oral intake
Primary disease mgt
Weight loss/poor weight gain
Can be traumatic for pt, fam
Prep is impt, OT can help
Tube feeding
Types: Parental (X into gut), Enteral (into gut), orogastric/nasogastric tubes, gastrotomy/ PEG
What do we need to consider as SLPs:
total vs. supplemental tube feeding (opportunity for any oral experience), bolus (100ml meal every 3 hours) vs. continuous feeds (fed 20ml/hour, drip feed, for chn who cannot keep food inside stomach for long time). Duration of tube feeding. Route (via oral/nasal cavity, directly into gut), freq of replacement of tube, size of tube, positioning during feeds