Lecture 3: Feeding Problems

Question 1

What is the function of feeding and swallowing?

Answer 1

Satisfies hunger
Reflexive sucking
Sensory & motor stimulation
Mother/caregiver-infant bonding
Oral-motor skill dev’t

Question 2

What is normal infant A&P?

Answer 2

Structures smaller & closer in proximity

• Ideal for sucking
  - Large tongue
  - Large buccal pads
  - No teeth
• Close approximation of tongue, soft palate, pharyngeal wall
• High larynx adjacent to C-1 – C-3
• Epiglottis tubular, narrow

Question 3

Physiology of Infant Feeding

Answer 3

• Oral phase – sucking to stabilize nipple, create pressure gradient for fluid flow, control bolus before swallow
  - Rooting reflex
  - Nipple compression
  - Negative pressure
• Pharyngeal phase – coordination of nasal breathing, sucking, & swallowing
• Esophageal phase – UES and LES

Question 4

What are signs/symptoms of pediatrics dysphagia?

Answer 4

Poor oral suction
Inadequate volume of intake
Lengthy feeding times
Nasal regurgitation
Excessive air intake – spit up or bloating
Coughing
Choking
Poor weight gain
Excessive energy expenditure (fatigue)
Discomfort during feeding
Stressful feeding (b/n caretaker & infant)

Question 5

What are general feeding modifications?

Answer 5

Relax
Proper feeding equipment & methods
  - Assistive squeezing
       - Hand-expressing breast milk
  - Breaks to rest or burp
  - Adaptive nipples/bottles
        - Slower/faster flow rate (hole/slit) 
        - Pliability
        - Shape & size  
Upright positioning
Be consistent w/ feeding method
Manage air intake
  - Break to burp every ounce or so
Limit feedings to 30 minutes or less per feed

Question 6

Airway Protection Assessment during Feeding

Answer 6

Videofluoroscopy
FEES (Fiberoptic Endoscopic Eval of Swallow)

Question 7

Types of bottles for clefts

Answer 7

Haberman
Mead Johnson (not really used anymore)
Dr.Brown’s
Pigeon Feeder (2 different nipples)

Question 8

Describe Haberman

Answer 8

• Has three different flow rates

- Has a valve that holds the milk inside nipple and caretaker can squeeze nipple to release milk

Question 9

Describe Dr. Brown’s

Answer 9

Can use any dr. brown nipple flow, also can add a valve like pigeon and haberman.

Question 10

Describe Pigeon feeder

Answer 10

Has a valve that holds the milk inside nipple and caretaker can squeeze nipple to release milk