FEEDING AND SWALLOWING pptx2r444554333566

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1. FEEDING AND SWALLOWING IN CHILDREN

2. TABLE OF CONTENT Introduction Incidence Structural differences Characteristics Risk factors Intervention

3. INTRODUCTION Feeding includes the act of preparing food and getting it to the child either orally or through alternative means. Swallowing includes the manipulation of food in the mouth and directing its passage from the oral cavity down to the stomach. This include: Oral This contain the gum, teeth, mandible, hard palate, tongue, anterior faucial arches. There is uvula in the oral cavity. Pharnyx This has soft palate (velum), there is pharyngeal walls – (superior medial and inferior pharyngeal muscles) epiglottis, upper oesophageal sphincter. Larynx Laryngeal vestibule, false vocal cord, true vocal cord, entrance to trachea Esophageal Rings made of cartilage, one third striated muscles, two third smooth muscles, lower esophageal sphincter (smooth muscle). At rest, swallowing muscles are relaxed except for the sphincter muscles. INCIDENCE 80% of children with developmental disabilities have feeding problems 25% and 50% of neurotypical children

4. The infant’s oral mechanisms differ anatomically from those of the adult; the infant’s oral cavity appears to be filled by the tongue. The small oral cavity, coupled with sucking fat pads that stabilize the infant’s cheeks, allows the infant to compress and suck on a nipple placed in the mouth. The Limited mobility of the tongue results in the back and forth movement of the tongue known as suckling. As the size ratios in the mouth change with the infant’s growth, a more mature oral motor pattern emerges. By 4 to 6 months of age, the area inside the infant’s mouth increases as the jaw grows and the sucking fat pads decrease. These changes allow increased movement of the infant’s cheeks and lips. A “true sucking” pattern develops, as the infant’s tongue can move up and down as well as forward and backward. Increased control of the jaw, lips, cheeks, and tongue allows the infant to move food and liquid toward the back of the mouth and prepares the infant to accept and control strained baby food. STRUCTURAL DIFFERENCES INFANTS Stability is positional (close structures) Tongue fills entire oral cavity Tongue tip sticks out alveolar ridge and touches lower lip Fat pads Large soft palate (uvula touch epiglottis) Faucial aches touch epiglottis on sides Hyoid and larynx are close and high in neck Shape of opening to larynx is affected by muscle action. Infants may show more penetration.

5. 6 MONTHS-1 YEAR Stability is provided posturally with structures moving farther apart as child grows Tongue drops down and moves posteriorly in mouth. Make space in mouth. Tongue tip behind alveolar ridge. Fat pads disappear stability provided by muscle control of lips and cheeks. Pharynx elongates, Soft palates moves away from epiglottis. Faucial arches do not touch epiglottis Hyoid and larynx move farther apart Entrance to airway more tightly closed OLDER CHILDREN Stability is provided posturally Oral and pharyngeal stages have both voluntary and reflexive components Tongue base is now anterior wall of pharynx Teeth erupted and tongue positioned behind teeth. Oral stability for oral control is provided by muscle control tone of lips, tongue and cheeks. Pharynx continues to elongate with hyoid and larynx moving further apart.

6. Dysphagia is difficulty in swallowing which impairs the oral, pharyngeal, and/or esophageal phases of swallowing . This condition happens when food or liquids can’t pass easily from your child’s mouth, into the throat, down the esophagus, and into the stomach when swallowing. CHARACTERISTICS Arching or stiffening of the body during feeding Chest congestion after eating or drinking Coughing or choking when eating or drinking or right after Drooling Eating slowly Feeling like food or liquids are sticking in the throat or esophagus or feeling like there’s a lump in the throat Gagging during feeding Getting respiratory infections often Having food or liquids come out of the nose during or after a feeding Trying to swallow one mouthful of food several times Trouble sucking and swallowing Spitting up or vomiting often

7. Irritability or not being alert during feedings  Wet or raspy sounding voice during or after eating Weight loss RISK FACTORS LEADING TO FEEDING AND SWALLOWING DISORDER Central nervous system abnormalities or injuries (e.g., neural tube defects genetic Premature birth or low birth weight Anatomic defects like clefts syndromes Cerebral palsy Sensory issues or autism Secondary to use of nasogastric tube in some children

8. INTERVENTION The use of adaptive equipment to enhance a child’s ability to eat and feed. Example of an adaptive device is a positioning device that provides upright posture necessary for an accurate swallow. Assessing of a child’s eating and feeding pattern. During assessment, an occupational therapist assesses oral motor function, muscle tone, posture, sensory response, behavior, social and environmental components and the child’s physical ability. Assessment tools used include: The developmental pre feeding checklist The neonatal oral-motor assessment scale Videofluoroscopic study (VFSS) Use of handling techniques which involves touching inside and around the mouth before and during feeding. Tapping, quick stretch or vibration to the cheeks and lips helps to improve muscle tone through sensory input. The therapist may support the child’s jaw to encourage normal chewing patterns.

9. To promote oral motor function the occupational therapist may recommend different bottles or feeding utensils to best fit a child's needs. For example they may recommend a different nipple size or shape, or a special spoon, cup, or plate. Different utensils may be recommended in order to maximize independence for the child during feeding and eating. Oral exploration is a normal phase for an infant or toddler to go through in order to explore different objects. When infants skip this step, it can produce hypersensitivity or other deficits in oral motor functioning. Therapists may have infants or toddlers who do not mouth objects on their own practice. Oral exploration can be facilitated by lying the infant or toddler on their side where they can easily reach their hands or feet, or may be done by providing toys, food, or other objects for the child to mouth. The therapist may physically assist the child to mouth and explore objects and foods. Oral massage is used to increase the child’s awareness of oral motor structures, or to decrease atypical responses by the child, such as gagging or bite reflexes. Massage may be done with a finger, if the child’s mouth is very small, a nuk brush, which is a small rubber brush with soft bristles on the end, or a washcloth may be used. The therapist will begin by massaging an area on the child that is not sensitive to get the child used to the therapist’s touch. The therapist will then work their way to the child’s mouth. The therapist will provide gentle but firm pressure to the areas around and in the child’s mouth.

10. A therapist may work on positioning with the child to determine the best position for the child to maximize oral motor functioning. The therapist may use different chairs, cushions, and bolsters to position your child. The therapist will both encourage and discourage specific positions to use when feeding your child at home. The therapist will also work with you on different ways to hold the child, in order to maximize comfort and functioning for the child.