Pediatric Dysphagia Final

causes of pediatric dysphagia

prematurity, respiratory disorders, cardiac disorders, GI disorders, neurological disorders, anatomic abnormality, genetic conditions, maternal and perinatal issues

coordination deficits are influenced by

gestational age, physiologic stability, presence of respiratory devices, feeding practices

feeding milestones 4-6 months

able to sit with support, breast and bottle fed for liquids, lips begin to show active movement and approximation of spoon feeding, sucking pattern present, intake is 6-8 oz even 4-6 hours, smooth pureed foods are introduced, may gag on thicker textures

feeding milestones 7-9 months

can sit upright but still need some support, messy self feeding, breast and/or bottle fed for liquids, introduce sippy cup, early immature chewing/munching with early tongue lateralization

feeding milestones 9-12 months

cup drinking occurs with successive swallow (no pause) with some liquid loss, self finger feeding, improved tongue lateralization, tongue tip elevates and emerging lateral tongue movements are separate from jaw, weaning from nipple

feeding milestones 12-18 months

rotary chew develops, biting through soft foods, straw drinking, tastes and preferences developing, well controlled cup drinking, whole milk allowed, increase in stability to eat mixed textures, largely self feeding

feeding milestones 18-24 months

swallows with complete lip closure, self feeding predominates but immature, swallows chewable foods without tongue protrusion, coarsely chopped table foods given

IDDSI level 7

regular (food)

IDDSI level 6

soft and bite sized (food)

IDDSI level 5

minced and moist (food)

IDDSI level 4

pureed (food) extremely thick (drink)

IDDSI level 3

liquidized (food) moderately thick (drink)

IDDSI level 2

mildly thick (drink)

IDDSI level 1

slightly thick (drink)

IDDSI level 0

thin (drink)

which IDDSI levels are transitional foods

5, 6 and 7

NDD classifications

thin, naturally thick liquids, nectar thick, honey thick, spoon thick

considerations for using thickening with infants

FDA approval for what age, prematurity, damaged gut, allergy, long term effects, stooling issues and constipation, difficulty with bolus extraction, conflicting and lack of evidence, variance in how much to use

thickener bases

gum, starch, rice cereal

pediatric feeding disorder

impaired oral intake that is not age appropriate and is associated with medical, nutritional, feeding skill, and/or psychological dysfunction

PFD psychosocial domain

active or passive avoidance behaviors by child when feeding or being fed, inappropriate caregiver management of child’s feeding and/or nutrition needs, disruption of social functioning within a feeding context

PFD feeding skill domain

need for texture modification of liquid or food, use of modified feeding position or equipment, use of modified feeding strategies

PFD nutritional domain

malnutrition, specific nutrient deficiency, reliance on enteral feeds or oral supplements to sustain nutrition and or hydration

PFD medical domain

cardiorespiratory compromise during oral feeding, aspiration or recurrent aspiration pneumonitis